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Aims: Childhood cancer survival is suboptimal inmost low- and middle-income countries (LMICs). Radiotherapy plays a significant role in the standard care of many patients. To assess the current status of paediatric radiotherapy, the International Atomic Energy Agency (IAEA) undertook a global survey and a review of practice in eight leading treatment centres in middle-income countries (MICs) under Coordinated Research Project E3.30.31; 'Paediatric radiation oncology practice in low and middle income countries: a patterns-of-care study by the International Atomic Energy Agency.' Materials and methods: A survey of paediatric radiotherapy practices was distributed to 189 centres worldwide. Eight leading radiotherapy centres in MICs treating a significant number of children were selected and developed a database of individual patients treated in their centres comprising 46 variables related to radiotherapy technique. Results: Data were received from 134 radiotherapy centres in 42 countries. The percentage of children treated with curative intent fell sequentially from high-income countries (HICs; 82%) to low-income countries (53%). Increasing deficiencies were identified in diagnostic imaging, radiation staff numbers, radiotherapy technology and supportive care. More than 92.3% of centres in HICs practice multidisciplinary tumour board decision making, whereas only 65.5% of centres in LMICs use this process. Clinical guidelines were used in most centres. Practice in the eight specialist centres in MICs approximated more closely to that in HICs, but only 52% of patients were treated according to national/international protocols whereas institution-based protocols were used in 41%. Conclusions: Quality levels in paediatric radiotherapy differ among countries but also between centres within countries. in many LMICs, resources are scarce, coordination with paediatric oncology is poor or non-existent and access to supportive care is limited. Multidisciplinary treatment planning enhances care and development may represent an area where external partners can help. Commitment to the use of protocols is evident, but current international guidelines may lack relevance; the development of resources that reflect the capacity and needs of LMICs is required. in some LMICs, there are already leading centres experienced in paediatric radiotherapy where patient care approximates to that in HICs. These centres have the potential to drive improvements in service, training, mentorship and research in their regions and ultimately to improve the care and outcomes for paediatric cancer patients. (C) 2020 The Royal College of Radiologists. Published by Elsevier Ltd.Y, IAEAInternational Atomic Energy Agency [E3.30.31], This study was funded through the IAEA Coordinated Research Project E3.30.31: Paediatric radiation oncology practice in low and middle income countries: a pattern of care study by the International Atomic Energy Agency.

Amaç: Hodgkin lenfoma (HL) sıklığı ve mortalite oranları tüm dünyada değişkenlik göstermektedir. Bu çalışmada, HL olgularının epidemiyolojik ve genel sağ kalım analizlerinin, global sonuçlarla karşılaştırılarak değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Ege Üniversitesi Kanserle Savaş Araştırma ve Uygulama Merkezi veri tabanına kayıtlı, 1992-2017 yıllarında HL tanısı alan 972 erişkin olgu retrospektif olarak değerlendirilmiş, CANREG-4 ile kaydedilen veriler SPSS’e aktarılmıştır. Bulgular: Olguların %59,9’u erkek olup, ortalama tanı yaşı 41,8 ve medyan tanı yaşı 39 idi. Olguların %94,4’ü klasik Hodgkin lenfoma (KHL) tanısı aldı. Alt tiplerine baktığımızda %42,1 nodüler sklerozan (NS)-KHL, %31,0 mikst sellüler (MS)-KHL, %5,2 lenfositten zengin (LZ)-KHL, %2,9 lenfositten fakir (LF)-KHL olarak değerlendirildi. Erkeklerde kadınlara göre anlamlı yüksekti. Noduler lenfosit predominant HL olgularının tamamı EBV negatif iken; KHL olgularının %52,7’si pozitifti (p

Amaç: Her yıl Dünyada 0-19 yaş arası yaklaşık 300.000 olgu kanser tanısı almaktadır. Gelişmiş ve gelişmekte olan ülkelerde çocukluk çağı kanserlerinin dağılımı ve sağ kalım hızlarında belirgin farklılık bildirilmektedir. Bu çalışmada amacımız merkezimizde kayıtlı olan çocukluk çağı kanser olgularının epidemiyolojik özelliklerini ve sağ kalım hızlarını değerlendirmektir.Gereç ve Yöntem: Merkezimizde 1992-2017 tarihleri arasında 0-19 yaş arasında kanser tanısı alan 4602 hastanın verileri Ege Üniversitesi Kanserle Savaş ve Araştırma Merkezi kayıtları kullanılarak geriye dönük olarak değerlendirildi. Yaşa, cinsiyete, yıllara göre tümör dağılımları ve genel sağ kalım hızları değerlendirildi.Bulgular: Olguların %55,3’ü erkek, %44,7’si kız ve erkek/kız oranı 1,23/1 idi. Olguların ortalama tanı yaşı 5,6 yıl idi. Merkezimizde en sık lösemi (%25,6), ikinci sıklıkta santral sinir sistemi tümörleri (%23,4), üçüncü sıklıkta ise lenfomalar (%14,2) görülmekteydi. Olguların ortalama izlem süresi 41,4 ay (0-316 ay) idi. Tüm olgular için beş yıllık genel sağ kalım hızı %74 saptandı.Sonuç: Merkezimizdeki kanser tiplerinin dağılımı ve genel sağ kalım hızları literatür ile benzerdir. Ülkemiz verileri ile karşılaştırıldığında genel sağ kalım hızlarımızın daha iyi olduğu görülmüştür. Bu sonuçlar sağ kalım hızlarının bölgeden bölgeye değiştiğini, bu değişimde hasta ve hasta yakınının farkındalık düzeyinin, gerekli tedaviye ulaşabilme imkanının ve multidisipliner merkezlerin varlığının önemini düşündürmektedir., Aim: Approximately 300.000 children between the ages of 0-19 diagnosed with cancer every year in the world. The distribution and survival rates of childhood cancers are significantly different in developed and developing countries. The aim of this study to evaluate the epidemiological characteristics and survival rates of childhood cancer cases registered in our center.Materials and Methods: Recordings of 4602 patients diagnosed with cancer between 0-19 years of age at our center between 1992 and 2017 were evaluated retrospectively using the registry of Ege University Cancer Control and Research Center. Distribution of cancer groups and overall survival rates were evaluated according to age, sex and years.Results: Median age was 5.6 years. 55,3% of the cases were male, 44,7% were female and the male/female ratio was 1.23/1. Leukemias (25.6%), central nervous system tumors (23.4%), and lymphomas (14.2%) were the most common tumors in our center. The median follow-up period was 41.4 months (0-316 months). The 5-year overall survival rate for all patients was 74%.Conclusion: The distribution of cancer types and overall survival rates in our center are similar with those reported in the literature. Compared with the cancer registry of our country, our overall survival rates were found to be better. These results suggest that survival rates vary from region to region, and the importance of awareness of the patient and his/ her relatives, access to the treatment and the presence of multidisciplinary centers.

Aim: To analyze the epidemiologic, and survival characteristics of 3179 bone and soft tissue sarcomas that were diagnosed as cancer and were treated in Ege University Hospital between 1992 and 2017, and compare the results with resources. Materials and Methods: The data of the bone, and soft tissue sarcomas collected in Ege University Cancer Research Center were recorded in the CANREG special computer program, and the analyses were performed after grouping in the basis of the WHO, and SEER systems. The Chi-square, General Linear Model, Kaplan Meier survival analyses were performed in statistical analyses. Log Rank (Mantel-Cox), Breslow (Generalized Wilcoxon), and Tarone-Ware statistics were used in Kaplan Meier survival analysis. p

Amac: Bu calismanin amaci, Ege Universitesi Tip Fakultesi Hastanesi veri tabaninda bulunan, merkezi sinir sistemi (MSS) tumoru tanisi ile tedavi edilen 5877 adet olgunun epidemiyolojik ve genel sag kalim ozelliklerini istatistiksel acidan degerlendirmek ve literatur ile karsilastirmaktir. Gerec ve Yontem: 1992 ile 2017 yillari arasinda Ege Universitesi Tip Fakultesi Hastanesinde tani alan 5877 adet MSS kanseri olgusu, Ege Universitesi Kanserle Savas, Uygulama ve Arastirma Merkezi’nin (EUKAM) ozel egitimli ve sertifikali kanser kayit elemanlari tarafindan kayit altina alinan veriler, Ki-kare testi ve dogrusal modelleme yontemi kullanilarak analiz edilmis, p

Langerhans cell histiocytosis (LCH) is a rare disorder. Uncontrolled clonal proliferation of langerhans cells leads to a diversity of clinical manifestations. Low dose Radiotherapy (RT) is used mainly for osseous manifestations as a sole treatment or in combination with surgery/chemotherapy/steroids. Altough the mechanism of action of RT is an unresolved issue, it’s usually used in adjuvant/palliative settings, also as first-line local therapy with curative intent in unresectable or resectable cases in case surgery would result in functional compromise. This study is conducted to review indications, dose-fractionation schedules, clinical characteristics and outcomes of LCH patients received local RT mainly for osseous lesions. the medical records of biopsy proven all LCH patients referred to our center and treated with RT between 2000-2016 were evaluated retrospectively. Disease-free survival (DFS), local control and side effects were defined as study end-points. There was 35 patients, 21 of them were children. At presentation 65.7% had single systemsingle bone, 20% had single system-multiple bone, 15% had multisystem disease.Soft tissue extension were detected in 16 children, 4 adults (p= 0.013).Mean radiation dose was 10.8 Gy. Median follow-up from the date of biopsy was 105 months (range= 8-204) in children and 88 (range:31-245) in adults (log rank p:0.029).Complete response rate was 97%. 11 children and 1 adult experienced relapse (p= 0.05), median interval for relapse was 9months in children, 19months in adults. the most common relapse pattern was as single system-multiple bone (58.3%). Local control was 97.1%. Median disease free survival was 85 months. Low dose local RT seems to be effective and safe in multidisciplinary management of LCH., Langerhans hücreli histiositozis (LCH), langerhans hücrelerine benzer dentritik hücrelerin çeşitli organlarda birikimi ve kontrolsüz klonal çoğalması ile karakterize, nadir görülen bir hastalıktır. Düşük doz radyoterapi (RT) ağrılı ve stabil olmayan kemik lezyonları ve kemik dışı yumuşak doku lezyonlarının tedavisinde tek başına ve/veya cerrahi, kemoterapi, steroidlerle birlikte kullanılmaktadır. Etki mekanizması halen net olarak anlaşılmamıştır. RT genelde adjuvant ve palyatif endikasyonlarda, ayrıca rezeke edilemeyen veya cerrahinin fonksiyonel hasar yaratabileceği rezektable olgularda küratif amaçlı olarak kullanılmaktadır. Bu çalışmada, çoğunlukla kemik lezyonlarına yönelik lokal RT uygulanan LCH tanılı olgularda klinik özellikler, RT endikasyonları, doz-fraksiyonizasyon şemaları ve tedavi sonuçlarının araştırılması amaçlanmıştır. 2000-2016 tarihlerinde kliniğimizde RT uygulanan biopsi ile kanıtlanmış tüm LCH tanılı olguların tedavi ve izlem kayıtları geriye dönük olarak değerlendirilmiştir. Hastalıksız sağkalım, lokal kontrol ve geç yan etki çalışmanın sonlanım noktaları olarak belirlenmiştir. 35 olgu saptanmıştır. Ortanca yaşı 12 (6-27), 21 olgu (%60) pediatrik yaş grubundadır. Olguların %65.7’sinde tek sistem-tek kemik tutulumu, %20’sinde tek sistem-çoklu kemik tutulumu, %15’inde çoklu sistem tutulumu saptanmıştır. Pediatrik yaş grubundaki olguların 16’sında ve erişkinlerin 4’ünde kemik lezyonlarına yumuşak doku uzanımının eşlik ettiği tespit edilmiştir (p= 0.013). Ortanca RT dozu10,8 Gy’dir. Patolojik tanı tarihinden itibaren olan ortanca izlem süresi pediatrik olgularda 105 (18-195), erişkinlerde 88 (31-245) aydır. Tam yanıt oranı %97’dir. İzlemde 11 pediatrik, 1 erişkin olguda yineleme saptanmıştır (p= 0.05), yineleme için geçen ortanca süre pediatrik olgularda 9ay, erişkin olguda 19aydır.Ortanca hastalıksız sağkalım 85 ay (52-117) olarak tespit edilmiştir. En sık yineleme paterni tek sistem-çoklu kemik tutulumu olarak izlenmiştir.Lokal control %97.1’dir. Ortanca hastalıksız sağkalım 85 aydır. LCH’de düşük dozda RT multidisipliner tedavinin bir parçası olarak, etkin lokal kontrol sağlayabilen, güvenilir bir tedavi seçeneğidir.

[No abstract available], The authors would like to thank the all radiation oncology centers of Turkey which participated in the survey and closely collaborated with TROD during COVID-19 pandemic.

[No abstract available], Amer Soc Radiat Oncol

Congress of the Pediatric-Radiation-Oncology-Society (PROS) -- JUN 19-22, 2019 -- Bangkok, THAILAND, WOS: 000491350500054, [No abstract available], Pediat Radiat Oncol Soc

WOS: 000465618700001, Multiple Myeloma (MM) and Solitary Plasmocytoma (SP) are given as Plasma Cell Neoplasms (PCNs). Radiotherapy (RT) is used for definitive and/or palliative purposes. We aimed to evaluate the role of RT upon pain relief, recalcification and local disease control for the patients with PCNs. From January 2009 to December 2016, total 80 patients were evaluated. Eleven (13.8%) patients were classified as SP, and 69 (86.3%) were as MM. The total treatment dose was 45 Gy with 1.8 Gy per fraction for the SP and total 30 Gy with 2.5-3 Gy per fraction for the MM. Numerical Rating Pain Scale (NRS) was used for pain level detection and the international consensus on palliative RT criteria was used for recalcification level classification before and after RT. Prior to RT, 56 (70%) patients suffered from severe pain, 19 (23.8%) patients suffered from moderate pain and only 5 (6.3%) patients reported mild pain. After RT, complete pain relief was achieved in 59 (73.8%) and partial pain relief was reported remaining 14 (17.5%) patients. We identified some kind of radiologic recalcification response in 77 (96.3%) patients. Complete and partial radiological response was recorded in 41 (51.3%) and 36 (45%) patients, respectively. Complete recalcification response was seen in 9 of 11 (82%) SP patients and 32 of 69 (46%) MM patients. The difference of complete recalcification response rates between two groups was significant (p= 0.031).Local disease control was achieved in 75 (94%) patients. The time interval after RT and applied RT doses are important factors for recalcification effect. Unlikely, pain relief can be achieved regardless of dose level. It can be stated that treatment doses over 30 Gy with multiple fractions should be suggested for the patients in good general condition with a life expectancy of > 1year.

Communicable diseases are still the leading cause of childhood mortality in third world countries. However, as prevention and treatment of malnutrition and infectious diseases improves, global health challenges are shifting towards combating non-communicable diseases including cancer which has high rates of mortality in children (Wilimas and Ribeiro 2001). More than two-thirds of the world’s pediatric cancers are currently diagnosed in low- and middle income countries (LMIC) (Kellie and Howard 2008). The patterns of occurrence of childhood cancer in LMIC compared to high income countries (HIC) and the lack of population-based cancer registries suggest that many patients die from undiagnosed cancer and the burden of childhood cancer is under-estimated. Children diagnosed with cancer in low-income countries (LIC) continue to have a much poorer chance of survival compared to those in HIC (Fig. 21.1).

WOS: 000422853200006, Background: The aim of this study was to evaluate the recurrence patterns and the times of recurrence after temozolomide-based radiochemotherapy for high grade gliomas. Methods: Magnetic resonance imaging (MRI), diffusion MRI, perfusion MRI, and MRI spectroscopy scans of 30 patients who were treated with radiotherapy concurrently with temozolomide chemotherapy between June 2009 and April 2012 were retrospectively evaluated. Central, in-field, marginal, and distant recurrences of progression were defined related to radiation therapy dose distribution (90% isodose line). Results: The overall survival (OS) rates of central recurrences at 1 year and 2 years were 78% and 25%, respectively (at a median of 16 months). The OS rate of in-field, marginal and distant recurrences at 1 year and 2 years were 100% and 40%, respectively (at a median of 24 months). The progression-free survival (PFS) rate of central recurrences at 1 year and 2 years were 21% and 0%, respectively (at a median of 5 months). The PFS rate of in-field, marginal and distant recurrences at 1 year and 2 years were 36% and 27%, respectively (at a median of 11 months). The PFS rate of pseudoprogression at 1 year and 2 years were 87% and 43% (range, 7-31 months). Conclusions: The survival of new in-field, marginal and distant recurrences are longer and these new lesions develop at a later time compared with central recurrences. Pseudoprogression predicts better response to temozolomide-based radiochemotherapy. Finally, the location of recurrence is determined as one of the prognostic factors for OS and PFS.

Amaç: Glioblastoma (GBM) primer beyin tümörlerinin 2/3'ünü oluşturmaktadır. Tedaviye uyumu arttırmada ve semptomları önlemede glukokortikoidler, antiepileptik tedaviye ek olarak sıklıkla yararlanılan ilaç grubudur. Deksametazon genellikle tanıda, tümör ilişkili vazojenik ödemi azaltmak amacı ile başlanır. Deksametazon kullanımının uzaması durumunda hipokalsemi, hipopotasemi ve 25- Hidroksi Vit-D seviyelerinde azalma ve ağrı kesicilere dirençli kas-eklem ağrıları ortaya çıkmaktadır. GBM tanılı hastalarda deksametazon kullanımı ile gelişen 25-Hidroksi Vit-D eksikliği ve tamamlayıcı 25-Hidroksi Vit-D tedavisinin kas-eklem ağrılarının yönetimine etkisini objektif veriler eşliğinde araştırmaktır.Yöntem: Kliniğimize GBM tanısı ile Ocak 2014 ile Aralık 2014 tarihleri arasında tedavi edilmiş 44 hastanı kas-eklem ağrı seviyeli VAS (visual analog scale) kullanarak sorgulanmış, D vitamini ile ilişkisi değerlendirilmiştir. Tamamlayıcı D vitamini tedavisi sonrası yapılan VAS skalası başlangıç değerlendirmesi ile karşılaştırılmıştır. Dahil edilen hastaların ortanca yaşı 54 olup, 16 (%36.4)'sı kadın, 28 (%63.6)'i erkektir.Bulgular: Tamamlayıcı 25-Hidroksi Vit-D tedavisi öncesi ortanca 25-Hidroksi Vit-D seviyesi 19,5 nmol/L olarak saptanmıştır. VAS değerlendirmesine göre hastaların ağrı seviyeleri ortanca 9 olarak derecelendirilmiştir. Tamamlayıcı 25-Hidroksi Vit-D tedavisi sonrasında ortanca 25-Hidroksi Vit-D seviyesi 89 nmol/L olarak saptanmış olup tamamında minimum istenen 50 nmol/L seviyesine ulaşılmıştır. VAS skorları ortanca 3 seviyesine gerilemiştir. 25-Hidroksi Vit-D seviyesi ne kadar düşükse VAS skorlarının da istatistiksel olarak anlamlı seviyede düşük olduğu saptanmıştır (p=.034).Sonuç: Deksametazon tedavisi, GBM hastalarının destek tedavisinde önemli bir role sahiptir. Deksametazon kullanımının 25-Hidroksi Vit-D seviyesinde azalmaya ve sonuç olarak kas gelişim problemleri ile birlikte kas-eklem ağrılarına neden olmaktadır. olgularda 25-Hidroksi Vit-D seviyesinin bakılması ve gerekli ise minimum 1800 IU olacak şekilde takviyesi önerilir., Aim: Glioblastoma (GBM) composes 2/3 of primary brain tumors. Glucocorticoids are the medication group added to antiepileptic treatment in order to increase treatment coherence and to prevent symptoms. Dexamethasone is generally prescribed at diagnosis for decreasing the tumor-related vasogenic edema. The prolonged use of dexamethasone causes hypocalcemia, hypokalemia, decreased 25-Hydroxi Vit-D and analgesic resistant muscle-join pains. We aim to evaluate the relation between the deficiency of 25-Hydroxi Vit-D due to prolonged use of dexamethasone in GBM patients and the effect of 25-Hydroxi Vit-D complementary treatment.Material-Method: Total 44 patients with GBM treated between January 2014 and December 2014 were queried for muscle-join pain by using VAS (visual analog scale). The pain levels and their relations with 25-Hydroxi Vit-D levels were compared. Complementary Vit-D treatment applied dring 6 months, basal and the last VAS scales were evaluated. Median age of included patients is 54 , 16 (36.4%) were woman and 28 (63.6%) were men.Results: The median 25-Hydoxi Vit-D levels before and after complementary treatment were 19,5 nmol/L and 89 nmol/L, respectively. The median VAS scores before and after complementary treatment were 9 and 3 , respectively. The lower the level of 25-hydroxy Vit-D, the lower the VAS scores were obtained and this relation was statistically significant (p=.034).Conclusion: Dexamethasone treatment has an important role in the supportive care of GBM patients. The prolonged use of dexamethasone causes a decrease in 25-Hydoxi Vit-D levels and this brings muscle maturation problems and muscle-join pain. We suggest that 25-Hydroxi Vit-D levels should be evaluated and if necessary complementary 25-Hydroxi Vit-D complementary treatment should be done to be minimum 1800 IU for this group of patients.

Summary Radiotherapy is used for cure or palliation in around half of patients with cancer. We analysed data on radiotherapy equipment in 33 European countries registered in the Directory of Radiotherapy Centres (DIRAC) database, managed by the International Atomic Energy Agency. As of July, 2012, Europe had 1286 active radiotherapy centres. The average number of teletherapy machines per radiotherapy centre ranged from 1·2 to 7·0 in different countries. Nordic countries, the UK, the Netherlands, and Slovenia all have large centres with four to ten teletherapy machines. Most western and southern European countries have several small centres with one or two machines, with few larger centres. The fragmentation in radiotherapy services that prevails in many European countries might affect the economic burden of radiotherapy and its quality. Eastern and southeastern European countries need to expand and modernise their radiotherapy equipment.

Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct lymphoma with specific clinical and pathological features that occurs in diverse anatomic locations. We conducted this retrospective study to demonstrate our experience in patients with MALT lymphomas and compare our results with the literature. We studied 23 patients with histologically confirmed diagnosis of MALT lymphomas (12 with gastric, 11 with non-gastric localization) treated during the past 13 years. The female/male ratio of patients was 15/8 with a median age at presentation of 56 years (range 27-88 years). 16 patients (70%) with stage I and II, 7 patients (30%) with stage III and IV were admitted. At presentation 93% of patients had good performance status (ECOG2) and 5 (22%) had B-symptoms. There was no difference between gastric and non-gastric MALT lymphomas when compared with sex, age, ECOG performance status, stage of the disease. Patients were treated with different treatment modality; H. Pylori eradication only (8.6%), radiotherapy only (21.7%), surgery alone (4.%) or followed by radiotherapy (26%) or chemotherapy (21.7%). All the patients are alive with a median 33 months (range 8-153 months) of follow-up and the 5- year PFS in gastric lymphoma and non-gastric lymphoma were 86% and 84% respectively with no statistical difference (p=0.5). Because of the indolent course the prognosis of MALT lymphoma was good regardless of the treatment modalities. The treatment choice should be patient-tailored, taking into account the site, stage, age and other clinical characteristic of patient.MALT lenfomalar genellikle midede görülmekle birlikte tükürük bezleri, tiroid, deri, orbita, akciğer, meme, prostat, böbrek gibi çeşitli bölgelerde mide dışı yerleşim de gösterebilmektedir. Bu çalışmada, merkezimizde 1992-2006 yılları arasında tanı konulan MALT lenfomalı 23 olgu klinik bulguları ve tedavi yaklaşımları açısından retrospektif olarak değerlendirilmiştir. 15’i kadın, 8’i erkek olan hastaların medyan yaşı 55 (27-88) yıl olup, 12’si (%52) mide, 11’i (%48) mide dışı (7 parotis tükrük bezi, 2 akciğer, 1 tiroid, 1 kolon) yerleşimlidir. Her iki grup arasında medyan yaş ve cinsiyet açısından farklılık saptanmamıştır. Tanı anında olguların %93’ü iyi performans (ECOG2) göstermektedir. %22’sinde B-semptomları eşlik eden olguların %70’inde erken evre (evre I-II) hastalık belirlenmiş; klinik evre ve B semptomları karşılaştırıldığında gruplar arasında fark bulunmamıştır. Hiçbir hastada kemik iliği tutulumu saptanmamıştır. Hastalara, hastalık yerleşimi, klinik evre ve tanı tarihine göre farklı tedaviler (1 olgu tedavisiz izlemde, 2 olgu sadece H.pilori eradikasyonu, 3 olgu antrasiklin içeren kombine kemoterapi rejimleri, 5 olgu sadece lokal radyoterapi, 12 olgu cerrahi bunların 5’i kemoterapi, 6’sı radyoterapi ile kombine) uygulanmıştır. Lokalize mide lenfomalı tüm hastalara helikobakter pilori eradikasyon tedavisi de başlanmıştır. Medyan 33 (8-153) aylık izlemde, tedavi alan tüm hastalarda tam remisyon sağlanmış, akciğer yerleşimi olan ve sadece cerrahi ile tedavi olan bir hastada oküler adnekste relaps (%4) gelişmiş olup, tüm hastalar yaşamdadır. 5 yıllık progresyonsuz sağkalım oranı mide-MALT lenfomalarda %92 iken, mide dışı lenfomalarda %86 olarak belirlenmiş, gruplar arasında anlamlı farklılık bulunmamıştır. Tedavi seçeneği ne olursa olsun MALT lenfomalar genellikle iyi seyirlidir: en uygun tedavi seçeneği net olmamakla birlikte, hastalığın yerleşimi, evresi, hastanın yaşı ve diğer klinik özellikleri göz önünde bulundurularak kararlaştırılmalıdır.

Purpose To evaluate the results of radiotherapy and the prognostic factors affecting local control in nonextremity Ewing sarcomas. Methods Between 1995 and 2011, 44 patients with nonextremity Ewing sarcomas were treated with radiotherapy. Tumor localizations were pelvis in 23, spine in 13, thoracic region in 5, and cranium in 3 patients. Tumor size was ≥8 cm in 56.8% of patients. Distant metastases were present in 19 of the patients at the time of diagnosis (43.1%). All patients were treated with 12 weeks of neoadjuvant chemotherapy followed by surgery and radiotherapy (45-54 Gy) or radiotherapy alone (54-64.8 Gy). Radiotherapy was applied due to microscopic residue (R1) in 5 patients after the operation and macroscopic tumor in 39 patients (macroscopic residue [R2] and nonresectable tumor). Results Median follow-up was 49 months (range 9-195). Local failures developed in 7 patients (15.9%) and local control at 5 years was 81.4%. Local recurrence was detected in 6 patients (6/38) who did not have residual tumor after RT. Progression was detected in 1 patient (1/6) who had residual tumor. All those patients with local failure experienced further distant metastases. Possible prognostic factors such as age (≤17 vs >17), tumor localization, tumor volume (≤8 cm vs >8 cm), and M status at diagnosis (0 vs 1) were not related to local control. Conclusions Radiotherapy, either alone or adjuvant to surgery, provides local control in 80% of nonextremity Ewing sarcomas and plays an important role in treatment.

Involvement of salivary glands with mucosa-associated lymphoid tissue (MALT) lymphoma is rare. This retrospective study was performed to assess the clinical profile, treatment outcome, and prognostic factors of MALT lymphoma of the salivary glands.Thirteen member centers of the Rare Cancer Network from 10 countries participated, providing data on 63 patients. The median age was 58 years; 47 patients were female and 16 were male. The parotid glands were involved in 49 cases, submandibular in 15, and minor glands in 3. Multiple glands were involved in 9 patients. Staging was as follows: IE in 34, IIE in 12, IIIE in 2, and IV in 15 patients.Surgery (S) alone was performed in 9, radiotherapy (RT) alone in 8, and chemotherapy (CT) alone in 4 patients. Forty-one patients received combined modality treatment (S + RT in 23, S + CT in 8, RT + CT in 4, and all three modalities in 6 patients). No active treatment was given in one case. After initial treatment there was no tumor in 57 patients and residual tumor in 5. Tumor progression was observed in 23 (36.5%) (local in 1, other salivary glands in 10, lymph nodes in 11, and elsewhere in 6). Five patients died of disease progression and the other 5 of other causes. The 5-year disease-free survival, disease-specific survival, and overall survival were 54.4%, 93.2%, and 81.7%, respectively. Factors influencing disease-free survival were use of RT, stage, and residual tumor (p0.01). Factors influencing disease-specific survival were stage, recurrence, and residual tumor (p0.01).To our knowledge, this report represents the largest series of MALT lymphomas of the salivary glands published to date. This disease may involve all salivary glands either initially or subsequently in 30% of patients. Recurrences may occur in up to 35% of patients at 5 years; however, survival is not affected. Radiotherapy is the only treatment modality that improves disease-free survival.

WOS: 000452548200039, PubMed ID: 30488862, Background: The most common subtype of aggressive non-Hodgkin Lymphomas is diffuse large B-cell lymphoma (DLBCL). Mediastinal DLBCL is a distinct entity with unique clinical, pathologic, and genetic features and accepted as a subtype of DLBCL. The aim of this study is to evaluate the patients treated with consolidative radiotherapy (RT) after rituximab-containing chemotherapy for mediastinal DLBCL regarding treatment outcomes and relapse patterns. Material and Methods: Forty-two patients with the diagnosis of mediastinal DLBCL who were treated at the Ege University Hospital between January 2008 and December 2014 were evaluated. All patients received 2-10 cycles of rituximab-containing chemotherapy schedule (mostly CHOP). RT was delivered to a total dose of 30.6-45 Gy with 1.8 Gy daily fractions in 4-5 weeks. The irradiation fields were designed by using involved lymphatic site technique. Results: The median age at diagnosis was 53 years (range, 18-85 years). Ann Arbor clinical stage at diagnosis was as follows: 8 patients (19%) at Stage I, 20 patients (47.6%) at Stage II, 7 patients (16.7%) at Stage III, and 7 patients (16.7%) at Stage IV. The median follow-up period was 47 months (range, 7-96 months). Complete response was obtained in 27 patients (64.3%), partial response was obtained in 14 patients (33.3%) across all stages. Estimated 5-year overall survival (OS) and progression-free survival (PFS) rates were, respectively, 84% and 77% for all patients, 100% and 92% for the patients without residual disease after chemotherapy. Conclusion: The response to chemotherapy is the most important factor affecting both OS and PFS. The role of consolidative RT is not clear in the rituximab era due to the lack of phase III trial. However, available literature shows that consolidative RT may still have a role in mediastinal DBLCLs.

Purpose The article summarises the current use of radiotherapy (RT) in childhood cancer and suggests methods to improve current practice in regions where outcomes of paediatric cancer patients are inferior to those of high-income countries. Methods and materials The International Atomic Energy Agency (IAEA) is supporting low- and mid-income countries (LMICs) in upgrading cancer care where nuclear applications, particularly RT, are used. A consensus meeting of experts was invited to advise IAEA on the needs for RT in paediatric cancer patients. The current indications for RT were reviewed, together with regional differences in access, practice and outcome. Results Regional variations in the use of evidence-based multidisciplinary care including RT were associated with varying outcomes of paediatric cancer patients. The contribution of modern and investigational technology to these differences is uncertain and should be determined in clinical trials. Adequate resources are required to support children through the acute phase of treatment and to permit early recognition and management of late effects. An IAEA sponsored project for prospective data collection to assess the current and future status of radiation treatment in childhood cancer in LMICs has commenced. Conclusion RT remains an essential component of the multidisciplinary management of many paediatric cancers. Excessive variations in outcome are inappropriate and call for action on harmonising training programmes and compliance with evidence-based recommendations. Training projects targeting paediatric cancer care are being implemented and clinical studies comparing new technologies against evidence-based approaches are needed to achieve this goal. The IAEA has an important role in these activities and has commenced prospective data collection in 13 LMICs to monitor trends in treatment techniques and outcomes.

The aim of this study was to assess the prognostic value of MIB-1 and p53 in the pediatric medulloblastoma group. Forty-two pediatric medulloblastoma cases diagnosed in a single institution during the past 10 years were evaluated. Follow-up data were available for 35 patients. The immunoreactivity of MIB-1 ranged from 10% to 95%; p53 immunoreactivity was found in five cases. Of the 35 patients with follow-up, 34 patients received a combination of chemotherapy and radiotherapy, while one received chemotherapy alone. The follow-up period ranged from 5 to 64 months. Of the 35 patients, 21 were alive without any evidence of recurrent disease, three were alive with evidence of recurrent disease and 11 died of disease during follow-up. The mean survival for these 11 patients was 21.9 ± 10.4 months. Of the 35 cases, 16 had MIB-1 value of 25% or lower and 19 had a value of 26% or more. Of the 16 cases with low MIB-1 value, six died of disease; of the 19 cases with high MIB-1 value, five died of disease. The statistical difference between MIB-1 and prognosis was not significant. Three of the 35 (8.5%) cases were found to be positive with p53 protein; no correlation was observed between p53 immunoreactivity and prognosis. It appears that the MIB-1 value and p53 immunoreactivity have no relation with prognosis in pediatric medulloblastomas. However, it is convenient to support these findings with large series.

A 9-year-old girl diagnosed with acute myeloblastic leukemia M4 developed isolated cutaneous relapse. She was given chemotherapy including idarubicin, fludarabine, and cytarabine. Although she developed very severe pancytopenia, increase in the number and size of the lesions was seen. Total skin electron beam therapy was applied to the skin lesions for a total of 18 Gy. All lesions responded to total skin electron beam therapy, some of them completely disappeared. After resolution of the skin findings, she underwent bone marrow transplantation from her matched brother. Twenty-six months after hematopoietic stem cell transplantation she is alive without any event.

WOS: 000354718200013, PubMed ID: 25301811, Background. Spinal myxopapillary ependymomas (MPEs) are slowly growing ependymal gliomas with preferential manifestation in young adults. The aim of this study was to assess the outcome of patients with MPE treated with surgery, radiotherapy (RT), and/or chemotherapy. Methods. The medical records of 183 MPE patients (male: 59%) treated at the MD Anderson Cancer Center and 11 institutions from the Rare Cancer Network were retrospectively reviewed. Mean patient' age at diagnosis was 35.5 +/- 15.8 years. Ninety-seven (53.0%) patients underwent surgery without RT, and 86 (47.0%) were treated with surgery and/or RT. Median RT dose was 50.4 Gy. Median followup was 83.9 months. Results. Fifteen (8.2%) patients died, 7 of unrelated cause. The estimated 10-year overall survival was 92.4% (95% CI: 87.7-97.1). Treatment failure was observed in 58 (31.7%) patients. Local failure, distant spinal relapse, and brain failure were observed in 49 (26.8%), 17 (9.3%), and 11 (6.0%) patients, respectively. The estimated 10-year progression-free survival was 61.2% (95% CI: 52.8-69.6). Age (= 36 y), treatment modality (surgery alone vs surgery and RT), and extent of surgery were prognostic factors for local control and progression-free survival on univariate and multivariate analysis. Conclusions. In this series, treatment failure of MPE occurred in approximately one third of patients. The observed recurrence pattern of primary spinal MPE was mainly local, but a substantial number of patients failed nonlocally. Younger patients and those not treated initially with adjuvant RT or not undergoing gross total resection were significantly more likely to present with tumor recurrence/progression.

Purpose This Rare Cancer Network (RCN) study was performed in pediatric nasopharyngeal carcinoma (PNPC) patients to evaluate the optimal dose of radiotherapy and to determine prognostic factors. Patients and Methods The study included 165 patients with the diagnosis of PNPC treated between 1978 and 2003. The median age was 14 years. There were 3 (1.8%) patients with stage I, 1 (0.6%) with IIA, 10 (6.1%) with IIB, 60 (36.4%) with III, 44 (26.7%) with IVA, and 47 (29%) with IVB disease. While 21 (12.7%) patients were treated with radiotherapy (RT) alone, 144 (87.3%) received chemotherapy and RT. The median follow-up time was 48 months. Results The actuarial 5-year overall survival (OS) was 77.4% (95% CI: 70.06–84.72), whereas the actuarial 5-year disease-free survival (DFS) rate was 68.8% (95% CI: 61.33–76.31). In multivariate analysis, unfavorable factors were age >14 years for LRC ( p =0.04); male gender for DMFS ( p =0.03); T3/T4 disease for LRFS ( p =0.01); and N3 disease for DFS ( p =0.002) and OS ( p =0.002); EBRT dose of less than 66Gy for LRFS ( p =0.02) and LRRFS ( p =0.0028); and patients treated with RT alone for LRFS ( p =0.0001), LRRFS ( p =0.007) and DFS ( p =0.02). Conclusion Our results support the current practice of using combined radiation and chemotherapy for optimal treatment of NPC. However, research should be encouraged in an attempt to reduce the potential for long-term sequelae in pediatric patients given their relatively favorable prognosis and potential for longevity.

Secondary malignant neoplasms (SMN) in CNS tumor survivors has become problem of increasing concern over the last 20 years. These tumors usually occur in a different site from the primary brain tumor several years after treatment.We report secondary cranial malignant neoplasms in three patients who were treated with irradiation and chemotherapy for their primary brain tumors. The first case is a male survivor of an orbital rhabdomyosarcoma who developed a meningioma 8 years later. The other two cases are female survivors of ependymomas who were irradiated at the age of 3 and developed secondary gliomas 8 and 17 years after therapy respectively.Patients carry a risk of developing SMNs many years later since irradiation is still an important part of the treatment. An SMN may have a benign course, as in meningioma, or be a dilemma for the patient, as in glioblastoma.

In this study, in vivo dosimetic data of 67 total skin electron irradiation (TSEI) treatments were analyzed. Thermoluminescent dosimetry (TLD) measurements were made at 10 different body points for every patient. The results demonstrated that the dose inhomogeneity throughout the skin surface is around 15%. The homogeneity was better at the trunk than at the extratrunk points, and was worse when a degrader was used. There was minimal improvement of homogeneity in subsequent days of treatment.

Aim: Undifferentiated nasopharyngeal carcinoma (UNPC) is a chemosensitive tumour; a randomized study evaluating neoadjuvant chemotherapy with bleomycin/epidoxorubicin/cisplatin (BEC) in addition to conventional radiotherapy has resulted in a better disease-free survival in the chemotherapy arm. The bleomycin infusion in the BEC regimen has necessitated hospitalization for the infusion, and resulted in serious pulmonary toxicity. This study has aimed to omit the bleomycin, and test the efficacy and toxicity of cisplatin (C) and a higher dose of epidoxorubicin (EPI) in patients with locally advanced UNPC. Methods: Seventy-one patients with locally advanced UNPC were treated with three cycles of C 100mg/m 2 day 1, and EPI 100mg/m 2 day 1 every 3 weeks followed by conventional radiotherapy of 70Gy. Results: Neoadjuvant chemotherapy was well tolerated. There was only 1-week delay in 14.3% of the patients and no dose modification. Grade III–IV neutropenia occurred in 18.9% of the cycles; none of the patients developed neutropenic fever. No patient progressed during chemotherapy, the complete response rate was 26.8% (95% CI=16.9–38.6) and the partial response rate was 59.1% (95% CI=46.8–70.7) for an objective response rate of 85.9% (95% CI=75.6–93.0) at the end of the three cycles of chemotherapy. After the completion of radiotherapy, the complete response rate increased to 81.7% (95% CI=70.7–89.9) and the objective response increased to 91.5% (95% CI=82.5–96.8). The median disease-free interval and the median survival have not been reached. The 5-year disease-free and overall survival rates are 53.0% (95% CI=43.7–62.0) and 57.2% (95% CI=48.3–65.2), respectively. Conclusion: Neoadjuvant C and EPI, easily administered in the outpatient setting, is an effective and well-tolerated regimen in the treatment of locally advanced UNPC. Onat, H. et al . (2002). Clinical Oncology 14 , 449–454 Copyright 2002 The Royal College of Radiologists. Published by Elsevier Science Ltd. All rights reserved.

Effective treatment of children with low grade glioma (LGG) requires a functioning multi-disciplinary team with adequate neurosurgical, neuroradiological, pathological, radiotherapy and chemotherapy facilities and personnel. In addition, the treating centre should have the capacity to manage a variety of LGG and treatment-associated complications. These requirements have made it difficult for many centers in low and middle-income countries (LMIC) to offer effective treatment and follow up. This article provides management recommendations for children with LGG according to the level of facilities available.

Pediatric radiotherapy is a critical part of pediatric oncology protocols and the quality of the radiotherapy may determine the future quality of life for long-term survivors. Multidisciplinary team decision making provides the basis for high-quality care. However, delivery of high-quality radiotherapy is dependent on resources. This article provides guidelines for delivery of good quality radiation therapy in resource-limited countries based on rational procurement and maintenance planning, protocol development, three-dimensional planning, quality assurance, and adequate staff numbers and training.

PURPOSE: Pseudoprogression is defined among the glioblastoma (GBM) patients as clinical deterioration and/or radiological enlargement and contrast enhancement after radiochemotherapy which resolves during the follow-up. It is typically detected within 3 months after radiochemotherapy. Late pseudoprogression is not common and not clearly defined yet. We analyzed 33 patients who were reoperated for clinical/radiological progression after chemoradiotherapy and compared the clinicopathologic characteristics of the patients without any histologic evidence of tumor with those having real tumor progression. MATERIAL AND METHODS: We identified histologically verified GBM patients who underwent a second tumor resection after radiochemotherapy due to clinical deterioration and/ or radiologically progression between January 2010- October 2013. All pathological specimens were evaluated in our center and were separated in two groups; GroupA: real recurrence of GBM, Group B:late pseudo progression, either no evidence of tumor, complete necrosis or treatment related changes reminding tumor regression. We determined survival after primary surgery and re-resection with regard to pathological results using Kaplan-Meier estimates. RESULTS: 33 patients were included in this study. Median age was 51 (range:17-72), male/female ratio was 2.3/1. After the radiochemotherapy, clinical deterioration and/ or radiologically progression was detected median 10 months later (range: 4-22months).After the secondary surgery, 18 patients (55%) showed late pseudoprogression but 15 patients (45%) experienced real tumor recurrence in the pathological evaluation. From the diagnosis, 2-year survival rate was 26.3% in whole group. 2-year survival rate was 36% in patients who had late pseudoprogression and 16.7% in patients who had real tumor progression (p:0,45). After the secondary surgery, 2 year survival rate was 11% in cases with late pseudoprogression and median survival was 9 months (range:4-28 months). In patients who experienced real tumor recurrence, 2-year survival after secondary surgery was%0 and median survival was 4 months (range: 2-12 months) . Median time to recurrence was 9 months (range :5-22 months) in patients with late pseudoprogression but 11 months (range:4-18 months) in patients experienced real tumor recurrence. CONCLUSION: GBM patients occasionally undergone reoperation due to clinical deterioration or radiological progression, however no evidence of tumor is found in some cases which may be defined as late pseudoprogression. The survival of these patients are better than the cases with tumor progression.

To compare calculated and measured doses for different regions of anthropomorphic phantom and patients using ion chamber and thermoluminescence dosimetry (TLD) for total body irradiation. METHODS Measurements were done for lateral fields with 6 MV, gantry 82°, 40×40 cm2 field and 400 cm source-axis distance (SAD). Entrance-exit and midline doses were measured on anthropomorphic phantom by TLD and entrance-exit doses were measured by TLD and ion chamber on patients. RESULTS For anthropomorphic phantom measurements differences between calculated and measured entrance-exit doses of head, neck, shoulder, lung and thick pelvis were 0.8%, 2.7%, 26.4%, 4.4% and 4.9% and for midline doses were 1.6%, 1.6%, 6.3%, -1.4% and 7.4% respectively. For patients; TLD differences were within -4.13% ile 6.7%, -3.3% ile 3.9%, 5.1% ile 16.6%, -7.8% ile 2.4%, and 3.6% ile 7.1% respectively. For thick pelvis measurements with ion chamber differences were within %0.1-1.9. CONCLUSION Total body irradiation is being applied in limit values in our clinic. © 2013 Association of Oncology.

To test the validity and reliability of The European Organization for Research and Treatment of Cancer (EORTC) core (QLQ-C30) and breast cancer module (QLQ-BR23) for Turkish breast cancer patients.A total of 127 patients treated with radiotherapy (RT) enrolled to this prospective study. EORTC QLQ-C30 and QLQ-BR23 modules applied to patients before initiation of RT and at follow-up period. Statistical analyses were performed by SPSS 13.0.Questionnaires' were found reliable and valid for Turkish breast cancer patients. Six of the 8 multi-item scales of QLQ-C30 had a high reliability (Cronbach's ?0.7); where physical functioning and pain scores were less reliable (Cronbach's ? of 0.66 and 0.68 respectively). In the QLQ-BR23, 3 of 5 multi-item scales were reliable; less reliable were breast and arm symptoms scale (Cronbach's ? of 0.65 and 0.61 respectively). In our analysis the most determinative subscales of QLQ-C30 on global health was emotional functioning followed by fatigue, role functioning and appetite loss (respectively p=0.002, p=0.01; p=0.03 and p=0.08). Among QLQ-BR23 scales systemic therapy SIDE effects, future perspective and upset by hair loss subscales had high impact on global health status (respectively p=0.006; p=0.01 and p=0.03).The Turkish version of EORTC QLQ-C30 and QLQ-BR23 modules are reliable and valid tools to assess quality of life of Turkish breast cancer patients.

Item does not contain fulltext PURPOSE: To evaluate the role of postoperative radiotherapy (RT) in Merkel cell carcinoma (MCC). METHODS AND MATERIALS: A retrospective multicenter study was performed in 180 patients with MCC treated between February 1988 and September 2009. Patients who had had surgery alone were compared with patients who received surgery and postoperative RT or radical RT. Local relapse-free survival (LRFS), regional relapse-free survival (RRFS), and distant metastasis-free survival (DMFS) rates were assessed together with disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates. RESULTS: Seventy-nine patients were male and 101 patients were female, and the median age was 73 years old (range, 38-93 years). The majority of patients had localized disease (n = 146), and the remaining patients had regional lymph node metastasis (n = 34). Forty-nine patients underwent surgery for the primary tumor without postoperative RT to the primary site; the other 131 patients received surgery for the primary tumor, followed by postoperative RT (n = 118) or a biopsy of the primary tumor followed by radical RT (n = 13). Median follow-up was 5 years (range, 0.2-16.5 years). Patients in the RT group had improved LRFS (93% vs. 64%; p < 0.001), RRFS (76% vs. 27%; p < 0.001), DMFS (70% vs. 42%; p = 0.01), DFS (59% vs. 4%; p < 0.001), and CSS (65% vs. 49%; p = 0.03) rates compared to patients who underwent surgery for the primary tumor alone; LRFS, RRFS, DMFS, and DFS rates remained significant with multivariable Cox regression analysis. However OS was not significantly improved by postoperative RT (56% vs. 46%; p = 0.2). CONCLUSIONS: After multivariable analysis, postoperative RT was associated with improved outcome and seems to be an important component in the multimodality treatment of MCC.