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Öğe Anti-inflammatory effects of hyperbaric oxygen on irradiated laryngeal tissues(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2018) Aricigil, Mitat; Dundar, Mehmet Akif; Yucel, Abitter; Arbag, Hamdi; Arslan, Abdullah; Aktan, Meryem; Findik, SidikaIntroduction: To manage the complications of irradiation of head and neck tissue is a challenging issue for the otolaryngologist. Definitive treatment of these complications is still controversial. Recently, hyperbaric oxygen therapy is promising option for these complications. Objective: In this study, we used biochemical and histopathological methods to investigate the efficacy of hyperbaric oxygen against the inflammatory effects of radiotherapy in blood and laryngeal tissues when radiotherapy and hyperbaric oxygen are administered on the same day. Methods: Thirty-two Wistar Albino rats were divided into four groups. The control group was given no treatment, the hyperbaric oxygen group was given only hyperbaric oxygen therapy, the radiotherapy group was given only radiotherapy, and the radiotherapy plus hyperbaric oxygen group was given both treatments on the same day. Results: Histopathological and biochemical evaluations of specimens were performed. Serum tumor necrosis factor-alpha, interleukin-1 beta, and tissue inflammation levels were significantly higher in the radiotherapy group than in the radiotherapy plus hyperbaric oxygen group, whereas interteukin-10 was higher in the radiotherapy plus hyperbaric oxygen group. Conclusion: When radiotherapy and hyperbaric oxygen are administered on the same day, inflammatory cytokines and tissue inflammation can be reduced in an early period of radiation injury. (C) 2017 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.Öğe Assessment of Quality of Life Following Radiotherapy in Patients with Rectum Cancer(Springer, 2022) Yavuz, Berrin Benli; Aktan, Meryem; Kanyilmaz, Gul; Demir, Lutfi SaltukPurpose The aim of the present study is to investigate the effects of radiotherapy (RT) on quality of life (QoL) and influencing factors. Methods Data of 106 patients who completely filled out the three questionnaires were evaluated in this prospective study. Quality of life was evaluated with cancer-specific QLQ-C30 and colorectal cancer module QLQ-CR29 created by European Organization for Research and Treatment of Cancer (EORTC). All statistical analyses were done with SPSS version 22 software. A p level of < 0.05 was accepted as statistically significant. Results Median age was 61 (27-86). Of the patients, 77 (72.6%) were male and 29 (27.4%) were female. When QLQ-C30 questionnaires were evaluated, it was observed that physical, role, cognitive, and emotional function scores were impaired following RT, however returned to pre-RT levels on control. According to the results of QLQ-CR29 questionnaire, after RT, impairment was observed in urination frequency, urinary incontinence, stool frequency, dysuria, fecal incontinence, embarrassment, and sexual interest in male scales; however, they returned to pre-RT values on control. When evaluated with regard to age, financial difficulty, global health score, mucus in stool, dysuria, dyspareunia, and abdominal pain were observed to be poorer in the young; urination frequency and urinary incontinence were observed to be poorer in the elderly. Conclusion Although both functional and symptom scales were shown to impair, most of them were detected to be temporal and patients could well tolerate radiotherapy. Additional assessment is required for evaluating the late effects of treatments on QoL.Öğe Brain metastases from prostate cancer: A single-center experience(Aves, 2019) Kanyilmaz, Gul; Aktan, Meryem; Yavuz, Berrin Benli; Koc, MehmetObjective: Metastases from prostate cancer to the brain are very unusual and very few case series have been reported in the literature. Present study was performed to assess the proportion of brain metastasis from prostate cancer among other brain metastasis in men, to evaluate the distribution, pattern and magnetic resonance imaging (MRI) appearance of these metastatic lesions, and prognosis of brain metastasis in patients with prostate cancer. Material and methods: Between January 2010 and November 2016, 339 males who had received radiotherapy at our department were retrospectively reviewed. After the first evaluation of patients data, we reviewed only the patients with brain metastases from prostate cancer. We evaluated MRI characteristics of metastatic brain lesions and characteristics of the patients, tumor and treatment modalities. Results: Ten of 339 patients (2.9%) had brain metastases from prostate cancer. Sixty percent of the patients had pure intraparenchymal metastasis, 20% of the patients had pure extensive dural metastasis and 20% of them had both. Seventy-five percent of the patients with intraparenchymal metastasis had multiple metastatic lesions. The median prostate specific antigen (PSA) level was 49.40 ng/mL and the Gleason score was >= 7 in all patients. Sixty percent of the patients had distant metastasis at the time of the diagnosis of prostate cancer. Median survival time in patients with brain metastasis was 4.5 months. Conclusion: Lesions of brain metastasis from prostate cancer had a large variety of imaging presentation and it is very difficult to distinguish them from the other brain metastasis originating from other types of cancer. Presence of a disseminated disease, high PSA level and high Gleason score can be useful parameters for the prediction of brain metastasis from prostate cancer.Öğe Breast Cancer Among Patients Below Age 40: Clinicopathological Features and Survival Results(Akad Doktorlar Yayinevi, 2020) Yavuz, Berrin Benli; Aktan, Meryem; Kanyilmaz, GulAmong young women breast cancer exhibits quite a heterogenous, quite agressive and complex biology. The purpose of this study is to describe clinicopathological features that affect survival ratio among breast cancer women below age-40. 803 patients having received adjuvant radiotherapy were retrospectively analyzed. Patients were categorized under two groups: age <= 40 and age > 40. Treatments and clinicopathological features were analyzed. 19.4% (156) of 803 patients were below age 40. In patient group below age 40, more neoadjuvant chemotherapy (NAC) was administered compared to the patient group above age 40 (p= 0.007) and it was detected that there were higher incidences of stage 3 disease (p= 0.011), more advanced nodal disease (N2-3) (p= 0.046) and more metastasis (p< 0.001). In conducted multivariate analysis for all age groups presence of N2-3 disease (p= 0.011) and in below age-40 group being grad 3 (p= 0.025) was found to affect overall survival (OS) negatively. In disease free survival (DFS)-focused analysis; for all age groups, receiving NAC (p= 0.001), presence of N2-3 disease (p= 0.002) and being below age 40 were found to have a negative effect; in below age-40 group presence of NAC (p= 0.013) and perineural invasion (p= 0.035); in above age-40 group receiving NAC (p= 0.023) and presence of N2-3 disease (p= 0.035) had a negative effect. Being below age 40 is an independent prognostic factor for DFS. It is suggested to conduct further studies on specific tumor biology to analyze the same group with respect to the characteristics of more aggressive tumors.Öğe Comparision of Radiochemotherapy Applications that Committing with Two Different Chemotherapies Route in Locally Advanced Lung Cancer(Aves, 2020) Ozmen, Hilal Kiziltunc; Sezen, Orhan; Aktan, Meryem; Erdemci, Burak; Alan, Burcu Saglam; Ertekin, Mustafa Vecdi; Ezirmik, SinanObjective: This study investigated pre- and post-treatment tumor and lymph node dimension response rates and differences between side-effect profiles in patients with locally advanced inoperable nonsmall-cell lung cancer (NSCLC) receiving radiotherapy (RT) and concurrent chemotherapy (CT). Materials and Methods: A total of 30 inoperable patients who had not previously received RT and having a mean age of 58.73 +/- 8.65 years with sufficient hematological reserves and normal hepatic and renal functions were included in the study. Those with pleural effusion, supraventricular lymph node metastasis, and N3 lymph node involvement were excluded. Group I (n=15) received a 21-day 75 mg/m(2) cisplatin (D1) and 15 mg/m(2) vinorelbine (D1, D8), whereas Group II (n=15) received 45 mg/m(2) paclitaxel and AUC2 carboplatin weekly. RT was administered using a linear accelerator device with the 3D conformal RT technique at 6-18 MV energy with a 1.8-2 Gy fraction for 6-7 weeks. Results: Patients were randomized into Group I receiving RT and concurrent cisplatin-vinorelbine and Group II receiving weekly paclitaxel-carboplatin CT. Pre- and post-treatment tumor and lymph node dimensions significantly differed in both groups (p<0.001 and p<0.01, respectively). No significant change was observed in post-RT tumor and lymph node dimensions in terms of applied CT regimens (p>0.05). Conclusion: The significant response achieved with concurrent RT and CT in groups I and II in the local advanced stage of NSCLC is important for local tumor control. Responses to treatment in the group of two arms did not differ.Öğe Comparison of Prognostic Factors in Glioblastoma Patients with Short- and Long-term Survival(Kare Publ, 2023) Yavuz, Berrin Benli; Kanyilmaz, Gul; Aktan, MeryemOBJECTIVE Glioblastoma (GBM) is the most aggressive primary brain tumor. Despite all treatments, very few have long-term survival. This retrospective study aimed to investigate the clinicopathological features, treatment modalities, and factors affecting survival in GBM patients with short-and long-term survival. METHODS Data from 217 GBM patients who received radiotherapy (RT) between 2010 and 2021 were analyzed. The patients were divided into two groups: short (<6 months) and long (>2 years) living groups. Treatment, patient, and tumor characteristics were evaluated. RESULTS While 37 (17.1%) of 217 patients included in the group lived <6 months, 49 (22.6%) were in the group that lived longer than 2 years. In the long-living group, being under 65 years of age, having better performance, performing total excision, applying conventional RT, and receiving adjuvant chemotherapy (CT) detected more frequently. The regression test showed that young age, good performance, and receiving conventional RT and adjuvant chemotherapy (CT) were independently associated with survival. CONCLUSION It was observed that patients who lived longer were frequently young and well-performing ones who underwent wide excision and received conventional RT and adjuvant CT. By estimating the pre-treatment survival, treatment and support plans can be made accordingly.Öğe Cutaneous Metastases of the Synchronous Primary Endometrial and Bilateral Ovarian Cancer: An Infrequent Presentation and Literature Review(Hindawi Ltd, 2016) Kanyilmaz, Gul; Aktan, Meryem; Koc, Mehmet; Findik, SiddikaThere are limited data about the cutaneous metastases of gynecological malignancies in the literature. Based on this limited number of studies, cutaneous metastases from gynecological malignancies are uncommon occurrences. Cutaneous metastases from the synchronous endometrioid carcinoma of the uterine corpus and bilateral ovaries arising from endometriosis are extremely rare. Herein, we report a 51-year-old woman with FIGO Stage 1A Grade 1 endometrial endometrioid-type adenocarcinoma and synchronous bilateral Stage 1B ovarian endometrioid-type adenocarcinoma who presented 34 months following total abdominal hysterectomy and bilateral salpingo-oophorectomy with skin metastases. After the patient underwent an excisional biopsy, we applied a palliative radiotherapy. The patient received the combination therapy with cisplatin and doxorubicin after the completion of radiotherapy but the disease evolution was rapidly fatal and the patient died 4 months after her admission to our department due to widely disseminated disease.Öğe Dosimetric Comparison of Three-Dimensional Conformal Radiotherapy (3D-CRT) and Intensity Modulated Radiotherapy Techniques (IMRT) with Radiotherapy Dose Simulations For Left-Sided Mastectomy Patients(Galenos Publ House, 2019) Aras, Serhat; Ikizceli, Turkan; Aktan, MeryemObjective: To compare 3-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiotherapy (IMRT) techniques on the target tissue and critical organ doses in terms of dosimetry, during treatment planning of patient's post-mastectomy radiotherapy (PMRT) to the left chest wall. Materials and Methods: Twenty breast cancer patients with left-sided post-mastectomy have selected for PMRT both 3D-CRT and IMRT techniques. Dosimetric calculation of dose simulation in Eclipse treatment planning system have been performed. Organs at risk with the maximum dose, minimum dose, mean. dose, D95, conformity and homogeneity indexes and total monitor unit for the Planning Target Volume were compared in terms of the critical organ doses. Results: There was no significant difference between the two treatment planning techniques in terms of maximum, minimum, mean dose and heterogeneity index (p>0.05). At low doses, the dose received at the heart was significantly lower with the 3D-CRT technique, but there was no significant difference between the two techniques at the maximum and average doses in the high dose regions. Conclusion: For PMRT to the left chest wall, IMRT significantly improves the conformity of plan and reduce the high-dose volumes of ipsilateral lung and heart compared to 3D-CRT, but 3D-CRT is superior in terms of low-dose volume.Öğe Erythema Multiforme Associated With Phenytoin and Cranial RadiationTherapy (EMPACT) Syndrome Associated With Cranial Radiotherapy and Levetiracetam: A Case Report(Cureus Inc, 2022) Yilmaz, Tugba; Yavuz, Berrin B.; Kanyilmaz, Gul; Aktan, Meryem; Temiz, Selami A.Cranial radiotherapy (RT) is an irradiated way to treat patients with brain malignancies. Seizure is the most common symptom. Due to the frequency of seizure risk, cranial RT is usually received concomitant with previously initiated antiepileptic drugs (AED). This combination can lead to erythema multiforme (EM) like serious skin reactions starting from the irradiated port site and spreading to whole cutaneous surfaces and mucosal membranes. This clinical entity is named after as an acronym of components which are Erythema Multiforme associated with Phenytoin And Cranial RadiationTherapy as EMPACT syndrome. Most cases of EMPACT syndrome are reported with phenytoin in the literature, but there are no reported cases with levetiracetam to the best of our knowledge in the literature. Here, we report a 62-year-old male with glioblastoma, presented with severe conjunctivitis, extensive bleeding erosions in his oral mucosa and erythematous macular eruptions on the right temporoparietal port region of the scalp, and EM-like generalized lesions involved neck, chest, back, and arms following the end of his cranial RT. He was diagnosed with EMPACT syndrome, related to using levetiracetam concomitant with cranial RT. Early diagnosis is crucial for the complete response of treatment. Physicians should be alert to possible skin and mucosal reactions of patients under levetiracetam treatment, especially co-existing use of cranial RT.Öğe Evaluation of the radioprotective effects of thymoquinone on dynamic thiol-disulphide homeostasis during total-body irradiation in rats(Oxford Univ Press, 2019) Deniz, Cigdem Damla; Aktan, Meryem; Erel, Ozcan; Gurbilek, Mehmet; Koc, MehmetIonizing radiation-induced free radicals cause functional and structural harmful effects. Thiol, an important antioxidant, plays a major role in the eradication of reactive oxygen molecules. Thiol/disulphide homeostasis is a marker of oxidative stress. The objective of this study was to assess the potential radioprotective effects of thymoquinone (TQ) on the dynamic thiol/disulphide homeostasis of rats receiving total-body irradiation (IR). Twenty-two rats were divided into three groups to test the radioprotective effectiveness of TQ. The sham control group did not receive TQ or IR. The IR group received only total-body IR. The TQ + IR group received IR plus TQ. Following IR, blood samples were taken. The thiol/disulphide homeostasis parameters were analysed by a newly established method. In the IR group, native thiol and the native thiol/total thiol ratio were significantly decreased (P = 0.003 and P = 0.003, respectively), whereas the disulphide/native thiol and disulphide/total thiol ratios were significantly increased when compared with those of the sham control group (P = 0.003 and P = 0.003, respectively). In the TQ + IR group, the mean disulphide, native thiol and total thiol levels and the disulphide/native thiol, disulphide/total thiol and native thiol/total thiol ratios were not found to be significantly different when compared with those of the sham control group (P > 0.05 for all). Thiol/disulphide homeostasis was found to be disturbed after IR exposure. The results showed that TQ had antioxidant effects and reduced the IR-induced oxidative stress, which was demonstrated through the dynamic thiol/disulphide homeostasis. Thus, the use of TQ before radiation treatment helped protect the rats from oxidant side effects.Öğe Factors affecting pathological response and survival following neoadjuvant chemoradiotherapy in rectal cancer patients(Wolters Kluwer Medknow Publications, 2021) Aktan, Meryem; Yavuz, Berrin Benli; Kanyilmaz, Gul; Oltulu, PembeBackground: Despite all advanced treatment methods for rectal cancer, not all patients can provide an adequate response, and hence, possible prognostic factors must be evaluated. The aim of this study was to evaluate the relationship between systemic inflammatory markers and pathological response, overall survival (OS) and disease-free survival (DFS) in patients treated with neoadjuvant chemoradiotherapy (nCRT). Methods: We evaluated data of 117 patients for the period 2010 to 2017. Serum measurements of albumin, hemoglobin, C-reactive protein, modified Glasgow prognostic score (mGPS), and white cell counts were obtained. Rodel scoring system was used to determine pathologic tumor regression. Results: Overall, 77% of the patients were in the good response group according to the radiological images. A total of 48% of patients were categorized as a good pathologic response. Pathologic response to treatment was associated with a mGPS of 0 (P = 0.001), normal platelet lymphocyte ratio (PLR) (P = 0.003), TNM stage (P = 0.03), pathologic T stage (P = 0.001), radiologic response to nCRT (P = 0.04), tumor differentiation (P = 0.001), lymphovascular invasion (LVI) (P = 0.001) and perineural invasion (P = 0.02). LVI (P = 0.04), albumin level (P = 0.05), C-reactive protein (P = 0.01), neutrophil platelet score (NPS) (P = <0.001) and mGPS (P = 0.01) had a statistically significant effect on OS. Operation type (P = 0.03), tumor differentiation (P = 0.01), depth of invasion (P = 0.03), NPS (P < 0.01), mGPS (P = 0.01), PLR (P = 0.004), neutrophil-lymphocyte ratio (P = 0.01) and LVI (P = 0.05) were statistically significant on DFS. Conclusions: There was an association between systemic inflammatory markers and pathologic response and also, between OS and DFS. This study can be preliminary data for prospective controlled studies.Öğe Factors affecting survival in glioblastoma patients below and above 65 years of age: A retrospective observational study(Wolters Kluwer Medknow Publications, 2021) Yavuz, Berrin B.; Kanyilmaz, Gul; Aktan, MeryemBackground: The purpose of this study is to identify the differences with respect to survival and prognostic factors in a comparison between radiotherapy-receiving glioblastoma (GBM) patients above and below 65 years of age. Methods: The results of 157 patients with GBM were analyzed retrospectively. Patients were divided into two groups as those below and above 65 years of age. A comparison was drawn with respect to each group's demographic characteristics, treatment methods, and findings. Results: Out of a total of 157 patients, 53 patients (33.8%) were above 65 years of age. Karnofsky performance status (KPS) was weaker among older patients (P = 0.002). On the other hand, with respect to radiotherapy dose, among older patient group, greater hypofractionation and whole-brain radiotherapy was applied (P = 0.003) compared with younger patients. The survival rates for 1, 2, and 5 years among patients aged <65 years were 63%, 30%, and 3%, respectively, and in patients aged >= 65 years were 43%, 13%, and 0%, respectively. In univariate analyses, a comparison between patients below and above 65 years of age revealed that values higher than 80 KPS (P = 0.002), applying total excision (P < 0.001), receiving concurrent chemotherapy (P = 0.004), receiving conventional radiotherapy (P < 0.001), and adjuvant chemotherapy (P < 0.001) were effective factors on overall survival rates. Conclusion: In the patient group above 65 years of age, the patient should be attentively selected before opting for a specific treatment, age alone should not be the sole determinant factor. Rather, by considering the KPS scores, potential aggressive treatment options should also be applied.Öğe The Influence of Hormone Therapy on the Development of Pulmonary Fibrosis after Radiotherapy in Patients with Breast Cancer(Akad Doktorlar Yayinevi, 2022) Yavuz, Berrin Benli; Poyraz, Necdet; Kanyilmaz, Gul; Aktan, Meryem; Tuncez, Ismail H.; Koc, MehmetThe aim of the present study is to investigate the effects of hormone therapy on pulmonary fibrosis in patients who received curative conformal radiotherapy for breast cancer. Data of 469 patients were evaluated. Computerized tomography images were evaluated by a radiologist as blindly. The influence of hormone therapy (tamoxifen and aromatase inhibitors), age, menopause, radiotherapy fields, ipsilateral lung volume receiving 5 Gy (V5), ipsilateral lung volume receiving 20 Gy (V20), ipsilateral mean lung dose (MLD) and the effects of taxane group of chemotherapy on pulmonary fibrosis were investigated. The mean age was 51 (range 27-83) years. As hormone therapy, 159 patients (33.9%) used tamoxifen and 253 patients (53.9%) used aromatase inhibitors. A significant relationship was found between both 6th month lung fibrosis and 2nd year lung fibrosis, and V5, V20, MLD, regional lymphatic irradiation and hormone therapy use. More grade 2 fibrosis was detected in the patients who received tamoxifen compared to the patients who received aromatase inhibitors and the control group (p< 0.001). No association was found between menopausal status, age, and taxane group chemotherapy and lung fibrosis development. In multivariate analysis, V5, MLD, and using hormone therapy were shown to be independent predictors of the risk of developing fibrosis at both 6 months and 2 years. Use of tamoxifen increases early and late lung fibrosis more than aromatase inhibitors in patients who receive radiotherapy for breast cancer. However, V5, V20, MLD and regional lymph node irradiation also contribute to the prevalence of fibrosis.Öğe Intramedullary spinal cord metastasis and radiotherapy(2018) Yavuz, Berrin Benli; Aktan, Meryem; Kanyılmaz, GülAim: Intramedullary spinal cord metastasis (ISCM) is a rare but a severe condition. We aimed to evaluate the clinical features, the effect of radiotherapy on the functional results, and the quality of life and survival in patients with ISCM.Material andMethods: We retrospectively assessed the results of 15 patients. Patients underwent 3D conformal radiotherapy (3D-CRT). Patients were reviewed in terms of neurological deficits, the localization of primary tumors, the duration of symptoms, onset symptoms, the localization of ISCM, and the interval between diagnosis and spinal metastasis. Post-radiotherapy outcomes and factors influencing the survival and the quality of life were analyzed. Results: The mean duration of symptoms before diagnosis was 14.93 days (range; 1-52 days). The most common presenting symptoms of patients were lower back and back pain. Neurological deficit was present in 9 patients. Of these patients, partial improvement was observed following the radiotherapy in four patients. After the radiotherapy, the need of painkillers and pain were decreased in 10 of the patients with pain at the outset (66.7%). An association was detected between the initiation of radiotherapy within 10 days from the onset of symptoms and the quality of life (p=0.026). The mean survival rate was 5.9 months after being diagnosed with ISCM.Conclusions: Motor deficit and pain-related quality of life were corrupted in most of the patients with ISCM. Early diagnosis and suitable treatment might promote to the functional condition of the patient. It is important to initiate radiotherapy within a period of less than 10 days from the onset of symptoms.Öğe Melatonin prevents possible radiotherapy-induced thyroid injury(Taylor & Francis Ltd, 2017) Aricigil, Mitat; Dundar, Mehmet Akif; Yucel, Abitter; Eryilmaz, Mehmet Akif; Aktan, Meryem; Alan, Mehmet Akif; Findik, SidikaPurpose: We aimed to investigate the protective effect of melatonin in radiotherapy-induced thyroid gland injury in an experimental rat model.Materials and methods: Thirty-two rats were divided into four groups: the control group, melatonin treatment group, radiotherapy group and melatonin plus radiotherapy group. The neck region of each rat was defined by simulation and radiated with 2 Gray (Gy) per min with 6-MV photon beams, for a total dose of 18Gy. Melatonin was administered at a dose of 50mg/kg through intraperitoneal injection, 15min prior to radiation exposure. Thirty days after the beginning of the study, rats were decapitated and analyses of blood and thyroid tissue were performed.Results: Tumor necrosis factor- (TNF-), interleukin-1 beta (IL-1), thiobarbituric acid reactive substances (TBARS) and nitric oxide (NO) levels in the radiotherapy group were significantly higher than those in the melatonin plus radiotherapy group (p<.05), whereas interleukin-10 (IL-10) and glutathione (GSH) values were higher in the melatonin plus radiotherapy group (p<.05). The infiltration of inflammatory cells and percentage of apoptosis in the radiotherapy group were significantly higher than those in the melatonin plus radiotherapy group (p<.05).Conclusions: Melatonin helped protect thyroid gland structure against the undesired cytotoxic effects of radiotherapy in rats.Öğe Meme Kanserinde 5 Yıllık Tedavi Sonuçlarımız ve Prognostik Faktörler: Tek Merkez Deneyimi(2017) Kanyılmaz, Gül; Aktan, Meryem; Benli Yavuz, Berrin; Koç, MehmetKliniğimizde tedavi edilen olgu serisini retrospektif olarak inceleyerek 5 yıllık sağkalım sonuçlarını ve sağkalımı etkileyen prognostik parametreleri saptamaktır. Meme kanseri tanısıyla başvuran ve kliniğimizin rutin meme prosedürüne göre küratif olarak tedavi olmuş olgu verileri incelenmiştir. Tüm olgular üç boyutlu konformal RT tekniği ile göğüs duvarı veya meme dokusuna karşılıklı paralel tanjansiyel alanlar kullanılarak günlük 2 Gy fraksiyon dozuyla haftada 5 gün olacak şekilde tedavi edilmiştir. Rejyonel lenf nodu bölgesinin tedavi edilmesi gereken durumlarda ise supraklavikuler fossa ışınlaması da tedaviye eklenmiştir. Olgulara sıklıkla antrasiklin bazlı kemoterapi rejimleri uygulanmış olup, östrojen reseptörü pozitif olan olgular hormon tedavisi, Her-2 reseptör pozitif olgular da trastuzumab tedavisi almıştır. Çalışmanın birincil sonlanım noktaları genel sağkalım (GS) ve hastalıksız sağkalım (HS) idi. İkincil sonlanım noktası ise sağkalım süreleri üzerine etkili olan prognostik faktörleri saptamak idi. Tüm istatistiksel analizler SPSS (Statistical Package for Social Sciences) 13 versiyonu kullanılarak yapılmıştır. 11.02.2010- 01.05.2016 tarihleri arasında kliniğimize başvuran toplam 559 meme kanseri olgusu değerlendirilmiştir. 2 ve 5 yıllık GS oranları sırasıyla %97 ve %84; 2 ve 5 yıllık HS oranları sırasıyla %97 ve %71 olarak bulunmuştur. Çok değişkenli analizlerde, 70 yaş, triple (-) olmak, T3-4 evre hastalığa sahip olmak, N2-3 nodal evre hastalığa sahip olmak ve metastaz yada lokal- bölgesel nüks olması GS’ yi olumsuz etkileyen bağımsız prognostik faktörler olarak bulunurken; N2-3 nodal hastalığa sahip olmak ve triple (-) olmak HS’ yi olumsuz etkileyen faktörler olarak saptanmıştır. Meme kanseri dünya genelinde kadınlar arasında görülen en sık kanser türü olup insidansı artmasına rağmen hastalığa bağlı mortalite oranları zamanla düşmeye başlamıştır. Güncel tedavi modaliteleri ışığında prognostik faktörlerin bilinmesi hem en doğru tedavi modalitesinin seçilmesi hem de uygulanan tedavi modalitesine alınacak yanıtın öngörülebilmesi açısından önemlidir.Öğe Outcomes of reirradiation in the treatment of patients with multiple brain metastases of solid tumors: a retrospective analysis(Ame Publ Co, 2015) Aktan, Meryem; Koc, Mehmet; Kanyilmaz, Gul; Tezcan, YilmazBackground: Patients with multiple brain metastases are often treated with whole brain radiation therapy (WBRT). Second course of WBRT is an important treatment option for patients with clinical or radiological intracranial disease progression. This study examines the outcomes in patients with multiple brain metastases who underwent reirradiation. Methods: We examined the medical records of 34 patients with multiple brain metastases who were treated WBRT. The median dose for the first course of WBRT was 30 Gy (range, 25-30 Gy) and for the second course 25 Gy (range, 20-30 Gy). Statistical analyses were performed with using Cox regression analyses, log-rank test and Kaplan-Meier method. Results: The median Karnofsky performance status (KPS) was 80 (range, 50-100) before reirradiation. Patients with KPS of >70 had a median survival of 11.4 months, compared to 2.2 months with KPS of <= 70 (P=0.012) and patients who have severe symptoms at the time of reirradiation with median survival 2.2 months while those with mild symptoms had a median of 4.8 months survival (P=0.08). The median overall survival for all patients after diagnosis of metastases was 24.7 months, after the re-irradiation WBRT (re-WBRT) it was 5.3 months (95% CI, 4.08-6.62) and from the diagnosis of primary tumor was 27.1 months (95% CI, 17.75-37.04). Conclusions: In select patients who have good performance status and who do not have severe symptoms might benefit from re-WBRT and re-WBRT seems to be associated with minimal toxicity in patients treated with lower palliation doses.Öğe A Preliminary Study of Serum Apelin Levels in Patients with Head and Neck Cancer(Aves, 2019) Aktan, Meryem; Ozmen, Hilal KiziltuncObjective: Treatment planning is primarily based on the tumor node metastasis (TNM) staging system for head and neck cancer (HNC). However, TNM does not give sufficient information about biological aggressiveness, treatment response, and prognosis. New molecular markers are needed for individualized cancer treatment. Apelin is a bioactive peptide and an endogenous ligand for the G protein-coupled receptor (APJ). Its expression is induced under hypoxic conditions. Apelin and its receptor APJ are important factors in physiological angiogenesis and may be novel targets for anti-angiogenic tumor therapies. This preliminary study aimed to investigate whether there was a difference in serum apelin levels between patients with HNC and control group and also to compare the serum apelin levels before and after radiotherapy. Materials and Methods: Twenty-two patients with HNC (patient group) and 30 healthy individuals (control group) were included in the study. In the patient group, blood samples were collected before and after radiotherapy. Serum apelin-36 levels were measured by enzyme-linked immunosorbent assay. Results: Serum apelin-36 levels were significantly higher in patients with HNC than in the control group (p<0.001). Coverage of the measured apelin-36 levels showed a significant decrease after radiotherapy according to the levels before radiotherapy. There was no statistically significant difference between the groups (p>0.05). Conclusion: Apelin may be a potential therapeutic target and a novel biomarker. Additional studies are needed to reveal the relationships between serum apelin and radiotherapy in solid human tumors.Öğe Prognostic factors for survival in adult patients with grade II glial tumors(2018) Kanyılmaz, Gül; Aktan, Meryem; Karahacıoğlu, Eray; Önder, HaticeAim: To investigate survival results of patients with low grade gliomas (LGGs) and to evaluate the predictive role of clinico-pathologic prognostic factors on survival. Material and Methods: Between 2003 and 2014, the adult patients with Grade II glial tumors were evaluated retrospectively. Several variables were investigated to find prognostic factors related with the overall survival (OS) and progression-free survival (PFS). Results: This study involved in 124 patients with median 40 (range; 6-132) months follow up. The average OS for the all patients was 7.8 years. 2-, 5- and 10- year OS ratios were 91%, 73% and 55%, respectively. Patients with low pignatti risk score had a longer OS than high pignatti risk score (p=0.01). Patients with seizure had a better OS (p=0.03). Patients with biopsy/partial resection had apoorer OS (p=0.02). Patients with residue after initial surgery had a worse OS (p=0.03). If the patients had recurrence or progression, the patients had poorer OS (p=0.01). Tumor with malignant transformation (p=0.01) and glioblastoma subtype after second surgery (p=0.003) had a poorer OS. The Pignatti risk score and seizure were the independent prognostic factors for PFS. Conclusion: The extent of surgery and recurrence or progression of Grade II glioma were the independent prognostic factors for OS. The Pignatti risk score and seizure were the independent prognostic factors for PFS.Öğe Prognostic importance of expression of mini-chromosome maintenance proteins (MCMs) in patients with nasopharyngeal cancer treated with curative radiotherapy(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2022) Kanyilmaz, Gul; Oltulu, Pembe; Yavuz, Berrin Benli; Aktan, MeryemObjective: The prognostic importance of minichromosome maintenance complex expression in nasopharyngeal cancer is still unknown. We aimed to find whether minichromosome maintenance complex 2-7 expression may potentially be used to predict the prognosis of nasopharyngeal cancer patients treated with definitive radiotherapy. Methods: Between April 2007 and July 2020, patients with nasopharyngeal cancer treated with radiotherapy were identified. Immunohistochemical analysis was performed on formalin-fixed paraffin-embedded tissues of cases. A single pathologist analyzed the histologic specimens of all patients. Results: Totally, 67 patients were included. The median followup was 75.3 months. Higher tumor (T) stage was correlated with minichromosome maintenance complex 2 overexpression. Minichromosome maintenance complex s expression was also associated with histopathologic subgroups. According to univariate analysis, AJCC stage, histopathological subgroups, tumor response after treatment, minichromosome maintenance complex 2, 3, 5, 6 and 7 expression were the prognostic factors that predict overall survival. According to multivariate analysis minichromosome maintenance complex 7 expression was the only prognostic marker for bothprogression-free survival and overall survival. Conclusion: The overexpression of minichromosome maintenance complex 2, 3, 5, 6 and 7 indicated bad prognosis. Minichromosome maintenance complex 7 was an independent prognostic factor for survival outcomes in nasopharyngeal cancer and may be a potential therapeutic target for treatment. (c) 2021 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
