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Öğe A case of severe vasculitis after FLOT chemotherapy in a patient with metastatic gastric cancer who received multiple line chemotherapy(Sage Publications Ltd, 2022) Hendem, Engin; Korkmaz, Mustafa; Ukrakli, Muzaffer; Eryilmaz, Melek Karakurt; Karaagac, Mustafa; Araz, Murat; Artac, MehmetIntroduction Leukocytoclastic vasculitis is a histopathological term describing vasculitis in which the inflammatory infiltrate in small vessels consists of neutrophils. Although FLOT is given perioperatively in locally advanced, resectable gastric or gastroesophageal junction adenocarcinoma, it has recently become a popular treatment option for metastatic cancers. In this case report, we present a case of FLOT-induced LCV. Case Report We present a 52-year-old patient with metastatic gastric adenocarcinoma treated with FLOT. The patient developed necrotizing vasculitis in the lower extremity after 5 cycles of FLOT. Management & Outcome After discontinuation of the FLOT regimen, the necrotizing morbid LCV gradually regressed with steroid therapy. Discussion To the best of our knowledge, our case is the first case of LCV that developed after FLOT chemotherapy. The clinical appearance of the patient, occurrence after chemotherapy, erythematous rash developing on bilateral lower extremities, and palpable purpuric vasculitis made us suspect. We found a potential relationship between FLOT and vasculitis according to the Naranjo scale (score 4 + ).Öğe Development of second primary multiple myeloma five years after treatment for limited-stage small cell lung cancer: a rare case report(Via Medica, 2021) Eryilmaz, Melek Karakurt; Aykut, Talat; Korkmaz, Mustafa; Karaagac, Mustafa; Araz, Murat; Artac, MehmetIntroduction. The development of a second primary malignancy (SPM) following small cell lung cancer (SCLC) has been previously reported in the literature. Especially smoking-related malignancy coupling is well known. The development of multiple myeloma (MM) in long-term survivors after treatment for SCLC is unknown. Here, we report the first case in the literature who developed MM 5 years after treatment for limited-stage SCLC. Case report. A 67-year-old male patient was diagnosed with limited-stage SCLC. After he received chemotherapy and radiotherapy, he was followed up without medication. He was admitted to the hospital with back pain and dyspnea 5 years after the diagnosis of small cell lung cancer. MRI revealed osteolytic lesions in the vertebrae. Laboratory testing revealed a markedly elevated serum IgA and an elevated serum beta-2 microglobulin level. Serum immunofixation revealed IgA lambda-type M-protein. Lambda excretion in urine immunofixation electrophoresis was observed. Bone marrow aspiration revealed the frequency of plasma cells to be 80% of all nucleated cells. Hence, the final diagnosis revealed IgA lambda free light chain MM. Treatment was given for multiple myeloma. In the follow-up, the patient experienced increased dyspnea and developed bilateral pleural effusion. The cytology sent from thoracentesis sampling was reported as plasmocyte-rich material. The patient fell into a coma and died in an intensive care unit. Conclusion. We presented the development of MM 5 years after treatment in a patient with SCLC who were treated for one year and then followed up with stable findings. It should be kept in mind that a patient with SCLC who is a long-term survivor and presents with back pain may have developed a primary malignancy originating from bone marrow rather than a bone metastasis. Patients should be advised smoking cessation after the treatment and diagnosis of SCLC. Also, the patients with SCLC who are long-term survivors should be closely monitored for the development of SPM.Öğe Early-stage gastric cancer presenting with tripe palm and acanthosis nigricans(Via Medica, 2021) Kocak, Mehmet Zahid; Araz, Murat; Korkmaz, Mustafa; Demirkiran, AykutTripe palm is a rare cutaneous paraneoplastic syndrome that can be overlooked and frequently appears with acanthosis nigricans. If tripe palm and acanthosis nigricans occur in a patient together, gastric cancer should come to mind. A 50-year-old female patient had signs of abdominal pain and velvety thickening in the palms and soles. Tripe palm and acanthosis nigricans were considered as paraneoplastic syndrome after other benign causes were excluded. It was determined that the underlying malignancy was gastric cancer. After neoadjuvant FLOT chemotherapy regimen, gastrectomy was performed, and the patient received adjuvant chemotherapy. With the recognition of tripe palm, a rare cutaneous paraneoplastic syndrome, patients can be diagnosed and treated early.Öğe Fifty-five months progression-free survival with crizotinib treatment in coexistence of ALK and ROS1 rearrangements in lung adenocarcinoma: an extremely rare case and review of the literature(Lippincott Williams & Wilkins, 2022) Korkmaz, Mustafa; Eryilmaz, Melek KarakurtWe wanted to present a case with coexistence of anaplastic lymphoma kinase (ALK) and c-ros oncogene 1 (ROS1) rearrangements that has been in remission for a long time with crizotinib. A 62-year-old nonsmoker male patient was diagnosed with Non-small cell lung cancer. Progression developed 9 months after the treatment, and coexistence of ALK and ROS1 positivity were detected in driver mutation analysis performed with fluorescent in situ hybridization. Crizotinib 2 x 250 mg was started in November 2016. The treatment of the patient, who has been in remission for approximately 55 months since then, continues. Until recently, the use of next-generation sequencing (NGS) was not common, but the more frequent epidermal growth factor receptor, then ALK, and finally ROS1 mutation were studied in tumor tissues. Sometimes ROS1 was not studied because there was not enough tissue left. We think that this rate will increase a little more with the widespread use of NGS from now on. Showing that ALK and ROS1 are positive together, longer survivals can be obtained by choosing therapies that are responsive to both.Öğe First renal metastasis report from tongue cancer(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2022) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Karaagac, Mustafa; Artac, Mehmet[Abstract Not Availabe]Öğe The goal of primary therapy in non-metastatic nasopharyngeal cancer should be radiological complete response(Springer, 2022) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Kocak, Mehmet Zahid; Demirkiran, Aykut; Karaagac, Mustafa; Artac, MehmetBackground: We aimed to investigate the effect of radiological complete response on survival outcomes in patients with non-metastatic nasopharyngeal cancer. This study is conducted as a retrospective cohort. Of the 185 patients screened, 60 were metastatic, 25 patients' data was not available, and as a result, 92 patients were included in the study. Among the complete response (CR) and incomplete response (IR) groups, overall survival (OS), distant metastasis-free survival (DMFS), and locoregional failure-free survival (LRFFS) were evaluated. Results: Of the 92 patients, 54 (58.6%) were CR and 38 (41.4%) were IR patients. Of the whole study group, the 5-year OS, DMFS, and LRFFS rates were 75%, 78%, and 95%, respectively. A significant difference was found between the 5-year OS (90% vs. 60%, p= 0.001) and DMFS (87% vs. 65%, p= 0.02) rates. However, there was no significant difference in the 5-year LRFFS rate (97% vs. 92%, p= 0.16). Complete response were determined as an independent predictor for OS (HR: 0.13, 95% CI: 0.045-0.36, p <0.001) and DMFS (HR: 0.26, 95% CI: 0.095-0.744, p= 0.012). Conclusion: As a result, the survival benefit in patients with CR after primary treatment is evident as shown in the above studies. Therefore, the aim of primary treatment should be to increase the CR rates. It is important to evaluate early tumor response to determine poor tumor regression.Öğe The goal of primary therapy in non-metastatic nasopharyngeal cancer should be radiological complete response(Springer, 2022) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Kocak, Mehmet Zahid; Demirkiran, Aykut; Karaagac, Mustafa; Artac, MehmetBackground: We aimed to investigate the effect of radiological complete response on survival outcomes in patients with non-metastatic nasopharyngeal cancer. This study is conducted as a retrospective cohort. Of the 185 patients screened, 60 were metastatic, 25 patients' data was not available, and as a result, 92 patients were included in the study. Among the complete response (CR) and incomplete response (IR) groups, overall survival (OS), distant metastasis-free survival (DMFS), and locoregional failure-free survival (LRFFS) were evaluated. Results: Of the 92 patients, 54 (58.6%) were CR and 38 (41.4%) were IR patients. Of the whole study group, the 5-year OS, DMFS, and LRFFS rates were 75%, 78%, and 95%, respectively. A significant difference was found between the 5-year OS (90% vs. 60%, p= 0.001) and DMFS (87% vs. 65%, p= 0.02) rates. However, there was no significant difference in the 5-year LRFFS rate (97% vs. 92%, p= 0.16). Complete response were determined as an independent predictor for OS (HR: 0.13, 95% CI: 0.045-0.36, p <0.001) and DMFS (HR: 0.26, 95% CI: 0.095-0.744, p= 0.012). Conclusion: As a result, the survival benefit in patients with CR after primary treatment is evident as shown in the above studies. Therefore, the aim of primary treatment should be to increase the CR rates. It is important to evaluate early tumor response to determine poor tumor regression.Öğe Ibrutinib and panitumumab used in combination safely in a patient with metachronous colorectal cancer and chronic lymphocytic leukemia(Lippincott Williams & Wilkins, 2022) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Karaagac, Mustafa; Araz, Murat; Ceneli, Ozcan; Artac, MehmetIbrutinib is a Bruton tyrosine kinase inhibitor used in the treatment of chronic lymphocytic leukemia (CLL). Panitumumab, an mAb for epidermal growth factor receptor, is used in the treatment of metastatic colorectal cancer (CRC). We wanted to present our case where we used ibrutinib and panitumumab in combination in a patient with metachronous CLL and CRC. A 58-year-old male patient with a diagnosis of CLL was receiving ibrutinib treatment and primary rectal cancer was detected. FOLFOX + panitumumab were started when metastasis was detected in the lung after neoadjuvant chemoradiotherapy for rectal cancer. The patients used ibrutinib and panitumumab in combination. There was no cumulative or unexpected toxicity due to the combination of both antineoplastic agents. The most important point to be considered in the use of combined drugs is the evaluation of drug-drug interactions. Toxic effects of the combination of ibrutinib and cetuximab have been reported in a patient with metastatic CRC. We used ibrutinib together with panitumumab in our case and we did not encounter any cumulative or unexpected side effects during the treatment.Öğe Is pancreatic giant cell tumor resistant to standard chemotherapy?(Lippincott Williams & Wilkins, 2022) Caglayan, Dilek; Eryilmaz, Melek Karakurt; Korkmaz, Mustafa; Karaagac, Mustafa; Hendem, Engin; Artac, MehmetPancreatic giant cell tumors (PGCTs), undifferentiated pancreatic carcinoma are rare tumors of the pancreas. PGCTs consist of osteoclastic, pleomorphic and mixed variants. PGCT is usually diagnosed at an advanced stage. PGCT has a worse prognosis than pancreatic ductal adenocarcinoma. Although surgery can be curative, there is no standard treatment approach for advanced PGCT. We present a case of PGCT that is resistant to standard therapy and progresses in a short time.Öğe Is the Prognostic Nutritional Index a Prognostic Marker for the Survival of Patients with Lymph-Node Positive Stage II-III Gastric Cancer Who Receive Adjuvant Chemotherapy?(Springer, 2023) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Er, Muhammed Muhiddin; Kocak, Mehmet Zahid; Demirkiran, Aykut; Karaagac, Mustafa; Araz, MuratPurpose The prognostic nutritional index (PNI), like other systemic inflammatory markers, has been shown to be a prognostic factor in various cancer patients. In this study, we aimed to show whether PNI calculated before adjuvant chemotherapy is a prognostic factor for overall survival (OS) and disease-free survival (DFS) in patients with lymph node-positive stage II-III gastric cancer.Methods The PNI was calculated using the albumin and lymphocyte count. The PNI cut-off value was found to be 39.5. They were divided into two groups as being = 39.5 (PNI low group) and > 39.5 (PNI high group).Results Our study included 168 patients with lymph node-positive stage II-III gastric cancer who received adjuvant chemotherapy. Of the patients, 116 (69.0%) were 65 years or younger, and 52 (31.0%) were over 65 years old. Of the patients, 117 (69.6%) were pT3, 51 (30.4%) were pT4. Seventy-three (43.4%) patients had pN1-2 disease and 95 (56.6%) patients had pN3 disease. The number of stage II patients was 73 (43.5%) and the number of stage III patients was 95 (56.5%). There were 73 patients with PNI = 39.5 and 95 patients with PNI > 39.5. The mOS of the patients with low PNI group was 39.5 months, while the OS of the patients with high PNI group was 96.8 months (p = 0.002). In the group of patients with PNI low group, mDFS 24.4 months was significantly higher than those with PNI high group was 50.7 months (p = 0.021). The PNI score was statistically significant in univariate and multivariate analyzes for both DFS and OS.Conclusion PNI can be used as an independent prognostic factor for both OS and DFS in patients lymph node-positive, stage II-III gastric cancer who will receive adjuvant chemotherapy.Öğe Low-dose (7.5 mg/kg) bevacizumab may be a viable option in recurrent ovarian cancer: A retrospective study(Wolters Kluwer Medknow Publications, 2023) Demirkiran, Aykut; Eryilmaz, Melek Karakurt; Karaagac, Mustafa; Araz, Murat; Korkmaz, Mustafa; Kocak, Mehmet Zahid; Artac, MehmetObjective: Bevacizumab (BEV) is a humanized monoclonal antibody of vascular endothelial growth factor receptors and, as a result of clinical trials, was approved for the treatment of recurrent ovarian cancer (ROC). The aim of this study was to assess the clinical utility of BEV in patients with ROC in real-world practice beyond clinical trials. Materials and Methods: In this single-center retrospective cohort study, we evaluated the medical data of all patients with ROC who were treated with BEV between October 2013 and March 2020. Results: A total of 76 females were evaluated. Forty-nine (64.5%) patients were platinum sensitive and 27 (35.5%) patients were platinum resistant. BEV was used in combination with chemotherapy agents in all patients, and the most preferred combinations were gemcitabine/carboplatin (GC) (78.9%) and carboplatin/paclitaxel (14.5%). In all patients, the BEV dose was 7.5 mg/kg every 3 weeks. The median progression-free survival (PFS) was 11.1 months (95% confidence interval [CI]: 9.6-12.6), and the median overall survival (OS) was 22.3 months (95% CI: 17.5-27.2). In multivariate analysis, serous histological type (P = 0.01), maintenance BEV administration (P = 0.001), and combination of GC-BEV (P < 0.001) were associated with better PFS, while serous histological type (P = 0.016) and good performance status (P = 0.006) were associated with prolonged OS. Conclusions: Low-dose (7.5 mg/kg) BEV was found to be effective in the second-line treatment of patients with ROC in our real-life study. In addition, the combination of BEV with GC was shown to be a viable option, especially in the treatment selection of platinum-resistant patients.Öğe Nephrotic syndrome induced by cetuximab in a patient with metastatic colorectal cancer(Sage Publications Ltd, 2022) Korkmaz, Mustafa; Hendem, Engin; Eryilmaz, Melek Karakurt; Demirkiran, Aykut; Karaagac, Mustafa; Artac, MehmetIntroduction Cetuximab, an anti-EGFR monoclonal antibody, often cause skin toxicity, most commonly acneiform rash. We present a rare case of glomerulonephritis associated with cetuximab therapy. Case Report A 58-year-old male patient recently completed cetuximab-based chemotherapy for metastatic colorectal adenocarcinoma. He presented with acute renal failure, anasarca edema and nephrotic proteinuria. The amount of protein in the 24-h urine test was over 15.6 grams. Management & Outcome The patient showed a dramatic improvement in renal function shortly after terminated of cetuximab therapy without immunosuppressive therapy. Discussion Therefore, drugs targeting epidermal growth factor receptor (EGFR) monoclonal antibody were thought to trigger nephrotic syndrome by causing glomerular damage. As a result, physicians using EGFR monoclonal inhibitors should be very careful about renal functions and proteinuria in patients.Öğe Pemetrexed-induced Sweet Syndrome: First case report in the medical literature(Sage Publications Ltd, 2021) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Karaagac, Mustafa; Demirkiran, Aykut; Araz, Murat; Artac, MehmetIntroduction Sweet Syndrome, also known as acute febrile neutrophilic dermatosis, is a rare inflammatory disease characterized by the sudden emergence of painful, edematous, and erythematous papules, plaques, or nodules on the skin, which usually fully responsive to systemic corticosteroids. Skin lesions are often accompanied by fever and leukocytosis. Here we present a case of Sweet Syndrome caused by pemetrexed in metastatic lung adenocarcinoma. Case report A 52-year-old patient with metastatic lung adenocarcinoma received multiple lines of chemotherapy. The patient presented with extensive skin lesions after performing of pemetrexed chemotherapy. He had a fever and elevations in blood levels of C-reactive protein (CRP), sedimentation, leucocytes, and neutrophils. Neutrophil predominant perivascular and interstitial dermatitis, focal micropustule formation, and severe neutrophilic dermatosis were reported in skin biopsy. Topical steroid and oral antihistamine treatment were started as initial treatment. Discussion and conclusions:Cutaneous side effects related to pemetrexed are often reported as 'skin rash,' which is a non-specific term. Therefore, the diagnosis of Sweet Syndrome must be confirmed by skin biopsy. It is essential to exclude the presence of an infection and medication history. Recovery in drug-induced Sweet Syndrome occurs after the drug that caused it was discontinued. Systemic corticosteroids are the first-line treatment for most cases.Öğe Perineural invasion is a better prognostic factor than extranodal extension in head and neck cancer(Springer, 2022) Eryilmaz, Melek Karakurt; Korkmaz, Mustafa; Karaagac, Mustafa; Artac, MehmetBackground: The prognostic value of perineural invasion (PNI) in head and neck squamous cell carcinoma (HNSCC) remains controversial. This study investigated the impact of PNI on prognosis in HNSCC. A total of 49 patients with HNSCC who underwent primary surgical treatment were selected for the study. Univariate analysis of the survival curve was performed using the Kaplan-Meier method. Multivariate analysis was carried out by Cox regression. Results: PNI was present in 17 of 49 (34.7%) patients. The median follow-up was 18.7 months. The median DFS and OS were 16.6 months and 41.9 months, respectively. Univariate analyses showed that PNI was associated with OS (p: 0.02), but not with DFS (p: 0.50). ENE was associated only with DFS in univariate analysis (p: 0.04), but not OS (yes vs. no; 24.1 vs. 44.6 months, p: 0.21), and in multivariate analysis, ENE lost its significance for DFS (p: 0.12). Also, PNI was the only significant independent adverse prognostic factor for OS in multivariate analysis (p: 0.02). The median OS for patients with and without PNI was 17.1 months and 92.1 months, respectively. Conclusion: PNI was an independent factor for poor prognosis in patients with HNSCC. The presence of PNI compared to ENE was associated with a greater risk of death in HNSCC. Therefore, it would be appropriate to consider adjuvant therapy in the presence of PNI alone without other adverse risk features.Öğe Perineural invasion is a better prognostic factor than extranodal extension in head and neck cancer(Springer, 2022) Eryilmaz, Melek Karakurt; Korkmaz, Mustafa; Karaagac, Mustafa; Artac, MehmetBackground: The prognostic value of perineural invasion (PNI) in head and neck squamous cell carcinoma (HNSCC) remains controversial. This study investigated the impact of PNI on prognosis in HNSCC. A total of 49 patients with HNSCC who underwent primary surgical treatment were selected for the study. Univariate analysis of the survival curve was performed using the Kaplan-Meier method. Multivariate analysis was carried out by Cox regression. Results: PNI was present in 17 of 49 (34.7%) patients. The median follow-up was 18.7 months. The median DFS and OS were 16.6 months and 41.9 months, respectively. Univariate analyses showed that PNI was associated with OS (p: 0.02), but not with DFS (p: 0.50). ENE was associated only with DFS in univariate analysis (p: 0.04), but not OS (yes vs. no; 24.1 vs. 44.6 months, p: 0.21), and in multivariate analysis, ENE lost its significance for DFS (p: 0.12). Also, PNI was the only significant independent adverse prognostic factor for OS in multivariate analysis (p: 0.02). The median OS for patients with and without PNI was 17.1 months and 92.1 months, respectively. Conclusion: PNI was an independent factor for poor prognosis in patients with HNSCC. The presence of PNI compared to ENE was associated with a greater risk of death in HNSCC. Therefore, it would be appropriate to consider adjuvant therapy in the presence of PNI alone without other adverse risk features.Öğe The prognostic role of HIF-1? and NF-?B expression in RAS wild-type metastatic colorectal cancer: A Turkish Oncology Group (TOG) study(Springer, 2023) Demirkiran, Aykut; Kilinc, Fahriye; Kocak, Mehmet Zahid; Demirkiran, Deniz; Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Araz, MuratBackground Not all RAS wild-type metastatic colorectal cancer (mCRC) patients experience the same benefit from anti-epidermal growth factor receptor (EGFR) treatments. Studies have shown that nuclear factor-kappa B (NF-kappa B), hypoxia-inducible factor-1 alpha (HIF-1 alpha), interleukin 8 (IL-8) and transforming growth factor beta (TGF-beta) may be therapeutic targets for mCRC. The aim of this study was to clarify the prognostic value of NF-kappa B, HIF-1 alpha, IL-8, and TGF-beta expression in patients with left-sided mCRC receiving EGFR inhibitors. Methods Patients with RAS wild-type, left-sided mCRC treated with anti-EGFR on the first line between September 2013 and April 2022 were included. Immunohistochemical staining for NF-kappa B, HIF-1 alpha, IL-8 and TGF-beta was performed from tumor tissues of 88 patients. Patients were divided into NF-kappa B, HIF-1 alpha, IL-8 and TGF-beta expression positive and negative group, moreover, expression positive group were also divided into two group as expression intensity low and high group. The median follow-up was 25.2 months. Results Median progression-free survival (PFS) was 8.1 (6-10.2) months in the cetuximab group, 11.3 (8.5-14) months in the panitumumab group (p = 0.09). Median overall survival (OS) was 23.9 (4.3-43.4) months in the cetuximab group, 26.9 (15.9-31.9) months in the panitumumab group (p = 0.8). Cytoplasmic NF-kappa B expression was present in all patients. The mOS was 19.8 (11-28.6) months in NF-kappa B expression intensity low group and 36.5 (20.1-52.8) months in high group (p = 0.03). The mOS of the HIF-1 alpha expression negative group was significantly longer compared with expression positive group (p = 0.014). There was no significant difference in IL-8 and TGF-beta expression status on mOS and mPFS (for all, p > 0.05). Positive expression of HIF-1 alpha was poor prognostic for mOS in the univariate analysis (HR:2.7, 95% CI 1.18-6.52, p = 0.02) and in multivariate analysis (HR 3.69, 95% CI 1.41-9.6, p = 0.008). High cytoplasmic expression intensity of NF-kappa B was found to have a good prognostic value for mOS (HR 0.47, 95% CI 0.26-0.85, p = 0.01). Conclusion High cytoplasmic expression intensity of NF-kappa B and negative expression of HIF-1 alpha could be a good prognostic marker for mOS in RAS wild-type left-sided mCRC.Öğe Prognostic Significance of Adipose Tissue Distribution and Metabolic Activity in PET/CT in Patients with Metastatic Colorectal Cancer(Springer, 2023) Karacelik, Tuba; Kaya, Bugra; Korkmaz, Mustafa; Karaagac, Mustafa; Araz, Murat; Eryilmaz, Melek Karakurt; Bozcuk, Hakan SatPurpose In this study, we aimed to evaluate the prognostic significance of adipose tissue distribution and metabolic activity in PET/CT to predict survival in patients with metastatic colorectal cancer (mCRC). Methods The volume, density (HU), and FDG uptake (standardized uptake value (SUV)) of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and maximum FDG uptake of the tumor tissue were measured. Subcutaneous adipose tissue of volume-to-density ratio (SAT ratio) was calculated. Results The median OS for the patients with SAT ratio value < -1.1 and >= -1.1 were 38.5 (95% CI 31.54-45.58) and 24.5 (95% CI 14.13-34.93) months, respectively (p = 0.05). During follow-up, 69 patients experienced disease progression. The median progression-free survival (PFS) was 11.03 months (95% CI: 9.11-12.95). Median PFS for patients with tumor SUV max value < 11.5 and >= 11.5 were 9.2 (95% CI 7.25-11.27) and 12.6 (95% CI 10.02-15.27) months, respectively (p = 0.14). Forty-eight patients received bevacizumab therapy. VAT SUV mean (HR: 0.09; 95% CI 0.01-0.52, p = 0.008) was significantly associated with PFS in patients receiving bevacizumab. SAT ratio was the significant parameter for the OS (HR: 0.58; 95% CI 0.33-1.01, p = 0.05) and PFS (HR: 1.99; 95% CI 1.02-3.91, p = 0.043). Conclusions SAT ratio was an independent prognostic factor for survival in patients with mCRC. Higher SAT volume is correlated with longer survival in mCRC patients.Öğe The Real-Life Data of BRAF Mutation on the Treatment of Colorectal Cancer: a TOG Study(Springer, 2021) Beypinar, Ismail; Demir, Hacer; Sakin, Abdullah; Taskoylu, Burcu Yapar; Sakalar, Teoman; Ergun, Yakup; Korkmaz, MustafaPurpose Colorectal cancer is the third leading diagnosis accounting for nearly 10% of all new cancers worldwide. The distinct features among BRAF mutant colorectal cancers make these tumor groups hard to treat for oncologists. The median overall survival (OS) of these types of cancers is reported to be 9 to 14 months. Methods The study was declared on the Turkish Oncology Study Group Conference and approved. The patients' data was received from the centers who confirmed to participate. The BRAF-mutated patients were included in the study. The demographic features (age, gender, etc.), type of mutation, tumor localizations, histology, microsatellite instability (MSI) status, metastasis patterns chemotherapeutic agents and progression, and death times were recorded. Results Thirty-nine patients were enrolled in the study. Sixteen patients had concurrent KRAS mutations, while 7 had NRAS mutations. Most of the patients received doublet chemotherapies in combination with anti-VEGF agents in the first and second line of the treatment. There was a significant difference in OS according to the stage which showed a decreased survival in stage IV patients at the time of diagnosis. Concurrent KRAS mutation resulted in increased OS. The median OS was 47 and 24 months favoring the KRAS mutant group. The patients whose primary tumor operated had better survival when compared with other patients. The median OS of the operated group was 47 months, while the non-operated group was 24 months. Liver metastasis was related to worse prognosis at the time of diagnosis in univariate analysis. Conclusion In our study we found a high concurrent RAS mutation ratio in a BRAF mutant patient group which was different from prior studies. The concurrent mutations resulted in a favorable outcome in terms of OS which is also different from the current knowledge. More prospective studies are needed especially BRAF-mutated patient population and especially with concurrent RAS mutations.Öğe Recurrent Her-2 positive occult breast cancer presenting with zosteriform cutaneous metastases: a case report(Via Medica, 2021) Kocak, Mehmet Zahid; Araz, Murat; Karaagac, Mustafa; Caglayan, Duck; Korkmaz, Mustafa; Demirkiran, AykutVarious cutaneous metastasis patterns are described in breast cancer. Zosteriform metastases are rare cutaneous metastases, which appear in a dermatomal distribution. A 66-year woman presented with a 1-month history of nodular lesions on the left posterior hemithorax area. Biopsy was reported as human epidermal growth factor receptor (Her) 2 positive, hormone receptor-negative breast carcinoma metastasis. Dual blockade therapy targeting Her-2 overexpression was initiated for the patient. Treatment response was obtained after 3 cycles. There was a significant improvement in skin lesions. Zosteriform cutaneous metastases can be the early sign of systemic spread and can show an initial response to therapy. Therefore, physicians should perform an exhaustive physical examination including that of skin.Öğe Sunitinib-induced small bowel wall edema as a prognostic marker in metastatic renal cell carcinoma(Wolters Kluwer Medknow Publications, 2023) Korkmaz, Mustafa; Eryilmaz, Melek Karakurt; Kerimoglu, Ulku; Karaagac, Mustafa; Kocak, Mehmet Zahid; Demirkiran, Aykut; Araz, MuratAim: The aim of this study was to evaluate the presence of small bowel wall edema (SBWE) on computed tomography (CT) images in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib and to investigate the relationship between the presence of SBWE and survival. Materials and Methods: We retrospectively evaluated the presence of SBWE on CT images of 27 mRCC patients who received at least one cycle of sunitinib. Then, we analyzed the relationship between the presence of SBWE and progression-free survival (PFS) and overall survival (OS). Results: All 27 patients had SBWE on at least one CT scan. The median value of SBWE thickness was 2.5 mm. SBWE thickness was <= 2.5 mm in 13 patients (group A) and >2.5 mm in 14 patients (group B). The median OS was significantly higher in group B (55 vs. 18 months, respectively, P = 0.02). Although it was not statistically significant (13 vs. 8 months, respectively, P = 0.69), the median PFS was longer in group B than in group A. Conclusions: This study showed that sunitinib treatment caused SBWE in all patients with mRCC who received the drug. Also, this study demonstrated an association between higher SBWE thickness and better survival outcomes.