Prognostic value of the systemic immune-inflammation index, systemic inflammation response index, and prognostic nutritional index in head and neck cancer

PURPOSE

This study sought to investigate the prognostic value of the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and prognostic nutritional index (PNI) in patients with head and neck cancer.

METHODS

The data of 310 patients with head and neck cancer who were referred to the Radiation Oncology Clinic of Sivas Cumhuriyet University Faculty of Medicine (n = 271, 87%) and to S.B.U. Dr. Abdurrahman Yurtaslan Ankara Oncology Health Practice and Research Centre (n = 39, 13%) between January 2009 and March 2020 were retrospectively analysed. At the time of diagnosis, patients' neutrophil, lymphocyte, monocyte, platelet and albumin levels were used to calculate their SII, SIRI and PNI indices.

RESULTS

Multivariate analysis found the after variables to be independent prognostic factors for overall survival (OS): SII [hazard ratio (HR) 1.71, 95% confidence interval (CI) 1.18-2.47; p = 0.002] and PNI (HR 0.66, 95% CI 0.43-0.97; p = 0.038), stage (HR 2.11, 95% CI 1.07-4.16; p = 0.030), fraction technique (HR 0.49, 95% CI 0.28-0.85; p = 0.011) and age (HR 2.51, 95% CI 1.77-3.57; p = 0.001).The following variables were found to be independent prognostic factors for disease-free survival (DFS) in multivariate analysis: SII (HR 2.16, 95% CI 1.22-3.83; p = 0.008), fractionation technique (HR 0.17, 95% CI 0.004-0.64; p = 0.017) and age (HR 2.11, 95% CI 1.13-3.93; p = 0.019).

CONCLUSION

This study found a high SII to be an independent poor prognostic factor for both OS and DFS, while a low PNI was found to be an independent poor prognostic factor only for OS.

Outcomes of fractionated CyberKnife radiosurgery in patients with choroidal malignant melanoma

OBJECTIVE

The aim of this study was to evaluate local tumor control and complication development rates of fractionated CyberKnife radiosurgery (CRS) in patients with choroidal melanoma.

METHODS

A total of 29 patients with choroidal melanoma were treated with fractionated CRS at Ankara Oncology Research and Training Hospital, Department of Radiotherapy between May 2009 and December 2013. Patients were treated with CRS if the initial height of the choroidal melanoma was ≥ 6 mm, or juxtapapillary and/or juxtamacular tumors with a height of >2.5 mm. Ophthalmic examinations were performed at baseline and at months 3, 6, 9 and 15 after radiotherapy. Assessment of visual acuity and measurement of tumor base dimension and height using A-scan and B-scan echography were done at each visit.

RESULTS

The mean age was 56 (27-75) years. Tumor was located on choroid in 23 and on ciliochoroid in 6 patients. 86.2% of all melanomas were classified as medium sized and 23.8% as large sized. A median total dose of 5000 cGy was applied. Median tumor height decreased from 7.5 mm at baseline to 4.4 mm at the last follow-up visit (p < 0.001). Median visual acuity decreased from 0.4 at baseline to hand motion (p < 0.001). One patient had been lost to the metastatic disease and one patient had been treated with enucleation due to recurrent tumor growth.

CONCLUSION

CRS is an effective and reliable local treatment modality in uveal melanoma.

Long-term clinical outcome and dosimetric comparison of tandem and ring versus tandem and ovoids intracavitary application in cervical cancer

PURPOSE

The two most common applicators used in the treatment of high dose rate (HDR) intracavitary brachytherapy (ICBT) are tandem and ovoid (TO) and tandem and ring (TR). We aimed to evaluate the relationship between these treatment plans with short and long-term clinical outcomes.

METHODS

This retrospective study included 50 patients who received a partial or complete response to external beam radiotherapy treatment (EBRT) and who were diagnosed with cervical cancer in our clinic between November 2015 and October 2019, including 25 TO patients and 25 TR patients. Left and right point A, high-risk clinical target volume (HR-CTV) EQD2, D0.1cc, 1cc, 2cc for the bladder, rectum, sigmoid, upper, middle, and lower vagina doses were recorded and compared according to the applicator type using the dose-volume histogram (DVH) parameter calculated from 200 computed tomography (CT) databases.

RESULTS

Right point A dose EQD2, HR-CTVD90,95,98, D2cc rectum EQD2, upper vagina V7Gy, 10Gy, middle and lower vagina 0,1, 1, 2cc, upper vagina 5-mm lateral point dose and upper, middle, lower vagina average doses were all found to be significantly lower for TR than for TO (p<0.005).

CONCLUSIONS

Although right point A dose EQD2, HR-CTVD90,95,98 values were higher in TO than in TR, the rectum and vaginal doses also seemed more advantageous in TR. GUS and GIS toxicities, local control, distant metastasis, treatment responses and survival rates were similar in both the applicators, although vaginal toxicity was observed more in TO. Studies with a higher number of patients are warranted in the future.

Prognostic value of systemic ımmune ınflammation ındex in patients with laryngeal cancer

PURPOSE

This study aimed to investigate the relationship between the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the systemic immune-inflammation index (SII) with the clinical and pathological parameters of 118 laryngeal cancer patients, as well as their effects on the survival of the disease.

METHODS

For the calculation of SII, PLR, and NLR, hemogram tests were conducted before treatment. Receiver-operating characteristic (ROC) analysis was used to calculate the cut-off value of SII, NLR, and PLR for overall survival (OS) and disease-free survival (DFS).

RESULTS

A statistically significant relationship was found between SII and lymphovascular invasion and between NLR and local recurrence, and lymphovascular invasion. In a univariate analysis, SII (p < 0.001) and NLR (p = 0.001) for OS and SII (p < 0.001), PLR (p = 0.043), and NLR (p < 0.001) for DFS were detected as prognostic factors. In a multivariate analysis for OS, SII (HR = 10.54, 95% CI 1.28-86.77; p = 0.029) and extracapsular extension (HR = 3.08, 95% CI 1.15-8.21; p = 0.024) were identified as independent prognostic factors. In a multivariate analysis for DFS, only an extracapsular extension presence (HR = 3.32, 95% CI 1.37-8.08; p = 0.008) was detected as an independent prognostic factor.

CONCLUSION

In laryngeal cancer, high SII values were determined as poor independent prognostic factors for OS. High SII, NLR, and PRL have been identified as poor prognostic factors in DFS. A correlation was found between NLR and local recurrence, and lymphovascular invasion and between SII with lymphovascular invasion positivity.

Stereotactic body radiotherapy in patients with early-stage non-small cell lung cancer: Does beam-on time matter?

PURPOSE

Stereotactic body radiotherapy (SBRT) is an effective treatment option for patients with early-stage non-small cell lung cancer (NSCLC). In this study, we evaluated the treatment results using two different SBRT techniques and the effect of beam-on time (BOT) on treatment outcomes.

METHODS

Between July 2007 and January 2018, 142 patients underwent SBRT for primary NSCLC. We have delivered SBRT using either respiratory tracking system (RTS) or internal-target-volume (ITV)-based motion management techniques. The effect of age, tumor size, pretreatment tumor SUVmax value, presence of tissue diagnosis, histopathological subtype, operability status, tumor location, motion management technique, BED10 value, BOT on overall survival (OS), loco-regional control (LRC), event-free survival (EFS) and primary tumor control (PTC) were evaluated.

RESULTS

Median age of the patients was 70 years (range, 39-91 years). Most of the patients were inoperable (90%) at the time of SBRT. Median BED10 value was 112.5 Gy. With a median follow-up of 25 months, PTC was achieved in 91.5% of the patients. Two-year estimated OS, LRC, PTC and EFS rates were 68, 63, 63 and 53%, respectively. For the entire group, OS was associated with BOT (P = 0.027), and EFS was associated with BOT (P = 0.027) and tumor size (P = 0.015). For RTS group, OS was associated with age (P = 0.016), EFS with BOT (P = 0.05) and tumor size (P = 0.024), LRC with BOT (P = 0.008) and PTC with BOT (P = 0.028). The treatment was well tolerated in general.

CONCLUSION

SBRT is an effective and safe treatment with high OS, LRC, EFS and PTC rates in patients with primary NSCLC. Protracted BOT might deteriorate SBRT outcomes.

Whole Brain Radiotherapy Combined with Stereotactic Radiosurgery versus Stereotactic Radiosurgery Alone for Brain Metastases

BACKGROUND

The aim of this study was to evaluate the effect of whole brain radiotherapy (WBRT) combined with streotactic radiosurgery versus stereotactic radiosurgery (SRS) alone for patients with brain metastases.

MATERIALS AND METHODS

This was a retrospective study that evaluated the results of 46 patients treated for brain metastases at Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Radiation Oncology Department, between January 2012 and January 2015. Twenty-four patients were treated with WBRT+SRS while 22 patients were treated with only SRS.

RESULTS

Time to local recurrence was 9.7 months in the WBRT+SRS arm and 8.3 months in SRS arm, the difference not being statistically significant (p= 0.7). Local recurrence rate was higher in the SRS alone arm but again without significance (p=0,06).

CONCLUSIONS

In selected patient group with limited number (one to four) of brain metastases SRS alone can be considered as a treatment option and WBRT may be omitted in the initial treatment.

Evaluation of quality of life in Turkish patients with head and neck cancer

BACKGROUND

In this study, our aim was to investigate the effect of factors, such as radiotherapy, the dose of radiotherapy, the region of radiotherapy, the age of the patient, performance, co-morbidity, the stage of the disease and the therapy modalities on the quality of life of patients with head and neck cancer.

MATERIALS AND METHODS

Eighty-two patients who were treated by either chemoradiotherapy or radiotherapy, at the Cumhuriyet University Faculty of Medicine, Department of Radiation Oncology, between February 2007 and September 2010, for head and neck cancer were included. The quality of life European Organisation for Research and Treatment of Cancer, Questionnaire module to be used in Quality of Life assessments in Head and Neck Cancer (EORTC QLQ-HandN35) questionnaire was conducted in all patients before starting the radiotherapy, in the middle, at the end, at 1 month and at 6 months after the treatment.

RESULTS

According to the questionnaires at the end and at the 6th month after the radiotherapy, it was found that the age of the patient, co-morbidity, ECOG performance state, localization, type of treatment, the stage of the disease, the dose and the region of radiotherapy affect some of the symptom scales for quality of life.

CONCLUSIONS

Quality of life was affected negatively during and after the radiotherapy. However, in the 6th month after the therapy, a significant improvement was observed in most symptoms.

Lack of impact of age on acute side effects and tolerance of curative radiation therapy

AIM

The aim of this study was to determine the impact of age on the occurrence, severity, and timing of acute side effects related to radiotherapy.

MATERIALS AND METHODS

We analysed the data of 423 patients.

RESULTS

Of the patients, 295 (70%) were under the age of 65 (group 1) and 128 (30%) were over the age of 65 (group 2). The frequencies of radiotherapy-induced side effects were 89% in group 1 and 87% in group 2 (p=0.286). The mean times to occurrence were 2.5±0.1 weeks in group 1 and 2.2±0.1 weeks in group 2 (p=0.013). Treatment was ended in 2% of patients in group 1 and 6% of those in group 2 (p=0.062). Treatment interruption was identified in 18% of patients in group 1 and 23% in group 2 (p=0.142). Changes in performance status were greater in older patients (p=0.013). There were no significant differences according to the frequency or severity of side effects, except skin and genitourinary complications, between the groups.

CONCLUSIONS

Early normal tissue reactions were not higher in older versus younger patients, though there was a tendency towards an earlier appearance.

Effect of the patient's age on radiotherapy-based adverse effect

e19575

Background: We aim to determine the acute side effects of radiotherapy and the contribution of age to side effect occurrence in patients treated with radiotherapy. Methods: The data of 346 patients having treatment at Cumhuriyet University Radiation Oncology Department in 2010 and 2011 were analyzed. The patients were evaluated according to Radiation Therapy Oncology Group (RTOG) one a week after starting to radiotherapy. Results: There were 167 women (48%) and 179 men (52%). Two-hundred-forty-seven (71%) of the patients were under the age of 65, 99 (29) were above the age of 65. Eastern Cooperative Oncology Group (ECOG) performance situation was 0, 1 and 2 in 278 (80%), 51 (15%) and 19 (5%) patients. Stage 1, 2, 3 and without metastasis stage 4 were found in 30 (9%), 105 (30%), 172 (50%) and 39 (11%) patients. Radiotherapy was applied to 55 head and neck regions (16%), 31 brains (9%), 86 breasts (25%), 30 thoraxes (9%), 52 abdomens (15%) and 90 pelvises (26%). Fifty-four patients (55%) of above the age of 65 received radiotherapy, 45 patients (45%) received chemoradiotherapy. One-hundred-twenty-six patients (51%) of under the age of 65, received radiotherapy and 121 patients (49%) received chemoradiotherapy. For all the patients, the ratio of radiotherapy dependent side effects was 89% (307). The verage time for occurrence was two weeks. When the treatment was over, the number of patients who lost more than five kg was 42 (12%). ECOG difference was seen in 70 (18%) patients. Twelve of them (4%) showed recovery in ECOG performance, 50 (16%) patients showed disruption. Seventy-nine patients (23%) had a interruption in treatment because of the side effects. The occurrence of dermal side effects was higher in the group of patients below the age of 65 and the occurrence of genitourinary side effects was higher in patients above the age of 65. Thedifferences for both of the side effects were statistically significant. Other side effects and time showed no difference between the patients under 65 and patients above 65. Conclusions: The age does not affect the acute side effects of radiotherapy or chemoradiotherapy, so that both groups can tolerate radiotherapy and chemoradiotherapy.

Assessment of the life quality in head and neck cancer patients

e16005

Background: In this study, we aimed to investigate the effect of radiotherapy on the life quality in head and neck cancer patients. Methods: Between 2007 and 2010 years, 82 head and neck cancer patients who had taken radiotherapy at Cumhuriyet University Department of Radiation Oncology were assessed at the beginning, midline of the treatment and 1 and 6 months after radiotherapy with European Organization for Reseach and Treatment of Cancer Ouality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N35). Wilcoxon sign test were used in the statistical analysis in SPSS version 15.0. Results: Seventy two (%88) men, 10 (%12) women; were analyzed. The median age of the patients was 57 (20-80). Squamous cell carcinoma was the most frequently seen case in 69 (%84) patients. The distribution of the patients according to the localization: larynx carcinoma in 37 (%45) patients, oral cavity tumor in 21 (%26) patients, nasopharynx carcinoma in 14 (%17) patients, paraphypopharynx in 8 (%10) patients and primary unknown in 2 (%2) patients were present. All the symptom scores were affected negatively at the midline, the end, 1 mount after radiotherapy than before the radiotherapy. Pain, swallowing, speech, social eating, social contact, less sexuality, feeling ill, weight loss, weight gain of the symptoms scale scores showed significant improvement at 6 months after the radiotherapy (p<0,05). However it was seen that senses, teeth problems, dry mouth, sticky saliva were affected negatively in the 6th month of radiotherapy than the beginning. Conclusions: In radiotherapy, the life quality of the patients has significantly degraded during the treatment and 1 month after the treatment. However after six months, all the symptom scales were measured as in the beginning. [Table: see text]