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Ugurluer G, Schneiders FL, Corradini S, Boldrini L, Kotecha R, Kelly P, Portelance L, Camilleri P, Ben-David MA, Poiset S, Marschner SN, Panza G, Kutuk T, Palacios MA, Castelluccia A, Zoto Mustafayev T, Atalar B, Senan S, Ozyar E. Factors influencing local control after MR-guided stereotactic body radiotherapy (MRgSBRT) for adrenal metastases. Clin Transl Radiat Oncol 2024; 46:100756. [PMID: 38450219 PMCID: PMC10915494 DOI: 10.1016/j.ctro.2024.100756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose Stereotactic body radiotherapy (SBRT) is an effective treatment for adrenal gland metastases, but it is technically challenging and there are concerns about toxicity. We performed a multi-institutional pooled retrospective analysis to study clinical outcomes and toxicities after MR-guided SBRT (MRgSBRT) using for adrenal gland metastases. Methods and Materials Clinical and dosimetric data of patients treated with MRgSBRT on a 0.35 T MR-Linac at 11 institutions between 2016 and 2022 were analyzed. Local control (LC), local progression-free survival (LPFS), distant progression-free survival (DPFS) and overall survival (OS) were estimated using Kaplan-Meier method and log-rank test. Results A total of 255 patients (269 adrenal metastases) were included. Metastatic pattern was solitary in 25.9 % and oligometastatic in 58.0 % of patients. Median total dose was 45 Gy (range, 16-60 Gy) in a median of 5 fractions, and the median BED10 was 100 Gy (range, 37.5-132.0 Gy). Adaptation was done in 87.4 % of delivered fractions based on the individual clinicians' judgement. The 1- and 2- year LPFS rates were 94.0 % (95 % CI: 90.7-97.3 %) and 88.3 % (95 % CI: 82.4-94.2 %), respectively and only 2 patients (0.8 %) experienced grade 3 + toxicity. No local recurrences were observed after treatment to a total dose of BED10 > 100 Gy, with single fraction or fractional dose of > 10 Gy. Conclusions This is a large retrospective multi-institutional study to evaluate the treatment outcomes and toxicities with MRgSBRT in over 250 patients, demonstrating the need for frequent adaptation in 87.4 % of delivered fractions to achieve a 1- year LPFS rate of 94 % and less than 1 % rate of grade 3 + toxicity. Outcomes analysis in 269 adrenal lesions revealed improved outcomes with delivery of a BED10 > 100 Gy, use of single fraction SBRT and with fraction doses > 10 Gy, providing benchmarks for future clinical trials.
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Affiliation(s)
- Gamze Ugurluer
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - Famke L. Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University Munich, Germany
| | - Luca Boldrini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Patrick Kelly
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL, USA
| | | | | | - Merav A. Ben-David
- Department of Radiation Oncology, Assuta Medical Center, Tel Aviv, Israel
- Faculty of Health Science, Ben-Gurion University, Beer Sheva, Israel
| | - Spencer Poiset
- Department of Radiation Oncology, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA, USA
| | - Sebastian N. Marschner
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University Munich, Germany
| | - Giulia Panza
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Miguel A. Palacios
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | | | | | - Banu Atalar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
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Ugurluer G, Zoto Mustafayev T, Gungor G, Abacioglu U, Atalar B, Ozyar E. Online Adaptive Magnetic Resonance-guided Radiation Therapy for Gynaecological Cancers: Preliminary Results of Feasibility and Outcome. Clin Oncol (R Coll Radiol) 2024; 36:12-20. [PMID: 38016848 DOI: 10.1016/j.clon.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 07/17/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
AIMS To present the preliminary results on the clinical utilisation of an online daily adaptive magnetic resonance-guided radiation therapy (MRgRT) for various gynaecological cancers. MATERIALS AND METHODS Twelve patients treated between September 2018 and June 2022 were included. Six patients (50%) were treated with pelvic radiation therapy followed by MRgRT boost as brachytherapy boost was ineligible or unavailable, three patients (25%) were treated with pelvic MRgRT followed by high dose rate brachytherapy, two patients (16.7%) were treated with only MRgRT, one patient (8.3%) was treated with linear accelerator-based radiation therapy followed by MRgRT boost for bulky iliac lymph nodes. RESULTS The median age was 56.5 years (range 31-86 years). Eight patients (66.7%) had a complete response, three patients (25%) had a partial response and one patient (8.3%) died due to acute renal failure. The mean follow-up time was 11.2 months (range 3.1-42.6 months). The estimated 1-year overall survival was 88.9%. The median treatment time was 47 days (range 10-87 days). During external beam radiation therapy, 10 (83.3%) patients had concomitant chemoradiotherapy. Pelvic external beam radiation therapy doses for all cohorts were 45-50.4 Gy with a fraction dose of 1.8 Gy. The median magnetic resonance-guided boost dose was 32 Gy (range 20-50 Gy) and fraction doses ranged between 4 and 10 Gy. Three patients were treated with intracavitary high dose rate brachytherapy (26-28 Gy in four to five fractions). None of the patients had grade >3 late genitourinary toxicities. CONCLUSION MRgRT is reliable and clinically feasible for treating patients with gynaecological cancers alone or in combination with brachytherapy with an acceptable toxicity and outcome. MRgRT boost could be an option when brachytherapy is not available or ineligible.
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Affiliation(s)
- G Ugurluer
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul, Turkey.
| | - T Zoto Mustafayev
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - G Gungor
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - U Abacioglu
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul, Turkey
| | - B Atalar
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul, Turkey
| | - E Ozyar
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul, Turkey
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Prunaretty J, Güngör G, Gevaert T, Azria D, Valdenaire S, Balermpas P, Boldrini L, Chuong MD, De Ridder M, Hardy L, Kandiban S, Maingon P, Mittauer KE, Ozyar E, Roque T, Colombo L, Paragios N, Pennell R, Placidi L, Shreshtha K, Speiser MP, Tanadini-Lang S, Valentini V, Fenoglietto P. A multi-centric evaluation of self-learning GAN based pseudo-CT generation software for low field pelvic magnetic resonance imaging. Front Oncol 2023; 13:1245054. [PMID: 38023165 PMCID: PMC10667706 DOI: 10.3389/fonc.2023.1245054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose/objectives An artificial intelligence-based pseudo-CT from low-field MR images is proposed and clinically evaluated to unlock the full potential of MRI-guided adaptive radiotherapy for pelvic cancer care. Materials and method In collaboration with TheraPanacea (TheraPanacea, Paris, France) a pseudo-CT AI-model was generated using end-to-end ensembled self-supervised GANs endowed with cycle consistency using data from 350 pairs of weakly aligned data of pelvis planning CTs and TrueFisp-(0.35T)MRIs. The image accuracy of the generated pCT were evaluated using a retrospective cohort involving 20 test cases coming from eight different institutions (US: 2, EU: 5, AS: 1) and different CT vendors. Reconstruction performance was assessed using the organs at risk used for treatment. Concerning the dosimetric evaluation, twenty-nine prostate cancer patients treated on the low field MR-Linac (ViewRay) at Montpellier Cancer Institute were selected. Planning CTs were non-rigidly registered to the MRIs for each patient. Treatment plans were optimized on the planning CT with a clinical TPS fulfilling all clinical criteria and recalculated on the warped CT (wCT) and the pCT. Three different algorithms were used: AAA, AcurosXB and MonteCarlo. Dose distributions were compared using the global gamma passing rates and dose metrics. Results The observed average scaled (between maximum and minimum HU values of the CT) difference between the pCT and the planning CT was 33.20 with significant discrepancies across organs. Femoral heads were the most reliably reconstructed (4.51 and 4.77) while anal canal and rectum were the less precise ones (63.08 and 53.13). Mean gamma passing rates for 1%1mm, 2%/2mm, and 3%/3mm tolerance criteria and 10% threshold were greater than 96%, 99% and 99%, respectively, regardless the algorithm used. Dose metrics analysis showed a good agreement between the pCT and the wCT. The mean relative difference were within 1% for the target volumes (CTV and PTV) and 2% for the OARs. Conclusion This study demonstrated the feasibility of generating clinically acceptable an artificial intelligence-based pseudo CT for low field MR in pelvis with consistent image accuracy and dosimetric results.
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Affiliation(s)
- Jessica Prunaretty
- Institut du Cancer de Montpellier, Department of Radiation Oncology, Montpellier, France
| | - Gorkem Güngör
- Department of Radiation Oncology, Maslak Hospital, Acibadem Mehmet Ali Aydınlar (MAA) University, Istanbul, Türkiye
| | - Thierry Gevaert
- Radiotherapy Department, Universitair Ziekenhuis (UZ) Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - David Azria
- Institut du Cancer de Montpellier, Department of Radiation Oncology, Montpellier, France
| | - Simon Valdenaire
- Institut du Cancer de Montpellier, Department of Radiation Oncology, Montpellier, France
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Luca Boldrini
- Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michael David Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, United States
| | - Mark De Ridder
- Radiotherapy Department, Universitair Ziekenhuis (UZ) Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | - Philippe Maingon
- Assistance publique – Hôpitaux de Paris (AP-HP) Sorbonne Universite, Charles-Foix Pitié-Salpêtrière, Paris, France
| | - Kathryn Elizabeth Mittauer
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
| | - Enis Ozyar
- Department of Radiation Oncology, Maslak Hospital, Acibadem Mehmet Ali Aydınlar (MAA) University, Istanbul, Türkiye
| | | | | | | | - Ryan Pennell
- Radiation Oncology, NewYork-Presbyterian/Weill Cornell Hospital, New York, NY, United States
| | - Lorenzo Placidi
- Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - M. P. Speiser
- Radiation Oncology Weill Cornell Medicine, New York, NY, United States
| | | | - Vincenzo Valentini
- Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pascal Fenoglietto
- Institut du Cancer de Montpellier, Department of Radiation Oncology, Montpellier, France
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Atahan C, Arslantas E, Ersen Danyeli A, Celik L, Bozkurt G, Ugurluer G, Corapcioglu FV, Ozyar E. A Rare Case of BRAF-mutated Metastatic Pleomorphic Xanthoastrocytoma Patient who Developed Radiodermatitis After Receiving Anti-BRAF Treatment. J Pediatr Hematol Oncol 2023; 45:e1005-e1009. [PMID: 37700448 DOI: 10.1097/mph.0000000000002754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/02/2023] [Indexed: 09/14/2023]
Abstract
Pleomorphic xanthoastrocytoma (PXA) is a rare type of grade 2 or 3 brain tumor that usually occurs in children and young adults. The standard treatment for PXA is maximally safe resection, usually with adjuvant radiation therapy, for high-grade tumors. BRAF V600E mutation is one of the most common molecular alterations in these tumors, with nearly 70% of cases carrying this mutation. Although BRAF inhibitors have shown promise in treating progressive or refractory disease, their use has been associated with various adverse effects, including radiodermatitis, which is a relatively common complication. This paper presents a case of a 16-year-old male patient with BRAF-mutated metastatic PXA, who developed mild radiodermatitis after receiving BRAF inhibitors with concurrent radiation therapy.
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Affiliation(s)
| | | | | | | | - Gokhan Bozkurt
- Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey
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Ugurluer G, Schneiders FL, Corradini S, Boldrini L, Kotecha R, Kelly P, Portelance L, Camilleri P, Ben-David MA, Poiset SJ, Marschner S, Panza G, Kutuk T, Palacios M, Mustafayev TZ, Atalar B, Senan S, Ozyar E. Outcomes of MR-Guided Stereotactic Body Radiotherapy (MRgSBRT) for Adrenal Metastases: A Multi-Institutional Pooled Analysis. Int J Radiat Oncol Biol Phys 2023; 117:S111-S112. [PMID: 37784293 DOI: 10.1016/j.ijrobp.2023.06.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiotherapy (SBRT) is an effective treatment for adrenal metastases, but it is technically challenging and there are concerns about toxicity due to the proximity of organs at risk. We hypothesized that MR-guided SBRT (MRgSBRT) using a 0.35 T MR-Linac for adrenal metastases can achieve durable local control (LC) with a low probability of toxicity. MATERIALS/METHODS In an ethics-approved study, we analyzed clinical and dosimetric data of patients treated with MRgSBRT at 10 institutions between 2016-2022. LC, local progression-free survival (LPFS), distant progression-free survival (DPFS) and overall survival (OS) were estimated using Kaplan-Meier method and log-rank test. Responses were evaluated using RECIST criteria. Toxicity was graded according to CTCAE (v4.0). OS and DPFS were calculated on a per-patient basis, while LC and LPFS were calculated on a per-lesion basis. RESULTS A total of 249 patients (260 adrenal lesions) were included; median age was 65 years (range 28-91), 65.5% were male, 83.9% had ECOG PS 0-1. The most common primary tumor was lung cancer (69.1%). Adrenal metastases were synchronous, metachronous, oligoprogressive or oligopersistent in 20%, 41.5%, 35.8% and 2.7% of patients, respectively. Metastatic pattern was solitary in 26.9%, oligometastatic in 57.3% and polymetastatic in 15.8% of patients. Right-sided metastases comprised 40%, left-sided 51.5% and lesions were bilateral in 8.5%. Chemotherapy and immunotherapy were administered in 67.1% and 60.6% of patients, respectively. Median gross tumor volume was 21.8 cc (range 1.1-383.2) and median planning target volume was 36.9 cc (range 3.6-516.9). Median total dose was 45 Gy (range 16-60), median fraction number was 5 (range 1-8) and median fraction dose used was 10 Gy (range 5-24). Median BED10 was 100 Gy (range 37.5-132); 87.8% of fractions used adapted plans. At a median follow-up was 17.7 months (IQR 5.5-21.7), local responses were scored as complete response (CR), partial response (PR), stable disease (SD) or progressive disease (PD) in 36.9%, 28.2%, 25.7%, and 9.1%, respectively. Median OS was 30.4 months, with 1- and 2- year OS rates of 75.3% and 57.1%, respectively. On multivariate analysis, significantly higher OS rates were seen in patients achieving a CR (p = 0.007, HR 0.50) and with ECOG scores of 0-1 (p = 0.001, HR 0.43). One- and 2- year LPFS rates were 94.5% and 88.8%, respectively. No local recurrences were observed after treatment to a BED10>100 or with single fraction (range 16-24 Gy). Only 2 patients (0.8%) had ≥grade 3 chronic toxicity. CONCLUSION This multi-institutional study of MRgSBRT outcomes for adrenal metastases revealed a 2-year LPFS of 89%, with a <1% risk of ≥grade 3 toxicity. Daily adaptation was performed in 90% of plans, indicating a beneficial role for MR guidance.
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Affiliation(s)
- G Ugurluer
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - F L Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S Corradini
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - L Boldrini
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - R Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - P Kelly
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - L Portelance
- Department of Radiation Oncology, University of Miami, Miami, FL
| | - P Camilleri
- Radiation Oncology, GenesisCare, Oxford, United Kingdom
| | - M A Ben-David
- Department of Radiation Oncology, Assuta Medical Center, Tel Aviv, Israel
| | - S J Poiset
- Department of Radiation Oncology, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA
| | - S Marschner
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - G Panza
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - T Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - M Palacios
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - T Zoto Mustafayev
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - B Atalar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - S Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - E Ozyar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
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Ozkaya Akagunduz O, Etit D, Yazici G, Veral A, Cetinayak O, Sarioglu S, Guler Tezel G, Duru Birgi S, Yuksel S, Kara G, Mustafayev TZ, Tokat F, Ceylaner Bicakli B, Basak K, Esassolak M, Akman F, Ozyar E. The effect of P53 expression and smoking/alcohol in P16(+) and P16(-) oropharyngeal carcinoma and risk classification: the Turkish Society of Radiation Oncology Head & Neck Study Group 01-002. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:80-90. [PMID: 37246057 DOI: 10.1016/j.oooo.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The aim of this study is to categorize the risk groups of patients with oropharyngeal carcinoma (OPC) according to p16 and p53 status, smoking/alcohol consumption history, and other prognostic factors. STUDY DESIGN The immunostaining of p16 and p53 of 290 patients was retrospectively evaluated. The history of smoking/alcohol consumption of each patient was noted. p16 and p53 staining patterns were reviewed. The results were compared with demographic findings and prognostic factors. Risk groups have been classified for the p16 status of patients. RESULTS The median follow-up was 47 months (range 6-240). Five-year disease-free survival (DFS) rates for patients with p16 (+) and (-) were 76% and 36%, and overall survival rates were 83% vs 40%, respectively (HR = 0.34 [0.21-0.57], P < .0001), HR = 0.22 [0.12-0.40] P < .0001, respectively). p16(-), p53(+), heavy smoking/alcohol consumption, performance status; advanced T and N stages in patients with p16(-), and continuing smoking/alcohol consumption after treatment were found to be unfavorable risk factors. Five-year overall survival rates were 95%, 78%, and 36% for low, intermediate, and high-risk groups, respectively. CONCLUSIONS The results of our study have shown that p16 negativity in patients with oropharyngeal cancer was found to be an important prognostic factor, especially for those with lower p53 expression and not smoking/consuming alcohol.
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Affiliation(s)
| | - Demet Etit
- Department of Pathology, Istanbul Aydin University, Faculty of Medicine, Istanbul, Turkey
| | - Gozde Yazici
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ali Veral
- Department of Pathology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Oguz Cetinayak
- Dokuzeylul University, Faculty of Medicine, Izmir, Turkey
| | - Sulen Sarioglu
- Department of Pathology, Dokuzeylul University, Faculty of Medicine, Izmir, Turkey
| | - Gaye Guler Tezel
- Department of Pathology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Sumerya Duru Birgi
- Department of Radiation Oncology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Seher Yuksel
- Department of Pathology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Gulsen Kara
- Department of Radiation Oncology, Ataturk Training and Research Hospital, Izmir, Turkey
| | | | - Fatma Tokat
- Department of Pathology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - Beyhan Ceylaner Bicakli
- Department of Radiation Oncology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Kayhan Basak
- Department of Pathology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Esassolak
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Fadime Akman
- Dokuzeylul University, Faculty of Medicine, Izmir, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
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7
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Yildirim HC, Kupik GE, Mustafayev TZ, Berber T, Yavuz B, Cetinayak O, Akagunduz O, Bıcakcı BC, Arslan SA, Soykut ED, Gundog M, Figen M, Teke F, Canyilmaz E, Birgi SD, Duzova M, İgdem S, Abakay CD, Atasoy B, Kaydihan N, Parvizi M, Uslu GH, Saginc H, Akman F, Ozyar E. A multicenter retrospective analysis of patients with nasopharyngeal carcinoma treated in IMRT era from a nonendemic population: Turkish Society for Radiation Oncology Head and Neck Cancer Group Study (TROD 01-001). Head Neck 2023; 45:1194-1205. [PMID: 36854873 DOI: 10.1002/hed.27333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND We aimed to evaluate patients with nasopharyngeal carcinoma (NPC) in a nonendemic population. METHODS In a national, retrospective, multicenteric study, 563 patients treated with intensity modulated radiotherapy at 22 centers between 2015 and 2020 were analyzed. RESULTS Median age was 48 (9-83), age distribution was bimodal, 74.1% were male, and 78.7% were stage III-IVA. Keratinizing and undifferentiated carcinoma rates were 3.9% and 81.2%. Patients were treated with concomitant chemoradiotherapy (48.9%), or radiotherapy combined with induction chemotherapy (25%) or adjuvant chemotherapy (19.5%). After 34 (6-78) months follow-up, 8.2% locoregional and 8% distant relapse were observed. Three-year overall survival was 89.5% and was lower in patients with age ≥50, male sex, keratinizing histology, T4, N3 and advanced stage (III-IVA). CONCLUSIONS Patients with NPC in Turkey have mixed clinical features of both east and west. Survival outcomes are comparable to other reported series; however, the rate of distant metastases seems to be lower.
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Affiliation(s)
- Halil Cumhur Yildirim
- Department of Radiation Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gulnihan Eren Kupik
- Department of Radiation Oncology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Faculty of Medicine, Acibadem University, Istanbul, Turkey
| | - Tanju Berber
- Department of Radiation Oncology, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Berrin Yavuz
- Department of Radiation Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Oguz Cetinayak
- Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ozlem Akagunduz
- Department of Radiation Oncology, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | | | - Ela Delikgoz Soykut
- Department of Radiation Oncology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Mete Gundog
- Department of Radiation Oncology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Metin Figen
- Department of Radiation Oncology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Fatma Teke
- Department of Radiation Oncology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Emine Canyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Teknik University, Trabzon, Turkey
| | - Sumerya Duru Birgi
- Department of Radiation Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Mursel Duzova
- Department of Radiation Oncology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Sefik İgdem
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Candan Demiroz Abakay
- Department of Radiation Oncology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Beste Atasoy
- Department of Radiation Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nuri Kaydihan
- Department of Radiation Oncology, Istanbul Bahcelievler Memorial Hospital, Istanbul, Turkey
| | - Murtaza Parvizi
- Department of Radiation Oncology, Manisa City Hospital, Manisa, Turkey
| | - Gonca Hanedan Uslu
- Department of Radiation Oncology, Trabzon Kanuni Education and Research Hospital, Trabzon, Turkey
| | - Halil Saginc
- Department of Radiation Oncology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Fadime Akman
- Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Faculty of Medicine, Acibadem University, Istanbul, Turkey
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Soran A, Ozbas S, Ozcinar B, Isik A, Dogan L, Senol K, Dag A, Karanlik H, Aytac O, Cakmak GK, Dalci K, Dogan M, Sezer YA, Gokgoz S, Ozyar E, Sezgin E. Correction: Intervention for Hepatic and Pulmonary Metastases in Breast Cancer Patients: Prospective, Multi-institutional Registry Study-IMET, Protocol MF 14-02. Ann Surg Oncol 2023; 30:1074. [PMID: 36484906 DOI: 10.1245/s10434-022-12931-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Atilla Soran
- Division of Surgical Oncology, Breast Surgical Oncology, UPMC Magee-Womens Hospital, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
| | - Serdar Ozbas
- Breast Surgery, Private Practice, Ankara, Turkey
| | - Beyza Ozcinar
- General Surgery Department, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Arda Isik
- General Surgery Department, Training and Research Hospital, Medeniyet University Goztepe, Istanbul, Turkey
| | - Lutfi Dogan
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Kazım Senol
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ahmet Dag
- General Surgery Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hasan Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Istanbul, Turkey.,Breast Oncology Unit, American Hospital, Istanbul, Turkey
| | - Ozgur Aytac
- General Surgery Department, Baskent University Faculty of Medicine, Adana, Turkey
| | - Guldeniz Karadeniz Cakmak
- General Surgery Department, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak, Turkey
| | - Kubilay Dalci
- General Surgery Department, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Mutlu Dogan
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yavuz Atakan Sezer
- General Surgery Department, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - Sehsuvar Gokgoz
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem Hospitals Group, Istanbul, Turkey
| | - Efe Sezgin
- Department of Food Engineering, Izmir Institute of Technology, Izmir, Turkey
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9
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Dincer N, Ugurluer G, Ozyar E. Neoadjuvant mFOLFIRINOX vs mFOLFIRINOX Plus Radiotherapy in Patients With Borderline Resectable Pancreatic Cancer-The A021501 Trial. JAMA Oncol 2023; 9:276-277. [PMID: 36454557 DOI: 10.1001/jamaoncol.2022.6141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Neris Dincer
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Gamze Ugurluer
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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10
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Azria D, Andratschke N, Balermpas P, Boldrini L, Bourdais R, Bruynzeel A, Chuong M, De Ridder M, Fenoglietto P, Gevaert T, Gungor G, Hardy L, Kandiban S, Lagerwaard F, Maingon P, Marciscano A, Mittauer K, Nagar H, Paragios N, Pennell R, Placidi L, Riou O, Simon J, Tanadini-Lang S, Ugurluer G, Valdes S, Valentini V, Vanspeybroeck B, Ozyar E. A Multi-Centric Evaluation of AI-Driven OARs Low Field MRgRT Pelvic /Abdomen Contouring. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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11
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Ugurluer G, Mustafayev T, Abacioglu M, Güngör G, Sengoz M, Ozyar E, Atalar B. MR-Guided Online Adaptive Stereotactic Body Radiotherapy (SBRT) of Primary and Metastatic Lung Tumors. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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12
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Ugurluer G, Mustafayev T, Atalar B, Güngör G, Sengoz M, Abacioglu M, Tuna M, Kural A, Ozyar E. PSA Kinetics and Outcomes after Magnetic Resonance Image-Guided Stereotactic Body Radiotherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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13
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Güngör G, Azria D, Balermpas P, Boldrini L, Chuong M, De Ridder M, Gevaert T, Hardy L, Kandiban S, Maingon P, Mittauer K, Ozyar E, Paragios N, Pennell R, Placidi L, Shreshtha K, Speiser M, Tanadini-Lang S, Valdes S, Valentini V, Fenoglietto P. A Multi-Centric Evaluation of AI-Driven Synthetic CT Generation Form Low Field Magnetic Resonance Imaging. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Stathakis S, Pissakas G, Alexiou A, Bertrand B, Bondiau P, Claude L, Cuthbert T, Damatopoulou A, Dejean C, Doukakis C, Güngör G, Hardy L, Maani E, Martel-Lafay I, Mavroidis P, Paragios N, Peppa V, Remonde D, Shumway J, Ugurluer G, Ozyar E. Evaluation of AI vs. Clinical Experts SBRT-Thorax Computed Tomography OARs Delineation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Soran A, Ozbas S, Ozcinar B, Isik A, Dogan L, Senol K, Dag A, Karanlik H, Aytac O, Karadeniz Cakmak G, Dalci K, Dogan M, Sezer YA, Gokgoz S, Ozyar E, Sezgin E. ASO Visual Abstract: Intervention for Hepatic and Pulmonary METastases in Breast Cancer Patients-Prospective, Multi-Institutional Registry Study: IMET; Protocol MF 14-02. Ann Surg Oncol 2022; 29:6337-6338. [PMID: 35933547 DOI: 10.1245/s10434-022-12320-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Atilla Soran
- Division of Surgical Oncology, Breast Surgical Oncology, UPMC Magee-Womens Hospital, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
| | - S Ozbas
- Breast Surgery, Private Practice, Ankara, Turkey
| | - B Ozcinar
- General Surgery Department, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - A Isik
- General Surgery Department, Training and Research Hospital, Medeniyet University Goztepe, Istanbul, Turkey
| | - L Dogan
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - K Senol
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - A Dag
- General Surgery Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - H Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Istanbul, Turkey
- Breast Oncology Unit, American Hospital, Istanbul, Turkey
| | - O Aytac
- General Surgery Department, Baskent University Faculty of Medicine, Adana, Turkey
| | - G Karadeniz Cakmak
- General Surgery Department, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak, Turkey
| | - K Dalci
- General Surgery Department, Cukurova University Faculty of Medicine, Adana, Turkey
| | - M Dogan
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Y A Sezer
- General Surgery Department, Trakya University Faculty of Medicinee, Edirne, Turkey
| | - S Gokgoz
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - E Ozyar
- Department of Radiation Oncology, Acibadem Hospitals Group, Istanbul, Turkey
| | - E Sezgin
- Department of Food Engineering, Izmir Institute of Technology, Izmir, Turkey
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16
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Dincer N, Ugurluer G, Gungor G, Zoto Mustafayev T, Atalar B, Ozyar E. Magnetic Resonance Imaging-Guided Radiation Therapy for Early-Stage Gastric Mucosa-Associated Lymphoid Tissue Lymphoma. Cureus 2022; 14:e29035. [PMID: 36249646 PMCID: PMC9550217 DOI: 10.7759/cureus.29035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
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17
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Soran A, Ozbas S, Ozcinar B, Isik A, Dogan L, Senol K, Dag A, Karanlik H, Aytac O, Karadeniz Cakmak G, Dalci K, Dogan M, Sezer YA, Gokgoz S, Ozyar E, Sezgin E. Intervention for Hepatic and Pulmonary Metastases in Breast Cancer Patients: Prospective, Multi-institutional Registry Study-IMET, Protocol MF 14-02. Ann Surg Oncol 2022; 29:6327-6336. [PMID: 35876920 DOI: 10.1245/s10434-022-12239-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND One fourth of early-stage breast cancer cases become metastatic during the follow-up period. Limited metastasis is a metastatic disease condition in which the number of metastatic sites and the extent of the disease both are limited, and the disease is amenable to metastatic intervention. This prospective study aimed to evaluate intervention for limited metastases in the lung, liver, or both. METHODS The study enrolled luminal A/B and/or human epidermal growth factor receptor 2 (HER2)-neu+ patients with operable lung and/or liver metastases in the follow-up assessment after completion of primary breast cancer treatment and patients with a diagnosis of metastasis after 2014. Demographic, clinical, tumor-specific, and metastasis detection-free interval (MDFI) data were collected. Bone metastasis in addition to lung and liver metastases also was included in the analysis. The patients were divided into two groups according to the method of treatment for metastases: systemic therapy alone (ST) group or intervention (IT) group. RESULTS Until June 2020, 200 patients were enrolled in the study. The demographic data were similar between the two groups. The median follow-up time was 77 months (range 55-107 months) in the IT group (n = 119; 59.5%) and 57 months (range 39-84) in the ST-only group (n = 81; 40.5%). The median MDFI was 40 months (range 23-70 months) in the IT group, and 35 months (range 13-61 months) in the ST-only group (p = 0.47). The groups had similar surgeries for the primary tumor and axilla. Most of the patients had liver metastases (49.5%, n = 99), and 42% (n = 84) of the patients had lung metastases. Both lung and liver metastases were found in 8.5% (n = 17) of the patients. The primary tumor was estrogen receptor/progesterone receptor-positive in 75% (n = 150) of the patients, and 32% (n = 64) of the patients had HER2-neu+ tumors. Metastatic-site resection was performed for 32% (n = 64) of the patients, and 27.5% (n = 55) of the patients underwent metastatic ablative interventions. In the Kaplan-Meier survival analysis, the hazard of death (HoD) was 56% lower in the IT group than in the ST-only group (hazard ratio [HR], 0.44; 95% confidence interval [CI] 0.26-0.72; p = 0.001). The HoD was lower in the IT group than in the ST-only group for the patients younger than 55 years (HR, 0.32; 95% CI 0.17-0.62; p = 0.0007). In the multivariable Cox regression model, HoD was significantly lower for the patients who underwent intervention for metastases and had an MDFI longer than 24 months, but their liver metastases doubled the risk of death compared with lung metastases. CONCLUSION Metastasis-directed interventions have reduced the risk of death for patients with limited lung/liver metastases who are amenable to interventions after completion of primary cancer treatment. For a select group of patients, such as those with luminal A/B or HER2-neu+ breast cancer who are younger than 55 years with limited metastases to the lung and liver or an MDFI longer than 24 months, surgical or ablative therapy for metastases should be considered and discussed on tumor boards.
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Affiliation(s)
- Atilla Soran
- Division of Surgical Oncology, Breast Surgical Oncology, UPMC Magee-Womens Hospital, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
| | - S Ozbas
- Breast Surgery, Private Practice, Ankara, Turkey
| | - B Ozcinar
- General Surgery Department, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - A Isik
- General Surgery Department, Training and Research Hospital, Medeniyet University Goztepe, Istanbul, Turkey
| | - L Dogan
- Department of Surgical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - K Senol
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - A Dag
- General Surgery Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - H Karanlik
- Surgical Oncology Unit, Istanbul University Institute of Oncology, Istanbul, Turkey.,Breast Oncology Unit, American Hospital, Istanbul, Turkey
| | - O Aytac
- General Surgery Department, Baskent University Faculty of Medicine, Adana, Turkey
| | - G Karadeniz Cakmak
- General Surgery Department, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak, Turkey
| | - K Dalci
- General Surgery Department, Cukurova University Faculty of Medicine, Adana, Turkey
| | - M Dogan
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Y A Sezer
- Department of Medical Oncology, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - S Gokgoz
- General Surgery Department, Uludag University Faculty of Medicine, Bursa, Turkey
| | - E Ozyar
- Department of Radiation Oncology, Acibadem Hospitals Group, Istanbul, Turkey
| | - E Sezgin
- Department of Food Engineering, Izmir Institute of Technology, Izmir, Turkey
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18
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Bicakci BC, Mustafayev TZ, Cetinayak O, Igdem S, Birgi SD, Meydan D, Demircioglu F, Atalar B, Ozyar E, Akman F. Outcomes of carotid sparing intensity-modulated radiotherapy for early stage glottic cancer in 201 patients: Multicenter study of Turkish Radiation Oncology Society/TROD-01-007. Head Neck 2022; 44:1825-1832. [PMID: 35596585 DOI: 10.1002/hed.27101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/22/2022] [Accepted: 05/05/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To assess and report clinical outcomes after carotid sparing intensity-modulated radiotherapy for early stage laryngeal cancer. METHODS We retrospectively analyzed 201 patients with early stage glottic laryngeal cancer treated with carotid sparing intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) techniques in six TROD centers. RESULTS After a median follow-up of 31 months the actuarial 1- and 3-year local and locoregional control rates were 99.4% and 94.7%, 98.4% and 93%, respectively. T classification, anterior commissure involvement, IMRT technique, and type of fractionation were not found to be prognostic for local control. Overall, eight patients had lost their organ function due to recurrence or toxicity. Grade 3 and 4 acute laryngeal edema was seen in eight (4%) and one (0.5%) of patients, respectively. Grade 3 and 4 late laryngeal edema developed in two (1%) and one patient (0.5%), respectively. CONCLUSION Oncologic outcomes of patients treated with carotid sparing IMRT were excellent; comparable with historical series, with acceptable side effects. Longer follow-up is needed to estimate long term effect on stroke.
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Affiliation(s)
- Beyhan Ceylaner Bicakci
- Department of Radiation Oncology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Oguz Cetinayak
- Department of Radiation Oncology, Medical School, Dokuz Eylul University, Izmir, Turkey
| | - Sefik Igdem
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Sumerya Duru Birgi
- Department of Radiation Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Deniz Meydan
- Department of Radiation Oncology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Fatih Demircioglu
- Department of Radiation Oncology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Fadime Akman
- Department of Radiation Oncology, Medical School, Dokuz Eylul University, Izmir, Turkey
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Azria D, Boldrini L, De Ridder M, Fenoglietto P, Gambacorta M, Gevaert T, Gungor G, Lagerwaard F, Marciscano A, Michalet M, Nagar H, Pennell R, Serbez I, Vanspeybroeck B, Zoto Mustafayev T, Caffaro A, Hardy L, Kandiban S, Oumani A, Roque T, Paragios N, Shreshtha K, Ozyar E. OC-0463 AI surpassing human expert: a multi-centric evaluation for organ at risk delineation. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02599-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Gungor G, Klausner G, Gur G, Serbez I, Temur B, Caffaro A, Hardy L, Kandiban S, Oumani A, Bertrand B, Shreshtha K, Roque T, Atalar B, Paragios N, Ozyar E. PO-1890 AI-based OAR delineation in brain T1w-MRI: Overcoming Inter- and Intra-observer variability. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03853-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Fenoglietto P, Gevaert T, Boussaer M, Delasalles E, Ioannidou D, Shreshtha K, Roque T, Paragios N, Azria D, Ozyar E, Gungor G. MO-0648 Clinical evaluation of self-learning GAN based pseudo-CT generation software for low field pelvic MR. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02406-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Dincer N, Ugurluer G, Zoto Mustafayev T, Gungor G, Atalar B, Guven K, Ozyar E. Magnetic Resonance Image-Guided Hypofractionated Ablative Radiation Therapy for Hepatocellular Carcinoma With Tumor Thrombus Extending to the Right Atrium. Cureus 2022; 14:e23981. [PMID: 35541296 PMCID: PMC9084425 DOI: 10.7759/cureus.23981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
Hepatocellular carcinoma (HCC) presenting with tumor thrombus (TT) and inferior vena cava (IVC)/right atrium (RA) infringement point to an advanced-stage disease that is deemed inoperable. Stereotactic body radiotherapy is an emerging treatment option for this group of patients with promising outcomes in recent studies that are comparable to conventional treatment methods, namely, transarterial chemoembolization and transarterial radioembolization. Here, we report a case of HCC with RA extension through the IVC. The patient was referred to our clinic for treatment options, and he was found suitable for magnetic resonance imaging-guided radiotherapy (MRgRT). We treated the patient with MRgRT in five fractions to a total dose of 40 Gray. The tumor was tracked during the treatment sessions, and adaptive treatment planning was performed before each fraction. The patient tolerated the treatment well with no acute grade 3-4 toxicities. The last follow-up showed that the patient had a complete biochemical response and is now a candidate for an orthotopic liver transplant. To our knowledge, this report is the first to document the MRgRT treatment of an HCC with TT and RA extension. MRgRT is safe and feasible for this patient group and can be an effective bridging therapy for liver transplants.
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Ugurluer G, Ozyar E, Corapcioglu F, Miller RC. Psychosocial impact of the War in Ukraine on pediatric cancer patients and their families receiving oncological care outside their country at the onset of hostilities. Adv Radiat Oncol 2022; 7:100957. [PMID: 35865369 PMCID: PMC9294973 DOI: 10.1016/j.adro.2022.100957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
Psychosocial care of pediatric cancer patients and their families is as critical as the medical and surgical components of their therapies. Strains on family communication and structure and financial need are linked to poorer psychological outcomes for both patients and families. It is critical that children remain as connected as possible to their communities and extended families during therapy. For Ukrainian pediatric cancer patients receiving care outside of their nation's borders on February 24, 2022, the Russian invasion of Ukraine compounded these problems. Based on conversations with patients and parents, we evaluated the psychosocial impact of war on pediatric Ukrainian cancer patients and their families who had left their country before the onset of the conflict to undergo treatment of pediatric malignancies at our medical center. These families shared with us the problems they have experienced after the Russian invasion of Ukraine. Their concerns can be summarized in 4 categories: (1) emotional stress experienced by the patients, families and relatives related to the dangers of war; (2) difficulties in obtaining previous hospital records in Ukraine; (3) medical expenses; and (4) uncertainty regarding the patient's and their family's future and the ability of the children to ever return to their homes. Psychosocial distress relating to the violence of war will hopefully pass in near future, but our pediatric patients and their families will continue to face stressors related to displacement and financial concerns for some time to come.
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Kutuk T, Herrera R, Mustafayev TZ, Gungor G, Ugurluer G, Atalar B, Kotecha R, Hall MD, Rubens M, Mittauer KE, Contreras JA, McCulloch J, Kalman NS, Alvarez D, Romaguera T, Gutierrez AN, Garcia J, Kaiser A, Mehta MP, Ozyar E, Chuong MD. Multi-Institutional Outcomes of Stereotactic Magnetic Resonance Image-Guided Adaptive Radiation Therapy (SMART) with a Median Biologically Effective Dose of 100 Gy10 for Non-Bone Oligometastases. Adv Radiat Oncol 2022; 7:100978. [PMID: 35647412 PMCID: PMC9130084 DOI: 10.1016/j.adro.2022.100978] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/16/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Randomized data show a survival benefit of stereotactic ablative body radiation therapy in selected patients with oligometastases (OM). Stereotactic magnetic resonance guided adaptive radiation therapy (SMART) may facilitate the delivery of ablative dose for OM lesions, especially those adjacent to historically dose-limiting organs at risk, where conventional approaches preclude ablative dosing. Methods and Materials The RSSearch Registry was queried for OM patients (1-5 metastatic lesions) treated with SMART. Freedom from local progression (FFLP), freedom from distant progression (FFDP), progression-free survival (PFS), and overall survival (LS) were estimated using the Kaplan-Meier method. FFLP was evaluated using RECIST 1.1 criteria. Toxicity was evaluated using Common Terminology Criteria for Adverse Events version 4 criteria. Results Ninety-six patients with 108 OM lesions were treated on a 0.35 T MR Linac at 2 institutions between 2018 and 2020. SMART was delivered to mostly abdominal or pelvic lymph nodes (48.1%), lung (18.5%), liver and intrahepatic bile ducts (16.7%), and adrenal gland (11.1%). The median prescribed radiation therapy dose was 48.5 Gy (range, 30-60 Gy) in 5 fractions (range, 3-15). The median biologically effective dose corrected using an alpha/beta value of 10 was 100 Gy10 (range, 48-180). No acute or late grade 3+ toxicities were observed with median 10 months (range, 3-25) follow-up. Estimated 1-year FFLP, FFDP, PFS, and OS were 92.3%, 41.1%, 39.3%, and 89.6%, respectively. Median FFDP and PFS were 8.9 months (95% confidence interval, 5.2-12.6 months) and 7.6 months (95% confidence interval, 4.5-10.6 months), respectively. Conclusions To our knowledge, this represents the largest analysis of SMART using ablative dosing for non-bone OM. A median prescribed biologically effective dose of 100 Gy10 resulted in excellent early FFLP and no significant toxicity, likely facilitated by continuous intrafraction MR visualization, breath hold delivery, and online adaptive replanning. Additional prospective evaluation of dose-escalated SMART for OM is warranted.
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Dincer N, Ugurluer G, Korkmaz L, Serkizyan A, Atalar B, Gungor G, Ozyar E. Magnetic Resonance Imaging-Guided Online Adaptive Lattice Stereotactic Body Radiotherapy in Voluminous Liver Metastasis: Two Case Reports. Cureus 2022; 14:e23980. [PMID: 35541303 PMCID: PMC9084247 DOI: 10.7759/cureus.23980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Lattice Radiotherapy (LRT) is a technique in which heterogeneous doses are delivered to the target so large tumors can have optimal doses of radiation without compromising healthy tissue sparing. To date, case reports and case series documented its application for bulky tumors mainly in the pelvic region. LRT not only provides dosimetric advantages but also promotes tumor control by triggering some radiobiological and immunological pathways. We report two cases of giant liver metastases for whom other treatment options were not suitable. We treated both patients with Magnetic Resonance Image-Guided Radiotherapy (MRgRT) with online adaptive LRT (OALRT) technique. Adaptive plans were generated before each fraction. Tumors were observed to have regressed interfractionally so the location and number of spheres were adapted to tumor size and daily anatomy of the surrounding organs at risk (OAR). Both patients had good treatment compliance without any Grade 3+ side effects. They are both under follow-up and report improvement. By reporting the first application of OALRT by using MRgRT in liver metastases, we show that MRgRT is a promising modality for LRT technique with better target and OAR visualization as well as online adaptive planning before each fraction according to the daily anatomy of the patient.
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Affiliation(s)
- Neris Dincer
- Radiation Oncology, Acibadem University, Istanbul, TUR
| | | | - Latif Korkmaz
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | | | - Banu Atalar
- Radiation Oncology, Acibadem University, Istanbul, TUR
| | - Gorkem Gungor
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | - Enis Ozyar
- Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, TUR.,Radiation Oncology, Acibadem Hospital, Istanbul, TUR
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26
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Bossi P, Trama A, Bernasconi A, Grisanti S, Mohamad I, Galiana IL, Ozyar E, Franco P, Vecchio S, Bonomo P, Cirauqui BC, El-Sherify M, Ursino S, Argiris A, Pan J, Wittekindt C, D'Angelo E, Costa L, Buglione M, Johnson J, Airoldi M, Mesia R, Resteghini C, Licitra L, Orlandi E. Nasopharyngeal cancer in non-endemic areas: Impact of treatment intensity within a large retrospective multicentre cohort. Eur J Cancer 2021; 159:194-204. [PMID: 34773903 DOI: 10.1016/j.ejca.2021.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/16/2021] [Accepted: 09/05/2021] [Indexed: 02/08/2023]
Abstract
AIM Recommendations for managing patients with nasopharyngeal carcinoma (NPC) in non-endemic areas are largely derived from studies conducted in endemic areas. We analysed the impact of treatment approaches on survival in non-endemic areas. METHODS In an international, multicentre, retrospective study, we analyse consecutive patients with NPC diagnosed between 2004 and 2017 in 36 hospitals from 11 countries. Treatment was categorised as non-intensive (NIT), including radiotherapy alone or concomitant chemoradiotherapy (cCRT), and intensive (IT) including cCRT preceded by and/or followed by chemotherapy (CT). The impact of IT on overall survival (OS) and disease-free survival (DFS) was adjusted for all the available potential confounders. RESULTS Overall, 1021 and 1113 patients were eligible for overall survival (OS) and disease-free survival (DFS) analyses, respectively; 501 and 554 with Epstein Barr-encoded RNA (EBER) status available. In the whole group, 5-year OS was 84% and DFS 65%. The use of NIT was associated with a risk of death or recurrence 1.37 times higher than patients receiving IT. Patients submitted to NIT and induction CT + concurrent concomitant chemo and three-dimensional Conformal Radiation Therapy (3DCRT) had a risk of death or recurrence 1.5 and 1.7 times higher than patients treated with induction CT + cCRT with intensity-modulated radiotherapy (IMRT), respectively. The IT had no impact on OS in neither patients with EBER+ nor in patients with EBER-; IT showed better DFS in EBER+ but not in patients with EBER-. CONCLUSIONS In low-incidence areas, patients with NPC treated with induction CT followed by concurrent IMRT cCRT achieved the highest DFS rate. The benefit of IT on DFS was restricted to patients with EBER+, suggesting that additional therapy offers no advantages in EBER- cases.
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Affiliation(s)
- Paolo Bossi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy; Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy.
| | - Annalisa Trama
- Evalutative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy.
| | - Alice Bernasconi
- Evalutative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy.
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy.
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan.
| | - Isabel L Galiana
- Radiation Oncology Department, Hospital Duran IReynals, Institut Català D'Oncologia-L'Hospitalet, Radiobiology and Cancer Group, IDIBELL, Barcelona, Spain.
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul, Turkey.
| | - Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont and AOU 'Maggiore Della Carita', Novara, Italy.
| | - Stefania Vecchio
- Medical Oncology, IRCCS San Martino, IST National Cancer Institute and University of Genova, Genova, Italy.
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Beatriz C Cirauqui
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, B-ARGO Group, IGTP, Badalona, Spain.
| | | | - Stefano Ursino
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
| | - Athanassios Argiris
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Jonathan Pan
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, Justus-Liebig University Giessen, Giessen, Germany.
| | - Elisa D'Angelo
- Radiation Oncology Unit, University Hospital of Modena, Italy.
| | - Loredana Costa
- Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
| | - Michela Buglione
- Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
| | - Jennifer Johnson
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Mario Airoldi
- Medical Oncology, Città Della Salute e Della Scienza, Torino, Italy.
| | - Ricard Mesia
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, B-ARGO Group, IGTP, Badalona, Spain.
| | - Carlo Resteghini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy.
| | - Lisa Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, Milan, 20133, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Ester Orlandi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
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Chuong M, Herrera R, Mustafayev T, Gungor G, Ugurluer G, Atalar B, Kotecha R, Hall M, Rubens M, Mittauer K, Contreras J, Gutierrez A, Kalman N, Alvarez D, Romaguera T, McCulloch J, Garcia J, Kaiser A, Mehta M, Ozyar E. Multi-Institutional Outcomes of Stereotactic Magnetic Resonance Image-Guided Adaptive Radiation Therapy (SMART) With Median Biologically Effective Dose of 100 Gy10 for Oligometastases. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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28
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Chuong M, Kirsch C, Herrera R, Rubens M, Gungor G, Schaff E, Dolan J, Kim J, Mittauer K, Kotecha R, Gutierrez A, Doemer A, Ugurluer G, Kwon D, Khan G, Alvarez D, Ucar A, Asbun H, Ozyar E, Parikh P. Long-Term Multi-Institutional Outcomes of 5-Fraction Ablative Stereotactic MR-Guided Adaptive Radiation Therapy (SMART) for Inoperable Pancreas Cancer With Median Prescribed Biologically Effective Dose of 100 Gy10. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gungor G, Michalet M, Lombard A, Roque T, Atalar B, Temur B, Serbez I, Azria D, de Vitry L, Riou O, Paragios N, Ozyar E, Fenoglietto P. Human-Level Precision Upper Abdominal OAR Contouring With Anatomically Preserving Deep Learning During Magnetic Resonance Imaging Guided Adaptive Radiotherapy (MRgRT). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sari R, Altinoz MA, Ozyar E, Danyeli AE, Elmaci I. A pediatric cerebral tumor with MN1 alteration and pathological features mimicking carcinoma metastasis: may the terminology "high grade neuroepithelial tumor with MN1 alteration" still be relevant? Childs Nerv Syst 2021; 37:2967-2974. [PMID: 34269865 DOI: 10.1007/s00381-021-05289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Astroblastoma, MN1-altered (old name: high-grade neuroepithelial tumor/HGNET with MN1 alteration) is a recently described central nervous system tumor mostly affecting pediatric patients and profoundly young girls. Differential pathological diagnoses of these tumors include ependymoma, pleomorphic xanthoastrocytoma, embryonal tumor with multilayered rosettes, meningioma, and even glioblastoma. As the treatment approaches to these tumors differ, it is essential to increase the awareness about these tumors in the neurosurgical community. CLINICAL PRESENTATION A 7-year-old female patient admitted with a 7-day history of headache, nausea, and vomiting. A contrasted MRI scan revealed a left parietal 4 × 4 × 5 cm mass with central necrosis and peripheral contrast enhancement. The tumor's histopathological findings were suggestive of a metastatic carcinoma with unknown primary, yet further genetic analysis revealed MN1 alteration. Peculiarly, the tumor pathomorphological features were not compatible with astroblastomas and exerted features strongly indicating a metastatic cancer; however, systemic PET and whole-body MRI failed to detect a primary malignancy. OUTCOME AND CONCLUSIONS Eighteen months after gross-total tumor resection, an in-field and out-field multifocal recurrence developed which required a second surgery and subsequent chemo-radiotherapy. The patient is doing well for 1 year after the second treatment regimen at the time of this report. Despite the final cIMPACT6 classification in 2020 advised to define all MN1 altered brain tumors as astroblastomas, there exist prognostic differences in MN1-altered tumors with and without morphological features of astroblastoma. Rare morphological variants of MN1-altered tumors shall be recognized for their future prognostic and clinical classification. HGNET with MN1 alteration seems still be a more proper definition of such malignancies as an umbrella term.
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Affiliation(s)
- Ramazan Sari
- Department of Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Meric A Altinoz
- Department of Medical Biochemistry, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ayca Ersen Danyeli
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ilhan Elmaci
- Department of Neurosurgery, Acibadem Maslak Hospital, Istanbul, Turkey. .,Department of Neurosurgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
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Zoto Mustafayev T, Ugurluer G, Gungor G, Atalar B, Serkizyan A, Abacioglu M, Agaoglu F, Sengoz M, Guven K, Ozyar E. PO-1208 Stereotactic MR-guided online adaptive radiation therapy for management of pancreatic malignancies. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07659-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Egriboyun S, Ugurluer G, Gungor G, Zoto Mustafayev T, Cicek B, Demir G, Atalar B, Ozyar E. Magnetic resonance image-guided hypofractionated ablative radiation therapy for extrahepatic cholangiocarcinoma: Plan adaptation in changing anatomy. Med Dosim 2021; 46:435-439. [PMID: 34244041 DOI: 10.1016/j.meddos.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
Extrahepatic cholangiocarcinoma is an aggressive malignancy of biliary duct epithelium which typically has a poor prognosis. Although surgical resection improves overall survival, many patients are deemed medically inoperable or have unresectable tumors. Herein, we report a case of an 84-year-old Caucasian male who was diagnosed with medically inoperable extrahepatic cholangiocarcinoma. Magnetic resonance image-guided hypofractionated ablative radiotherapy was administered which has the advantages of superior soft tissue resolution, better visualization of the target and organ at risk, daily online adaptive planning and continuous cine MR tracking of the target during irradiation. Concomitant chemotherapy was used. On the first fraction the patient presented with a broken arm that forced the patient take a treatment position much different than the one used for simulation CT and planning. The patient was able to finish the treatment without the need of another simulation by adapting the plan according to the new anatomy. The patient is being followed up until today and is alive with no evidence of disease.
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Affiliation(s)
- Sebnem Egriboyun
- Medical Student, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Gamze Ugurluer
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Bahattin Cicek
- Department of Gastroenterology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Gokhan Demir
- Department of Medical Oncology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey.
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Ng WT, Soong YL, Ahn YC, AlHussain H, Choi HCW, Corry J, Grégoire V, Harrington KJ, Hu CS, Jensen K, Kwong DL, Langendijk JA, Le QT, Lee NY, Lin JC, Lu TX, Mendenhall WM, O'Sullivan B, Ozyar E, Pan JJ, Peters LJ, Poh SS, Rosenthal DI, Sanguineti G, Tao Y, Wee JT, Yom SS, Chua MLK, Lee AWM. International Recommendations on Reirradiation by Intensity Modulated Radiation Therapy for Locally Recurrent Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2021; 110:682-695. [PMID: 33571626 DOI: 10.1016/j.ijrobp.2021.01.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/11/2021] [Accepted: 01/23/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Reirradiation for locally recurrent nasopharyngeal carcinoma (NPC) is challenging because prior radiation dose delivered in the first course is often close to the tolerance limit of surrounding normal structures. A delicate balance between achieving local salvage and minimizing treatment toxicities is needed. However, high-level evidence is lacking because available reports are mostly retrospective studies on small series of patients. Pragmatic consensus guidelines, based on an extensive literature search and the pooling of opinions by leading specialists, will provide a useful reference to assist decision-making for these difficult decisions. METHODS AND MATERIALS A thorough review of available literature on recurrent NPC was conducted. A set of questions and preliminary draft guideline was circulated to a panel of international specialists with extensive experience in this field for voting on controversial areas and comments. A refined second proposal, based on a summary of the initial voting and different opinions expressed, was recirculated to the whole panel for review and reconsideration. The current guideline was based on majority voting after repeated iteration for final agreement. RESULTS The initial round of questions showed variations in clinical practice even among the specialists, reflecting the lack of high-quality supporting data and the difficulties in formulating clinical decisions. Through exchange of comments and iterative revisions, recommendations with high-to-moderate agreement were formulated on general treatment strategies and details of reirradiation (including patient selection, targets contouring, dose prescription, and constraints). CONCLUSION This paper provides useful reference on radical salvage treatment strategies for recurrent NPC and optimization of reirradiation through review of published evidence and consensus building. However, the final decision by the attending clinician must include full consideration of an individual patient's condition, understanding of the delicate balance between risk and benefits, and acceptance of risk of complications.
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Affiliation(s)
- Wai Tong Ng
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hussain AlHussain
- Department of Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Horace C W Choi
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
| | - June Corry
- Radiation Oncology, GenesisCare, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Vincent Grégoire
- Center for Molecular Imaging, Oncology, and Radiotherapy, Université Catholique de Louvain, Brussels, Belgium, and Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Kevin J Harrington
- Royal Marsden/Institute of Cancer Research National Institute for Health Research Biomedical Research Centre, London, United Kingdom
| | - Chao Su Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Kenneth Jensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Dora L Kwong
- Department of Clinical Oncology, University of Hong Kong and Queen Mary Hospital, Hong Kong
| | - Johannes A Langendijk
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University, NRG Oncology and HNCIG, Stanford, California
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Jin Ching Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Tai Xiang Lu
- Department of Radiation Oncology, Cancer Center of Sun Yat-Sen University, Guangzhou, China
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Canada
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Jian Ji Pan
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Lester J Peters
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sharon S Poh
- Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
| | - David I Rosenthal
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Yungan Tao
- Department of Radiation Oncology, Institut Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Joseph T Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Melvin L K Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
| | - Anne W M Lee
- Department of Clinical Oncology, University of Hong Kong Shenzhen Hospital and University of Hong Kong, Hong Kong, China.
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Seravalli E, Kroon PS, Buatti JM, Hall MD, Mandeville HC, Marcus KJ, Onal C, Ozyar E, Paulino AC, Paulsen F, Saunders D, Tsang DS, Wolden SL, Janssens GO. The potential role of MR-guided adaptive radiotherapy in pediatric oncology: Results from a SIOPE-COG survey. Clin Transl Radiat Oncol 2021; 29:71-78. [PMID: 34159265 PMCID: PMC8202186 DOI: 10.1016/j.ctro.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Magnetic resonance guided radiotherapy (MRgRT) has been successfully implemented for several routine clinical applications in adult patients. The purpose of this study is to map the potential benefit of MRgRT on toxicity reduction and outcome in pediatric patients treated with curative intent for primary and metastatic sites. MATERIALS AND METHODS Between May and August 2020, a survey was distributed among SIOPE- and COG-affiliated radiotherapy departments, treating at least 25 pediatrics patients annually and being (candidate) users of a MRgRT system. The survey consisted of a table with 45 rows (clinical scenarios for primary (n = 28) and metastatic (n = 17) tumors) and 7 columns (toxicity reduction, outcome improvement, PTV margin reduction, target volume daily adaptation, online re-planning, intrafraction motion compensation and on-board functional imaging) and the option to answer by 'yes/no' . Afterwards, the Dutch national radiotherapy cohort was used to estimate the percentage of pediatric treatments that may benefit from MRgRT. RESULTS The survey was completed by 12/17 (71% response rate) institutions meeting the survey inclusion criteria. Responders indicated an 'expected benefit' from MRgRT for toxicity/outcome in 7% (for thoracic lymphomas and abdominal rhabdomyosarcomas)/0% and 18% (for mediastinal lymph nodes, lymph nodes located in the liver/splenic hilum, and liver metastases)/0% of the considered scenarios for the primary and metastatic tumor sites, respectively, and a 'possible benefit' was estimated in 64%/46% and 47%/59% of the scenarios. When translating the survey outcome into a clinical perspective a toxicity/outcome benefit, either expected or possible, was anticipated for 55%/24% of primary sites and 62%/38% of the metastatic sites. CONCLUSION Although the benefit of MRgRT in pediatric radiation oncology is estimated to be modest, the potential role for reducing toxicity and improving clinical outcomes warrants further investigation. This fits best within the context of prospective studies or registration trials.
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Affiliation(s)
- Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra S. Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - John M. Buatti
- Departments of Radiation Oncology, University of Iowa, Iowa City, USA
| | - Matthew D. Hall
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, USA
| | - Henry C. Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Karen J. Marcus
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA
| | - Cem Onal
- Department of Radiation Oncology, Baskent University, Ankara, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Arnold C. Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Derek S. Tsang
- Radiation Medicine Program, University Health Network – Princess Margaret Cancer Centre, Toronto, Canada
| | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Geert O. Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Ugurluer G, Mustafayev TZ, Gungor G, Atalar B, Abacioglu U, Sengoz M, Agaoglu F, Demir G, Ozyar E. Stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of liver metastases in oligometastatic patients: initial clinical experience. Radiat Oncol J 2021; 39:33-40. [PMID: 33794572 PMCID: PMC8024184 DOI: 10.3857/roj.2020.00976] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose We aimed to present our initial clinical experience on the implementation of a stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of liver metastases in oligometastatic disease. Materials and Methods Twenty-one patients (24 lesions) with liver metastasis treated with SMART were included in this retrospective study. Step-and-shoot intensity-modulated radiotherapy technique was used with daily plan adaptation. During delivery, real-time imaging was used by acquiring planar magnetic resonance images in sagittal plane for monitoring and gating. Acute and late toxicities were recorded both during treatment and follow-up visits. Results The median follow-up time was 11.6 months (range, 2.2 to 24.6 months). The median delivered total dose was 50 Gy (range, 40 to 60 Gy); with a median fraction number of 5 (range, 3 to 8 fractions) and the median fraction dose was 10 Gy (range, 7.5 to 18 Gy). Ninety-three fractions (83.7%) among 111 fractions were re-optimized. No patients were lost to follow-up and all patients were alive except one at the time of analysis. All of the patients had either complete (80.9%) or partial (19.1%) response at irradiated sites. Estimated 1-year overall survival was 93.3%. Intrahepatic and extrahepatic progression-free survival was 89.7% and 73.5% at 1 year, respectively. There was no grade 3 or higher acute or late toxicities experienced during the treatment and follow-up course. Conclusion SMART represents a new, noninvasive and effective alternative to current ablative radiotherapy methods for treatment of liver metastases in oligometastatic disease with the advantages of better visualization of soft tissue, real-time tumor tracking and potentially reduced toxicity to organs at risk.
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Affiliation(s)
- Gamze Ugurluer
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Ufuk Abacioglu
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Meric Sengoz
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Fulya Agaoglu
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Gokhan Demir
- Department of Medical Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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Egriboyun S, Ugurluer G, Corapcioglu FV, Celik L, Gungor G, Atalar B, Ozyar E. Magnetic resonance image-guided stereotactic body radiation therapy for liver rhabdoid tumor in infancy: A case report. J Med Imaging Radiat Sci 2021; 52:305-311. [PMID: 33741278 DOI: 10.1016/j.jmir.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/07/2020] [Accepted: 02/22/2021] [Indexed: 12/31/2022]
Abstract
Extracranial malignant rhabdoid tumors are rare and aggressive tumors that typically occur in the pediatric age group and have a poor prognosis. Herein, we report a case of a one year and five months old male infant who was referred with the diagnosis of malignant rhabdoid tumor of the liver. Magnetic resonance guided stereotactic body radiotherapy was administered with concomitant chemotherapy. Treatment was well tolerated with no severe acute side effects. A 40.8% volumetric reduction of the tumor was observed at the last fraction of MR guided radiotherapy.
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Affiliation(s)
- Sebnem Egriboyun
- Medical Student, Acibadem MAA University School of Medicine, Istanbul 34450, Turkey
| | - Gamze Ugurluer
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450, Turkey
| | | | - Levent Celik
- Department of Radiology, Acibadem Maslak Hospital, Istanbul 34450, Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450, Turkey.
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Ugurluer G, Atalar B, Zoto Mustafayev T, Gungor G, Aydin G, Sengoz M, Abacioglu U, Tuna MB, Kural AR, Ozyar E. Magnetic resonance image-guided adaptive stereotactic body radiotherapy for prostate cancer: preliminary results of outcome and toxicity. Br J Radiol 2021; 94:20200696. [PMID: 33095670 PMCID: PMC7774684 DOI: 10.1259/bjr.20200696] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/19/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Using moderate or ultra-hypofractionation, which is also known as stereotactic body radiotherapy (SBRT) for treatment of localized prostate cancer patients has been increased. We present our preliminary results on the clinical utilization of MRI-guided adaptive radiotherapy (MRgRT) for prostate cancer patients with the workflow, dosimetric parameters, toxicities and prostate-specific antigen (PSA) response. METHODS 50 prostate cancer patients treated with ultra-hypofractionation were included in the study. Treatment was performed with intensity-modulated radiation therapy (step and shoot) technique and daily plan adaptation using MRgRT. The SBRT consisted of 36.25 Gy in 5 fractions with a 7.25 Gy fraction size. The time for workflow steps was documented. Patients were followed for the acute and late toxicities and PSA response. RESULTS The median follow-up for our cohort was 10 months (range between 3 and 29 months). The median age was 73.5 years (range between 50 and 84 years). MRgRT was well tolerated by all patients. Acute genitourinary (GU) toxicity rate of Grade 1 and Grade 2 was 28 and 36%, respectively. Only 6% of patients had acute Grade 1 gastrointestinal (GI) toxicity and there was no Grade ≥ 2 GI toxicity. To date, late Grade 1 GU toxicity was experienced by 24% of patients, 2% of patients experienced Grade 2 GU toxicity and 6% of patients reported Grade 2 GI toxicity. Due to the short follow-up, PSA nadir has not been reached yet in our cohort. CONCLUSION In conclusion, MRgRT represents a new method for delivering SBRT with markerless soft tissue visualization, online adaptive planning and real-time tracking. Our study suggests that ultra-hypofractionation has an acceptable acute and very low late toxicity profile. ADVANCES IN KNOWLEDGE MRgRT represents a new markerless method for delivering SBRT for localized prostate cancer providing online adaptive planning and real-time tracking and acute and late toxicity profile is acceptable.
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Affiliation(s)
- Gamze Ugurluer
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Gokhan Aydin
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Meric Sengoz
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Ufuk Abacioglu
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | | | - Ali Riza Kural
- Department of Urology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
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Mustafayev T, Atalar B, Gungor G, Sengoz M, Abacioglu U, Ozyar E. Feasibility of Stereotactic MR-Guided Adaptive Radiotherapy in Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sayan M, Serbez I, Teymur B, Gur G, Zoto Mustafayev T, Gungor G, Atalar B, Ozyar E. Patient-Reported Tolerance of Magnetic Resonance-Guided Radiation Therapy. Front Oncol 2020; 10:1782. [PMID: 33072560 PMCID: PMC7537416 DOI: 10.3389/fonc.2020.01782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Magnetic resonance-guided radiation therapy (MRgRT) has been incorporated into a growing number of clinical practices world-wide, however, there is limited data on patient experiences with MRgRT. The purpose of this study was to prospectively evaluate patient tolerance of MRgRT using patient reported outcome questionnaires (PRO-Q). Methods Ninety patients were enrolled in this prospective observational study and treated with MRgRT (MRIdian Linac System, ViewRay Inc. Oakwood Village, OH, United States) between September 2018 and September 2019. Breath-hold-gated dose delivery with audiovisual feedback was completed as needed. Patients completed an in-house developed PRO-Q after the first and last fraction of MRgRT. Results The most commonly treated anatomic sites were the abdomen (47%) and pelvis (33%). Respiratory gating was utilized in 62% of the patients. Patients rated their experience as positive or at least tolerable with mean scores of 1.0–2.8. The most common complaint was the temperature in the room (61%) followed by paresthesias (57%). The degree of anxiety reported by 45% of the patients significantly decreased at the completion of treatment (mean score 1.54 vs. 1.36, p = 0.01). Forty-three percent of the patients reported some degree of disturbing noise which was improved considerably by use of music. All patients appreciated their active role during the treatment. Conclusion This evaluation of PROs indicates that MRgRT was well-tolerated by our patients. Patients’ experience may further improve with adjustment of room temperature and noise reduction.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Ilkay Serbez
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
| | - Bilgehan Teymur
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
| | - Gokhan Gur
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
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Sayan M, Mustafayev TZ, Atalar B, Gungor G, Ozyar E. Magnetic Resonance–Guided Radiation Therapy to Boost Cervical Cancer When Brachytherapy Is Not Available: A Case Report. Adv Radiat Oncol 2020; 5:1066-1070. [PMID: 33083668 PMCID: PMC7557129 DOI: 10.1016/j.adro.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/25/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022] Open
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Sayan M, Mustafayev TZ, Balmuk A, Mamidanna S, Kefelioglu ESS, Gungor G, Chundury A, Ohri N, Karaarslan E, Ozyar E, Atalar B. Management of symptomatic radiation necrosis after stereotactic radiosurgery and clinical factors for treatment response. Radiat Oncol J 2020; 38:176-180. [PMID: 33012145 PMCID: PMC7533401 DOI: 10.3857/roj.2020.00171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Approximately 10% of patients who received brain stereotactic radiosurgery (SRS) develop symptomatic radiation necrosis (RN). We sought to determine the effectiveness of treatment options for symptomatic RN, based on patient-reported outcomes. MATERIALS AND METHODS We conducted a retrospective review of 217 patients with 414 brain metastases treated with SRS from 2009 to 2018 at our institution. Symptomatic RN was determined by appearance on serial magnetic resonance images (MRIs), MR spectroscopy, requirement of therapy, and development of new neurological complaints without evidence of disease progression. Therapeutic interventions for symptomatic RN included corticosteroids, bevacizumab and/or surgical resection. Patient-reported therapeutic outcomes were graded as complete response (CR), partial response (PR), and no response. RESULTS Twenty-six patients experienced symptomatic RN after treatment of 50 separate lesions. The mean prescription dose was 22 Gy (range, 15 to 30 Gy) in 1 to 5 fractions (median, 1 fraction). Of the 12 patients managed with corticosteroids, 6 patients (50%) reported CR and 4 patients (33%) PR. Of the 6 patients managed with bevacizumab, 3 patients (50%) reported CR and 1 patient (18%) PR. Of the 8 patients treated with surgical resection, all reported CR (100%). Other than surgical resection, age ≥54 years (median, 54 years; range, 35 to 81 years) was associated with CR (odds ratio = 8.40; 95% confidence interval, 1.27-15.39; p = 0.027). CONCLUSION Corticosteroids and bevacizumab are commonly utilized treatment modalities with excellent response rate. Our results suggest that patient's age is associated with response rate and could help guide treatment decisions for unresectable symptomatic RN.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Aykut Balmuk
- School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Swati Mamidanna
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Gorkem Gungor
- Institute of Health Sciences, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Anupama Chundury
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Nisha Ohri
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Ercan Karaarslan
- Department of Radiology, School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Enis Ozyar
- School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Banu Atalar
- School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
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Asoglu O, Tokmak H, Bakir B, Demir G, Ozyar E, Atalar B, Goksel S, Koza B, Mert AG, Demir A, Guven K. Corrigendum to "The impact of total neo-adjuvant treatment on nonoperative management in patients with locally advanced rectal cancer: The evaluation of 66 cases in a single center" [Eur. J. Surg. Oncol. 46/3 (2019) 402-409]. Eur J Surg Oncol 2020; 46:1774. [PMID: 32800281 DOI: 10.1016/j.ejso.2020.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Oktar Asoglu
- Bogazici Academy for Clinical Sciences General Surgery, Istanbul, Turkey
| | - Handan Tokmak
- Acibadem University Maslak Hospital, Nuclear Medicine, Istanbul, Turkey.
| | - Baris Bakir
- İstanbul University, Istanbul Faculty of Medicine, Radiology Istanbul, Turkey
| | - Gokhan Demir
- Acibadem University Maslak Hospital, Medical Oncology, Istanbul, Turkey
| | - Enis Ozyar
- Acibadem University Maslak Hospital, Radiation Oncology, Istanbul, Turkey
| | - Banu Atalar
- Acibadem University Maslak Hospital, Radiation Oncology, Istanbul, Turkey
| | - Suha Goksel
- Acibadem University Maslak Hospital, Pathology, Istanbul, Turkey
| | - Burak Koza
- Bogazici Academy for Clinical Sciences General Surgery, Istanbul, Turkey
| | | | - Atakan Demir
- Acibadem University Maslak Hospital, Medical Oncology, Istanbul, Turkey
| | - Koray Guven
- Acibadem University Maslak Hospital, Radiology, Istanbul, Turkey
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Sahin B, Atalar B, Kaytan Saglam E, Akgun Z, Abacioglu U, Arifoglu A, Ozyar E, Yaprak G, Ozseker Isik N, Guney Y, Caglar HB, Karaman S, Igdem S, Selek U, Berber T, Oner Dincbas F, Sengoz M, Yucel S, Demiral AN, Akyurek S. Prognostic factors in medically inoperable early stage lung cancer patients treated with stereotactic ablative radiation therapy (SABR): Turkish Radiation Oncology Society Multicentric Study. Clin Respir J 2020; 14:1050-1059. [PMID: 32749053 DOI: 10.1111/crj.13240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/30/2020] [Accepted: 07/27/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We identified factors influencing outcomes in patients with medically inoperable early stage lung cancer (MIESLC) treated with stereotactic ablative radiation therapy (SABR) at 14 centers in Turkey. MATERIALS AND METHODS We retrospectively analyzed 431 patients with stage I-II MIESLC treated with SABR from 2009 through 2017. Age; sex; performance score; imaging technique; tumor histology and size; disease stage radiation dose, fraction and biologically effective dose with an α/β ratio of 10 (BED10 ); tumor location and treatment center were evaluated for associations with overall survival (OS), local control (LC) and toxicity. RESULTS Median follow-up time was 27 months (range 1-115); median SABR dose was 54 Gy (range 30-70) given in a median three fractions (range 1-10); median BED10 was 151 Gy (range 48-180). Tumors were peripheral in 285 patients (66.1%), central in 69 (16%) and <1 cm from mediastinal structures in 77 (17.9%). Response was evaluated with PET/CT in most cases at a median 3 months after SABR. Response rates were: 48% complete, 36.7% partial, 7.9% stable and 7.4% progression. LC rates were 97.1% at 1 year, 92.6% at 2 years and 91.2% at 3 years; corresponding OS rates were 92.6%, 80.6% and 72.7%. On multivariate analysis, BED10 > 100 Gy (P = .011), adenocarcinoma (P = .025) and complete response on first evaluation (P = .007) predicted favorable LC. BED10 > 120 Gy (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.1-3.2, P = .019) and tumor size (<2 cm HR 1.9, 95% CI 1.3-3, P = .003) predicted favorable OS. No grade 4-5 acute side effects were observed; late effects were grade ≤3 pneumonitis (18 [4.2%]), chest wall pain (11 [2.5%]) and rib fracture (1 [0.2%]). CONCLUSION SABR produced encouraging results, with satisfactory LC and OS and minimal toxicity. BED10 > 120 Gy was needed for better LC and OS for large, non-adenocarcinoma tumors.
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Affiliation(s)
- Bilgehan Sahin
- Faculty of Medicine, Radiation Oncology Department, Acıbadem MAA University, Istanbul, Turkey
| | - Banu Atalar
- Faculty of Medicine, Radiation Oncology Department, Acıbadem MAA University, Istanbul, Turkey
| | - Esra Kaytan Saglam
- Radiation Oncology Department, Istanbul University Institute of Oncology, Istanbul, Turkey.,Radiation Oncology Department, Memorial Şişli Hospital, Istanbul, Turkey
| | - Zuleyha Akgun
- Radiation Oncology Department, Memorial Şişli Hospital, Istanbul, Turkey
| | - Ufuk Abacioglu
- Radiation Oncology Department, Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Alptekin Arifoglu
- Radiation Oncology Department, Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Enis Ozyar
- Faculty of Medicine, Radiation Oncology Department, Acıbadem MAA University, Istanbul, Turkey
| | - Gokhan Yaprak
- Radiation Oncology Department, University of Health Sciences Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Naciye Ozseker Isik
- Radiation Oncology Department, University of Health Sciences Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Yıldız Guney
- Radiation Oncology Department, Memorial Ankara Hospital, Ankara, Turkey
| | - Hale Basak Caglar
- Radiation Oncology Department, Anadolu Medical Center John Hopkins International, Istanbul, Turkey
| | - Sule Karaman
- Radiation Oncology Department, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Sefik Igdem
- Faculty of Medicine, Radiation Oncology Department, Bilim University, Istanbul, Turkey
| | - Ugur Selek
- Radiation Oncology Department, School of Medicine, Koc University, Istanbul, Turkey.,MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Tanju Berber
- Radiation Oncology Department, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Fazilet Oner Dincbas
- Faculty of Medicine, Radiation Oncology Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Meric Sengoz
- Faculty of Medicine, Radiation Oncology Department, Acıbadem MAA University, Istanbul, Turkey
| | - Serap Yucel
- Faculty of Medicine, Radiation Oncology Department, Acıbadem MAA University, Istanbul, Turkey
| | - Ayşe Nur Demiral
- Faculty of Medicine, Radiation Oncology Department, Dokuz Eylül University, Izmir, Turkey
| | - Serap Akyurek
- Faculty of Medicine, Radiation Oncology Department, Ankara University, Ankara, Turkey
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Gungor G, Korkmaz L, Kayalilar N, Aydin G, Yapici B, Zoto Mustafayev T, Atalar B, Ozyar E. Multichannel Film Dosimetry for Quality Assurance of Intensity Modulated Radiotherapy Treatment Plans Under 0.35 T Magnetic Field. Cureus 2020; 12:e7334. [PMID: 32313775 PMCID: PMC7164695 DOI: 10.7759/cureus.7334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the intensity modulated radiotherapy (IMRT) quality assurance (QA) results of the multichannel film dosimetry analysis with single scan method by using Gafchromic™ EBT3 (Ashland Inc., Covington, KY, USA) film under 0.35 T magnetic field. Methods Between September 2018 and June 2019, 70 patients were treated with ViewRay MRIdian® (ViewRay Inc., Mountain View, CA) linear accelerator (Linac). Film dosimetry QA plans were generated for all IMRT treatments. Multichannel film dosimetry for red, green and blue (RGB) channels were compared with treatment planning system (TPS) dose maps by gamma evaluation analysis. Results The mean gamma passing rates of RGB channels are 97.3% ± 2.26%, 96.0% ± 3.27% and 96.2% ± 3.14% for gamma evaluation with 2% DD/2 mm distance to agreement (DTA), respectively. Moreover, the mean gamma passing rates of RGB channels are 99.7% ± 0.41%, 99.6% ± 0.59% and 99.5% ± 0.67% for gamma evaluation with 3% DD/3 mm DTA, respectively. Conclusion The patient specific QA using Gafchromic™ EBT3 film with multichannel film dosimetry seems to be a suitable tool to implement for MR-guided IMRT treatments under 0.35 T magnetic field. Multichannel film dosimetry with Gafchromic™ EBT3 is a consistent QA tool for gamma evaluation of the treatment plans even with 2% DD/2 mm DTA under 0.35 T magnetic field presence.
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Affiliation(s)
- Gorkem Gungor
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | - Latif Korkmaz
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | | | - Gokhan Aydin
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | - Bulent Yapici
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | | | - Banu Atalar
- Radiation Oncology, Acibadem University School of Medicine, Istanbul, TUR
| | - Enis Ozyar
- Radiation Oncology, Acıbadem Hospital, Istanbul, TUR.,Radiation Oncology, Acıbadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, TUR
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Sayan M, Zoto Mustafayev T, Sahin B, Kefelioglu ESS, Wang SJ, Kurup V, Balmuk A, Gungor G, Ohri N, Weiner J, Ozyar E, Atalar B. Evaluation of response to stereotactic radiosurgery in patients with radioresistant brain metastases. Radiat Oncol J 2019; 37:265-270. [PMID: 31918464 PMCID: PMC6952719 DOI: 10.3857/roj.2019.00409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 12/03/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Renal cell carcinoma (RCC) and melanoma have been considered 'radioresistant' due to the fact that they do not respond to conventionally fractionated radiation therapy. Stereotactic radiosurgery (SRS) provides high-dose radiation to a defined target volume and a limited number of studies have suggested the potential effectiveness of SRS in radioresistant histologies. We sought to determine the effectiveness of SRS for the treatment of patients with radioresistant brain metastases. MATERIALS AND METHODS We performed a retrospective review of our institutional database to identify patients with RCC or melanoma brain metastases treated with SRS. Treatment response were determined in accordance with the Response Evaluation Criteria in Solid Tumors. RESULTS We identified 53 radioresistant brain metastases (28% RCC and 72% melanoma) treated in 18 patients. The mean target volume and coverage was 6.2 ± 9.5 mL and 95.5% ± 2.9%, respectively. The mean prescription dose was 20 ± 4.9 Gy. Forty lesions (75%) demonstrated a complete/partial response and 13 lesions (24%) with progressive/stable disease. Smaller target volume (p < 0.001), larger SRS dose (p < 0.001), and coverage (p = 0.008) were found to be positive predictors of complete response to SRS. CONCLUSION SRS is an effective management option with up to 75% response rate for radioresistant brain metastases. Tumor volume and radiation dose are predictors of response and can be used to guide the decision-making for patients with radioresistant brain metastases.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Bilgehan Sahin
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | | | - Shang-Jui Wang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Varsha Kurup
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Aykut Balmuk
- School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Nisha Ohri
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Joseph Weiner
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Enis Ozyar
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
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Sahin B, Zoto Mustafayev T, Gungor G, Aydin G, Yapici B, Atalar B, Ozyar E. First 500 Fractions Delivered with a Magnetic Resonance-guided Radiotherapy System: Initial Experience. Cureus 2019; 11:e6457. [PMID: 32025388 PMCID: PMC6977582 DOI: 10.7759/cureus.6457] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives Improved soft-tissue visualization, afforded by magnetic resonance imaging integrated into a radiation therapy linear accelerator-based radiation delivery system (MR-linac) promises improved image-guidance. The availability of MR-imaging can facilitate on-table adaptive radiation planning and enable real-time intra-fraction imaging with beam gating without additional exposure to radiation. However, the novel use of magnetic resonance-guided radiation therapy (MRgRT) in the field of radiation oncology also potentially poses challenges for routine clinical implementation. Herein the early experience of a single institution, implementing the first MRgRT system in the country is reported. We aim to describe the workflow and to characterize the clinical utility and feasibility of routine use of an MR-linac system. Methods The ViewRay MRIdian MR-linac system consists of a split-magnet 0.35 T MR-imaging scanner with a double focused multi-leaf collimator (MLC) equipped 6MV linear accelerator. Unique to the system are the control console integrated on-table adaptive radiation therapy (oART) planning capabilities as well as automated beam gating based on real-time intra-fraction MR imaging. From the first day of clinical implementation, oART was performed according to physicians’ discretion when medically indicated. All fractions were delivered under real-time imaging with soft tissue-based automated beam gating with individualized gating boundary settings. Patients actively assisted in breath-hold beam gating with the help of custom designed prismatic glasses allowing sight of a computer monitor mounted on the back wall just behind the MRI system bore. Patient demographics and treatment experience, indications for MRgRT including diagnosis and disease site, radiation dose prescribed and fractionation scheme, utilization of oART, respiratory gating settings, as well as duration of each treatment phase were analyzed. Results Between September 2018 and May 2019, 72 patients with 84 tumor sites were treated with MRgRT in 500 total fractions. Median patient age was 66 years (range: 28-83 years). Among 84 tumor sites, the most frequently treated regions were upper abdominal and pelvic (n = 36, 43% and n = 29, 34%, respectively). The most common diagnosis was prostate cancer, with 14 patients treated. In 69 patients (93.2%) oART was used at least once during a treatment course. Twenty-nine targets (43.1%) with significant breathing-related motion were treated in breath-hold with patient visual feedback. Median prescribed dose was 36.25 Gy (range: 24-70 Gy) in median five fractions (range: 3-28 fractions). A gating boundary of 3 mm around a gating region of interest (gROI) was most commonly used (range: 3-5 mm) with 95% of the gROI (range: 93-97%) required to be within the gating boundary for the beam to automatically engage. Mean total treatment time was 47 min (range: 21-125 min) and mean beam-on time was 16.7 min (range: 6-62 min). Conclusions MRgRT afforded by an MR-linac system has been successfully implemented into routine clinical use at our institution as the first system of its kind in Turkey. While the overall number of patients treated and fractions delivered is still limited, we have demonstrated the feasibility of both on-table adaptive radiation therapy as well as automated real-time beam gating on a daily basis in acceptable time schedules.
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Affiliation(s)
- Bilgehan Sahin
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | | | - Gorkem Gungor
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | - Gokhan Aydin
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | - Bulent Yapici
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | - Banu Atalar
- Radiation Oncology, Acibadem University School of Medicine, Istanbul, TUR
| | - Enis Ozyar
- Radiation Oncology, Acibadem University School of Medicine, Acibadem Maslak Hospital, Istanbul, TUR
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Lee AW, Ng WT, Pan JJ, Chiang CL, Poh SS, Choi HC, Ahn YC, AlHussain H, Corry J, Grau C, Grégoire V, Harrington KJ, Hu CS, Kwong DL, Langendijk JA, Le QT, Lee NY, Lin JC, Lu TX, Mendenhall WM, O'Sullivan B, Ozyar E, Peters LJ, Rosenthal DI, Sanguineti G, Soong YL, Tao Y, Yom SS, Wee JT. International Guideline on Dose Prioritization and Acceptance Criteria in Radiation Therapy Planning for Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2019; 105:567-580. [PMID: 31276776 DOI: 10.1016/j.ijrobp.2019.06.2540] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 06/12/2019] [Accepted: 06/25/2019] [Indexed: 12/09/2022]
Abstract
PURPOSE The treatment of nasopharyngeal carcinoma requires high radiation doses. The balance of the risks of local recurrence owing to inadequate tumor coverage versus the potential damage to the adjacent organs at risk (OARs) is of critical importance. With advancements in technology, high target conformality is possible. Nonetheless, to achieve the best possible dose distribution, optimal setting of dose targets and dose prioritization for tumor volumes and various OARs is fundamental. Radiation doses should always be guided by the As Low As Reasonably Practicable principle. There are marked variations in practice. This study aimed to develop a guideline to serve as a global practical reference. METHODS AND MATERIALS A literature search on dose tolerances and normal-tissue complications after treatment for nasopharyngeal carcinoma was conducted. In addition, published guidelines and protocols on dose prioritization and constraints were reviewed. A text document and preliminary set of variants was circulated to a panel of international experts with publications or extensive experience in the field. An anonymized voting process was conducted to rank the proposed variants. A summary of the initial voting and different opinions expressed by members were then recirculated to the whole panel for review and reconsideration. Based on the comments of the panel, a refined second proposal was recirculated to the same panel. The current guideline was based on majority voting after repeated iteration for final agreement. RESULTS Variation in opinion among international experts was repeatedly iterated to develop a guideline describing appropriate dose prioritization and constraints. The percentage of final agreement on the recommended parameters and alternative views is shown. The rationale for the recommendations and the limitations of current evidence are discussed. CONCLUSIONS Through this comprehensive review of available evidence and interactive exchange of vast experience by international experts, a guideline was developed to provide a practical reference for setting dose prioritization and acceptance criteria for tumor volumes and OARs. The final decision on the treatment prescription should be based on the individual clinical situation and the patient's acceptance of optimal balance of risk.
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Affiliation(s)
- Anne W Lee
- Department of Clinical Oncology, University of Hong Kong Shenzhen Hospital and University of Hong Kong, China
| | - Wai Tong Ng
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Jian Ji Pan
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Chi-Leung Chiang
- Department of Clinical Oncology, University of Hong Kong Shenzhen Hospital and University of Hong Kong, China
| | - Sharon S Poh
- Division of Radiation Oncology, National Cancer Centre Singapore, Oncology ACP, Duke-NUS Medical School, Singapore
| | - Horace C Choi
- Department of Clinical Oncology, University of Hong Kong, Hong Kong
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hussain AlHussain
- Department of Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - June Corry
- Radiation Oncology, GenesisCare, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Cai Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Vincent Grégoire
- Center for Molecular Imaging, Oncology and Radiotherapy, Université Catholique de Louvain, Brussels, Belgium and Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Kevin J Harrington
- The Royal Marsden/The Institute of Cancer Research National Institute for Health Research Biomedical Research Centre, London, UK
| | - Chao Su Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Dora L Kwong
- Department of Clinical Oncology, University of Hong Kong and Queen Mary Hospital, Hong Kong
| | - Johannes A Langendijk
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University, NRG Oncology and Head and Neck Cancer International Group, California
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York
| | - Jin Ching Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Tai Xiang Lu
- Department of Radiation Oncology, Cancer Center of Sun Yat-Sen University, Guangzhou, China
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Canada
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Lester J Peters
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Oncology ACP, Duke-NUS Medical School, Singapore
| | - Yungan Tao
- Department of Radiation Oncology, Institut Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Sue S Yom
- Department of Radiation Oncology, University of California-San Francisco, San Francisco, California
| | - Joseph T Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, Oncology ACP, Duke-NUS Medical School, Singapore.
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Bossi P, Grisanti S, Mohamad I, Linares Galiana I, Ozyar E, Franco P, Vecchio S, Livi L, Cirauqui Cirauqui B, El-Sherify M, Ursino S, Argiris A, Pan J, Wittekindt C, D’angelo E, Buglione M, Airoldi M, Mesia Nin R, Licitra L, Orlandi E. Survival and prognostic factors of nasopharyngeal cancer patients in non-endemic countries: A large multicentric database analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mustafayev T, Sahin B, Gungor G, Aydin G, Serbez I, Teymur B, Gur G, Arabaci G, Atalar B, Yapici B, Abacioglu U, Agaoglu F, Sengoz M, Ozyar E. Time Analysis in Magnetic Resonance Image-Guided Radiotherapy Workflow. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lassen‐Ramshad Y, Ozyar E, Alanyali S, Poortmans P, Van Houtte P, Sohawon S, Esassolak M, Krengli M, Villa S, Miller RC, Demiroz C, Akyurek S, Aggerholm‐Pedersen N, Thariat J. Reply to “Proper tumor classification and growth rate are key elements when considering indications and results of radiotherapy for head and neck paragangliomas”. Head Neck 2019; 41:2837-2838. [DOI: 10.1002/hed.25800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yasmin Lassen‐Ramshad
- Danish Centre for Particle TherapyAarhus University Hospital Aarhus Denmark
- Department of OncologyAarhus University Hospital Aarhus Denmark
| | - Enis Ozyar
- Acibadem M.A. Aydinlar UniversitySchool of Medicine, Department of Radiation Oncology Turkey
| | - Senem Alanyali
- Department of Radiation OncologyFaculty of Medicine, Ege University Turkey
| | | | - Paul Van Houtte
- Department of Radiation OncologyJules Bordet Institute Brussels Belgium
| | - Schoeb Sohawon
- Department of Radiation OncologyJules Bordet Institute Brussels Belgium
| | - Mustafa Esassolak
- Department of Radiation OncologyFaculty of Medicine, Ege University Turkey
| | - Marco Krengli
- Department of RadiotherapyUniversity of Piemonte Orientale Novara Italy
| | - Salvador Villa
- Department of Radiation OncologyCatalan Institute of Oncology Badalona Spain
| | - Robert C. Miller
- Department of Radiation OncologyMayo Clinic Jacksonville Florida
| | - Candan Demiroz
- Uludag University Faculty of MedicineRadiation Oncology Clinical Division Turkey
| | - Serap Akyurek
- Department of RadiotherapyAnkara University School of Medicine Ankara Turkey
| | | | - Juliette Thariat
- Radiation Oncology DepartmentCentre Francois Baclesse Caen France
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