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Kayan Tapan T, Çelebi F, Yaghouti K, Ağaçayak F, İlgün S, Soybir G, Alço G, Ak N, Ordu Ç, Özkurt E, Ünal Ç, Kurt S, Öztürk A, İyigün Z, Duymaz T, Özmen V. The Relationship of Pathological Response and Visceral Muscle and Fat Volume in Women With Breast Cancer Who Received Neoadjuvant Chemotherapy. Eur J Breast Health 2024; 20:117-121. [PMID: 38571683 PMCID: PMC10985580 DOI: 10.4274/ejbh.galenos.2024.2023-12-5] [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: 12/19/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024]
Abstract
Objective Differences in individual muscle/fat volumes may change the effectiveness of chemotherapy. In this study, the relationship between trunkal muscle and fat volume and body mass index (BMI) obtained before receiving neoadjuvant chemotherapy (NCT) in patients with breast cancer and complete pathological response (pCR) was investigated. Materials and Methods The volumes of psoas, abdominal and paraspinal muscles, and trunkal subcutaneous and visceral fat were calculated using CoreSlicer AI 2.0 opensource program from the F-18 fluorodeoxyglucose positron emission tomography/computed tomography (CT) and CT images before NCT and postoperative pCR rates to NCT were recorded. Muscle/fat volumes and BMI prior to NCT were compared in terms of pathological pCR rates. Patients were followed up regularly for recurrence and survival. Results Ninety-three patients were included with median (range) values for age, BMI, and body weights of 48 (28-72) years, 27 (16.8-51.6) kg/m2, and 71.94 (43-137) kg, respectively. The median follow-up time was 18.6 (6.7-59.6) months. No significant correlation was found between total muscle or fat volumes of patients with and without pCR. BMI [26.2 (16.8-51.6) kg/m2 vs. 24.6 (20.3-34.3) kg/m2, p = 0.03] and pCR rates in patients with low right-psoas muscle volume [11.74 (7.03-18.51) vs. 10.2 (6.71-13.36), p = 0.025] were significantly greater. A significant relationship was found between right psoas muscle volume and disease-free survival (DFS) (11.74 cm3 (7.03-18.51) vs. 10.2 cm3 (6.71-13.36), p = 0.025). However, no significant relationship was detected between total muscle-fat volume, BMI and overall survival and DFS (p>0.05). Conclusion This is the first published study investigating the relationship between the pCR ratio and body muscle and fat volume measured by CoreSlicer AI 2.0 in patients with breast cancer who received NCT. No correlation was found between the pCR ratio and total muscle plus fat volume. However, these results need to be validated with larger patient series.
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Affiliation(s)
- Tuba Kayan Tapan
- Department of Nutrition and Dietetic, Demiroğlu Bilim University Faculty of Health Sciences, İstanbul, Turkey
| | - Filiz Çelebi
- Department of Radiology, Yeditepe University Faculty of Medicine, İstanbul, Turkey
| | - Kourosh Yaghouti
- Clinic of Radiology, Gayrettepe Florance Nightingale Hospital, İstanbul, Turkey
| | - Filiz Ağaçayak
- Clinic of Radiology, İstanbul Florance Nightingale Hospital, İstanbul, Turkey
| | - Serkan İlgün
- Clinic of Breast Surgeon, Mater Dei Hospital, Central Region, Malta
| | - Gürsel Soybir
- Clinic of General Surgeon, Şişli Memorial Hospital, İstanbul, Turkey
| | - Gül Alço
- Clinic of Radiation Oncology, Gayrettepe Florance Nightingale Hospital, İstanbul, Turkey
| | - Naziye Ak
- Clinic of Oncology, Gayrettepe Florance Nightingale Hospital, İstanbul, Turkey
| | - Çetin Ordu
- Clinic of Oncology, Gayrettepe Florance Nightingale Hospital, İstanbul, Turkey
| | - Enver Özkurt
- Clinic of Breast Surgeon, İstanbul Florance Nightingale Hospital, İstanbul, Turkey
| | - Çağlar Ünal
- Clinic of Oncology, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Sevgi Kurt
- Clinic of Plastic Surgeon, Gayrettepe Florance Nightingale Hospital, İstanbul, Turkey
| | - Alper Öztürk
- Department of General Surgeon, Biruni University Hospital, Biruni University Faculty of Medicine, İstanbul, Turkey
| | - Zeynep İyigün
- Department of Physical Therapy and Rehabilitation, Göztepe Medicalpark Hospital, Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
| | - Tomris Duymaz
- Department of Physical Therapy and Rehabilitation, İstanbul Bilgi University Faculty of Health Sciences, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, Breast Surgery, Surgical Oncology, İstanbul University-İstanbul Faculty of Medicine, İstanbul, Turkey
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Kurt S, İlgün AS, Özkurt E, Soybir G, Alço G, Ünal Ç, Çelebi FE, Duymaz T, Tapan TK, Ak N, Ordu Ç, Özmen V. Outcomes of reconstructive techniques in breast cancer using BCCT. core software. World J Surg Oncol 2024; 22:82. [PMID: 38519998 PMCID: PMC10960372 DOI: 10.1186/s12957-024-03343-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/14/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Surgery remains a priority for breast cancer treatment. This study aimed to compare the cosmetic outcomes of oncoplastic patients who had undergone breast-conserving surgery, mini-LDF (latissimus dorsi flap), and immediate implant reconstruction using both the Japanese scale and the BCCT.core (The Breast Cancer Conservative Treatment cosmetic results software) program and to validate this program. PATIENTS AND METHODS Patients who underwent surgery for breast cancer between 1997 and 2021 were retrospectively studied. Patients were divided into three groups: 1-those who had undergone breast-conserving surgery (245 patients, 71.3%), 2-those who had undergone mini-LDF after lumpectomy (38 patients, 11.02%), and 3- those who underwent reconstruction with implants after nipple-sparing mastectomy (61 patients, 17.68%). The patients were called for a follow-up examination, and their photos were taken. The photographs were shown to an independent breast surgeon and a plastic surgeon who was not included in the surgeries, and they were asked to evaluate and rate them according to the Japanese cosmetic evaluation scale. The same images were transferred to the computer and scored using BCCT.core. RESULTS The plastic and breast surgeon evaluation results showed no significant difference between the three cosmetic techniques (p = 0.99, 0.98). The results of BCCT.core software measurements were similar to the results of plastic and breast surgeons (p: 0.43). CONCLUSION Patients are more knowledgeable about cosmetic outcomes and expect more objective data. In this study, we used 3 different cosmetic evaluation scales. We found that these techniques give results that are compatible with each other in terms of evaluating the work done in a more concrete way. For this reason, we recommend the use of such software, which offers objective results in a subjective field such as aesthetics and is very easy to apply.
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Affiliation(s)
- Sevgi Kurt
- Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey.
| | | | - Enver Özkurt
- Department of General Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Gürsel Soybir
- Department of General Surgery, Memorial Şişli Hospital, Istanbul, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Çağlar Ünal
- Division of Medical Oncology, Department of Internal Medicine, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | | | - Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
| | - Tuğba Kayan Tapan
- Department of Nutrition and Dietetics, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Naziye Ak
- Division of Medical Oncology, Department of Internal Medicine, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Çetin Ordu
- Division of Medical Oncology, Department of Internal Medicine, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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Ünal Ç, Ordu Ç, Özmen T, İlgun AS, Çelebi F, Baysal B, Özkurt E, Duymaz T, Erdoğan İyigün Z, Kurt S, Öztürk MA, Pilancı KN, Alço G, Yararbaş K, Kayan Tapan T, Güven DC, Soybir G, Özmen V. Evaluation of Anti-Mullerian Hormone Levels, Antral Follicle Counts, and Mean Ovarian Volumes in Chemotherapy-Induced Amenorrhea among Breast Cancer Patients: A Prospective Clinical Study. Curr Oncol 2023; 30:9217-9229. [PMID: 37887566 PMCID: PMC10605884 DOI: 10.3390/curroncol30100666] [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: 09/20/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
Estradiol (E2), a follicle-stimulating hormone (FSH), AMH, and inhibin B levels, along with AFC and MOV, are used to determine ovarian reserve in pre-menopausal women. Studies have shown that AMH levels are more sensitive than those of E2, FSH, and inhibin B and that AFC and MOV can be used to evaluate ovarian reserve. AMH, AFC, and MOV measurements were performed before and after adjuvant SC in 3-month periods for one year. Patients were classified as experiencing chemotherapy-induced amenorrhea (CIA) if they did not have menstrual cycles for a period of six months or longer following the conclusion of their chemotherapy treatment. We aimed to evaluate the factors affecting chemotherapy-induced amenorrhea in breast cancer patients treated with adjuvant chemotherapy and the performance of baseline measurements of AMH, AFC, and MOV to predict chemotherapy-induced amenorrhea. The effects of different chemotherapy regimens on the AMH level, AFC, and MOV in CIA patients were investigated. Seventy-one patients were eligible for this study, and the median age was 38 years (range: 23-45). The median follow-up was 37 months (range: 20-51), and CIA developed in 62% of the patients. The AMH level and AFC were significantly decreased one year after SC (p < 0.0001), whereas MOV was not (p = 0.507). AMH levels before chemotherapy (median: 1.520 vs. 0.755, p = 0.001) and at the end of the first year (median: 0.073 vs. 0.010, p = 0.030) and pre-treatment AFC (median: 12 vs. 4.50, p = 0.026) were lower in patients with CIA compared to those without CIA. The AMH levels before SC were the most valuable and earliest factor for predicting CIA development. In addition, there was no difference between the chemotherapy regimens (including or not including taxane) in terms of CIA development.
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Affiliation(s)
- Çağlar Ünal
- Division of Medical Oncology, Department of Internal Medicine, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul 34865, Turkey
| | - Çetin Ordu
- Division of Medical Oncology, Department of Internal Medicine, Gayrettepe Florence Nightingale Hospital, Istanbul 34349, Turkey
| | - Tolga Özmen
- Division of Gastrointestinal and Oncologic Surgery, Harvard Medical School, Boston, MA 02115, USA
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Filiz Çelebi
- Department of Radiology, Yeditepe University Hospital, Istanbul 34755, Turkey
| | - Bülent Baysal
- Department of Obstetrics and Gynecology, İstanbul Florence Nightingale Hospital, Istanbul 34381, Turkey
| | - Enver Özkurt
- Department of General Surgery, İstanbul Florence Nightingale Hospital, Istanbul 34381, Turkey
| | - Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul 34060, Turkey
| | - Zeynep Erdoğan İyigün
- Department of Physical Theraphy and Rehabilitation, Göztepe Medical Park Hospital, Istanbul 34732, Turkey
| | - Sevgi Kurt
- Department of Plastic Surgery, İstanbul Florence Nightingale Hospital, Istanbul 34381, Turkey
| | | | - Kezban Nur Pilancı
- Division of Medical Oncology, Department of Internal Medicine, Memorial Bahçelievler Hospital, Istanbul 34180, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul 34349, Turkey
| | - Kanay Yararbaş
- Department of Medical Genetics, Demiroglu Bilim University, Istanbul 34394, Turkey
| | - Tuba Kayan Tapan
- Department of Nutrition and Dietetic, Faculty of Health Science, Demiroglu Bilim University, Istanbul 34394, Turkey
| | - Deniz Can Güven
- Division of Medical Oncology, Department of Internal Medicine, Elazıg Fethi Sekin City Hospital, Elazıg 23280, Turkey
| | - Gürsel Soybir
- Department of General Surgery, Memorial Şişli Hospital, Istanbul 34384, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul School of Medicine, İstanbul University, Istanbul 34093, Turkey
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Ünal Ç, Özmen T, İlgün AS, Ordu Ç, Özkurt E, Ak N, Alço G, Erdoğan İyigün Z, Kurt S, Duymaz T, Öztürk MA, Elbüken Çelebi F, Yararbaş K, Soybir G, Aktepe F, Özmen V. MCM-2 Levels as a Potential Biomarker for Predicting High-Risk Breast Cancer Patients According to TAILORx Classification. Breast Cancer (Dove Med Press) 2023; 15:659-669. [PMID: 37674872 PMCID: PMC10478780 DOI: 10.2147/bctt.s421535] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/11/2023] [Indexed: 09/08/2023]
Abstract
Background The minichromosome maintenance protein-2 (MCM-2) is a more sensitive proliferation marker than Ki-67. This study aimed to evaluate the relationship between MCM-2 and Oncotype DX recurrence score (ODX-RS) and determine an MCM-2 cutoff value in high-risk patients according to TAILORx risk categorization. Methods Hormone receptor (HR) positive HER-2 negative early-stage breast cancer patients (pT1-2, pN0-N1, M0) who had ODX-RS were included in the study. According to the TAILORx trial, patients were divided into two groups with high (ODX-RS ≥26) and low risk (ODX-RS <26) in terms of ODX-RS. Formalin-fixed-paraffin-embedded tissues of patients were re-evaluated, and 3 µm sections were prepared for MCM-2 immuno-histochemical staining. The relationship between ODX-RS and the percentage of MCM-2 staining was evaluated in two groups. The ROC curve analysis was performed to determine the MCM-2 cut-off value for the TAILORx high-risk group (ODX-RS ≥26). Results The mean MCM-2 value was significantly higher in the high-risk group [(60.2 ± 11.2 vs 34.4 ± 13.8, p < 0.001)]. In the multivariate analysis, MCM-2 (OR: 1.27, 95% CI: 1.08-1.49, p = 0.003) and progesterone receptor (PR) levels ≤10% (OR: 60.9, 95% CI: 4.1-89.7, p = 0.003) were found to be independent factors indicating a high-risk group. A one-unit increase in MCM-2 level increased the likelihood of being in the high-risk group by 1.27 times. In the ROC curve analysis, the optimal MCM-2 cut-off level was 50 (AUC: 0.921, sensitivity: 86.7%, specificity: 96.0%, p < 0.001). Conclusion Our study is the first study in the literature to investigate the relationship between ODX-RS and MCM-2 levels in HR-positive HER-2 negative early breast-cancer patients. In this study, MCM-2 was an independent risk factor in identifying high-risk patients according to TAILORx risk classification. MCM 2 cut-off value (50) may help the decision on adjuvant chemotherapy in patients where the Oncotype DX test cannot be performed.
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Affiliation(s)
- Çağlar Ünal
- Division of Medical Oncology, Department of Internal Medicine, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Tolga Özmen
- Division of Gastrointestinal and Oncologic Surgery, Harvard Medical School, Boston, MA, USA
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Çetin Ordu
- Division of Medical Oncology, Department of Internal Medicine, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Enver Özkurt
- Department of General Surgery, Istanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Naziye Ak
- Division of Medical Oncology, Department of Internal Medicine, Istanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Zeynep Erdoğan İyigün
- Department of Physical Therapy and Rehabilitation, Göztepe Medical Park Hospital, İstanbul, Turkey
| | - Sevgi Kurt
- Department of Plastic Surgery, Istanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
| | | | | | - Kanay Yararbaş
- Department of Medical Genetics, Demiroglu Bilim University, Istanbul, Turkey
| | - Gürsel Soybir
- Department of General Surgery, Memorial Şişli Hospital, İstanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Memorial Şişli Hospital, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, Istanbul University Istanbul School of Medicine, İstanbul, Turkey
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5
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Ünal Ç, Özmen T, Ordu Ç, Pilanci KN, İlgün AS, Gökmen E, Almuradova E, Özdoğan M, Güler N, Uras C, Kara H, Demircan O, Işık S, Alço G, Saip P, Aydın E, Duymaz T, Çelebi F, Yararbaş K, Soybir G, Ozmen V. Survival results according to Oncotype Dx recurrence score in patients with hormone receptor positive HER-2 negative early-stage breast cancer: first multicenter Oncotype Dx recurrence score survival data of Turkey. Front Oncol 2023; 13:1151733. [PMID: 37448522 PMCID: PMC10338087 DOI: 10.3389/fonc.2023.1151733] [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: 01/26/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Background The Oncotype Dx recurrence score (ODx-RS) guides the adjuvant chemotherapy decision-making process for patients with early-stage hormone receptor-positive, HER-2 receptor-negative breast cancer. This study aimed to evaluate survival and its correlation with ODx-RS in pT1-2, N0-N1mic patients treated with adjuvant therapy based on tumor board decisions. Patients and methods Estrogen-positive HER-2 negative early-stage breast cancer patients (pT1-2 N0, N1mic) with known ODx-RS, operated on between 2010 and 2014, were included in this study. The primary aim was to evaluate 5-year disease-free survival (DFS) rates according to ODX-RS. Results A total of 203 eligible patients were included in the study, with a median age of 48 (range 26-75) and median follow-up of 84 (range 23-138) months. ROC curve analysis for all patients revealed a recurrence cut-off age of 45 years, prompting evaluation by grouping patients as ≤45 years vs. >45 years. No significant difference in five-year DFS rates was observed between the endocrine-only (ET) and chemo-endocrine (CE) groups. However, among the ET group, DFS was higher in patients over 45 years compared to those aged ≤45 years. When stratifying by ODx-RS as 0-17 and ≥18, DFS was significantly higher in the former group within the ET group. However, such differences were not seen in the CE group. In the ET group, an ODx-RS ≥18 and menopausal status were identified as independent factors affecting survival, with only an ODx-RS ≥18 impacting DFS in patients aged ≤45 years. The ROC curve analysis for this subgroup found the ODx-RS cut-off to be 18. Conclusion This first multicenter Oncotype Dx survival analysis in Turkey demonstrates the importance of Oncotype Dx recurrence score and age in determining treatment strategies for early-stage breast cancer patients. As a different aproach to the literature, our findings suggest that the addition of chemotherapy to endocrine therapy in young patients (≤45 years) with Oncotype Dx recurrence scores of ≥18 improves DFS.
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Affiliation(s)
- Çağlar Ünal
- Division of Medical Oncology, Department of Internal Medicine, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Türkiye
| | - Tolga Özmen
- Division of Gastrointestinal and Oncologic Surgery, Harvard Medical School, Boston, MA, United States
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Çetin Ordu
- Division of Medical Oncology, Department of Internal Medicine, Gayrettepe Florence Nightingale Hospital, İstanbul, Türkiye
| | - Kezban Nur Pilanci
- Division of Medical Oncology, Department of Internal Medicine, Memorial Bahçelievler Hospital, İstanbul, Türkiye
| | | | - Erhan Gökmen
- Division of Medical Oncology, Department of Internal Medicine, Ege University School of Medicine, Izmir, Türkiye
| | - Elvina Almuradova
- Division of Medical Oncology, Department of Internal Medicine, Tınaztepe Galen Bayraklı Hospital, Izmir, Türkiye
| | - Mustafa Özdoğan
- Division of Medical Oncology, Department of Internal Medicine, Akdeniz University, Antalya, Türkiye
| | - Nilüfer Güler
- Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Institute of Oncology, Ankara, Türkiye
| | - Cihan Uras
- Department of General Surgery, Acıbadem University, İstanbul, Türkiye
| | - Halil Kara
- Department of General Surgery, Acıbadem University, İstanbul, Türkiye
| | - Orhan Demircan
- Department of General Surgery, Çukurova University School of Medicine, Adana, Türkiye
| | - Selver Işık
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Türkiye
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Türkiye
| | - Pınar Saip
- Division of Medical Oncology, Department of Internal Medicine, İstanbul University Institute of Oncology, İstanbul, Türkiye
| | - Esra Aydın
- Division of Medical Oncology, Department of Internal Medicine, İstanbul University Institute of Oncology, İstanbul, Türkiye
| | - Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İstanbul Bilgi University, İstanbul, Türkiye
| | - Filiz Çelebi
- Department of Radiology, Yeditepe University Hospital, İstanbul, Türkiye
| | - Kanay Yararbaş
- Department of Medical Genetics, Demiroglu Bilim University, İstanbul, Türkiye
| | - Gursel Soybir
- Department of General Surgery, Memorial Şişli Hospital, Istanbul, Türkiye
| | - Vahit Ozmen
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Türkiye
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Kaydıhan N, Alço G, Şenocak MŞ, Beşe N. Temporary Implant Irradiation: Survey of Turkish Society of Radiation Oncology Breast Cancer Study Group. Eur J Breast Health 2020; 17:21-27. [PMID: 33796827 DOI: 10.4274/ejbh.2020.5797] [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: 05/23/2020] [Accepted: 08/29/2020] [Indexed: 12/01/2022]
Abstract
Objective To understand the clinical approach of radiation oncologists during the treatment of patients with breast reconstruction. Materials and Methods A questionnaire survey was emailed to 105 active members of the Turkish Radiation Oncology Society, the Breast Cancer Study Group. The factors associated with radiation oncologists and their current practice was identified. Results Fifty radiation oncologists (47.6%) responded, and most of the responders (83%) were physicians who treated >50 new breast cancer patients annually. The majority of the physicians worked in academic hospitals and had more than 15 years of work experience. The early reconstruction rate was noted to be low among patients with mastectomy (<10% of the mastectomy patients) (p<0.05). Early implant irradiation with temporary tissue expander was noted to be a more common procedure. The majority of the respondents (68%) preferred to irradiate an inflated implant (20% total, 80% partial). In addition, 22% of the physicians declared that they routinely used bolus and that 60% of them used it only for patients at a high risk of local recurrence factors. Conclusion It can thus be concluded that variations exist between experienced radiation oncologists and others. Hypofractionation is not yet commonly practiced for patients with reconstruction in Turkey. A concrete consensus can be helpful to create a homogeneity in treatment decisions and practical applications.
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Affiliation(s)
- Nuri Kaydıhan
- Department of Radiation Oncology (Resigned), İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, İstanbul, Turkey.,Department of Radiation Oncology (In now), Memorial Bahçelievler Hospital, İstanbul, Turkey
| | - Gül Alço
- Clinic of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Mustafa Şükrü Şenocak
- Department of Biostatistics (Retired), İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Nuran Beşe
- Department of Radiation Oncology, Acıbadem University, Senology Research Institute, İstanbul, Turkey
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İzci F, Özdem G, İlgün AS, Ağaçayak F, Duymaz T, Erdoğan Z, Alço G, Elbüken F, Öztürk A, Ordu Ç, Ateşal KC, Doğan Öİ, Aktepe F, Özmen V. Pre-Treatment and Post-Treatment Anxiety, Depression, Sleep and Sexual Function Levels in Patients with Breast Cancer. Eur J Breast Health 2020; 16:219-225. [PMID: 32656524 DOI: 10.5152/ejbh.2020.5259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/24/2019] [Accepted: 03/05/2020] [Indexed: 12/20/2022]
Abstract
Objective In the phase of diagnosis and treatment of breast cancer cases, patients can usually experience sexual dysfunctions, sleep disorders and psychiatric disorders such as anxiety and depression. The main objective of our research is to study of the pre-treatment and post-treatment anxiety, depression, sleep and sexual function levels in the patients with breast cancer. Materials and Methods Fifty-six patients with breast cancer and 52 healthy women have participated in our study. In order to determine the anxiety, depression, sleep and sexual function levels, Sociodemographic and Clinical Data Form, Hospital Anxiety Depression Scale (HADS), Pittsburgh Sleep Quality Scale (PSQI) and Arizona Sexual Experiences Scale (ASEX) scores are utilized at pre-treatment and post-treatment phases for patients with breast cancer and our control group. Results According to scale scores applied to patients and control group, it has been determined that patients with breast cancer HADS sexual and sleep disorders, that their HADS and PSQI scores were higher and that ASEX scores decreased significantly (p<0.05). According to the scale scores calculated before and after treatment, there was a significant decrease in HADS and PSQI scores, whereas SEX scores have been increased significantly (p<0.05). Conclusion According to the findings of our study, anxiety, depression, sexual dysfunction and sleep disorders in patients with breast cancer are far more explicit in the pre-treatment phase than post-treatment phase. Therefore, it is crucial to psycho-socially support patients with breast cancer in the early periods before starting the treatment after diagnosis.
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Affiliation(s)
- Filiz İzci
- Department of Psychiatry, İstanbul Erenköy Training and Research Hospital, İstanbul, Turkey
| | - Gözdem Özdem
- İstanbul Florence Nightangale Hospital, Breast Health Center, İstanbul, Turkey
| | - Ahmet Serkan İlgün
- Department of General Surgery, İstanbul Taksim Training and Research Hospital, İstanbul, Turkey
| | - Filiz Ağaçayak
- İstanbul Florence Nightangale Hospital, Breast Health Center, İstanbul, Turkey
| | - Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, İstanbul Bilgi University Faculty of Health Sciences, İstanbul, Turkey
| | - Zeynep Erdoğan
- İstanbul Florence Nightangale Hospital, Breast Health Center, İstanbul, Turkey
| | - Gül Alço
- Gayrettepe Florence Nightingale Hospital, Breast Health Center, İstanbul, Turkey
| | - Filiz Elbüken
- Gayrettepe Florence Nightingale Hospital, Breast Health Center, İstanbul, Turkey
| | - Alper Öztürk
- Department of General Surgery, Biruni University School of Medicine, İstanbul, Turkey
| | - Çetin Ordu
- Gayrettepe Florence Nightingale Hospital, Breast Health Center, İstanbul, Turkey
| | - Kübra Ceren Ateşal
- Department of Psychiatry, İstanbul Erenköy Training and Research Hospital, İstanbul, Turkey
| | - Özge İpek Doğan
- Department of Psychiatry, İstanbul Erenköy Training and Research Hospital, İstanbul, Turkey
| | - Fatma Aktepe
- Gayrettepe Florence Nightingale Hospital, Breast Health Center, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
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8
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Çelebi F, Ordu Ç, Ilgün S, Oztürk A, Erdoğan Iyigün Z, Alço G, Duymaz T, Aktepe F, Soybir G, Baysal B, Özmen V. The Effect of Systemic Chemotherapy on Ovarian Function: A Prospective Clinical Trial. Eur J Breast Health 2020; 16:177-182. [PMID: 32656517 DOI: 10.5152/ejbh.2020.5114] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/25/2019] [Indexed: 11/22/2022]
Abstract
Objective Premenopausal women with breast cancer are at risk of developing ovarian failure after chemotherapy. The aim of this study was to investigate the negative effects of systemic chemotherapy on ovarian function in premenoupausal women with breast cancer. Materials and Methods Thirty-one premenopausal women with operable breast cancer aged between 26-48 years were enrolled in this prospective cohort study to investigate preliminary results. Additional 69 patients' data will be included after the completion of all five measurements. The change in serum Antimullerian Hormone (AMH) levels, mean ovarian volumes (MOV) and antral follicle counts (AFCs) at 3-month intervals were recorded to evaluate ovarian function. Women who had at least one pretreatment and four post-treatment measurements in one year follow-up period were included in the study. Decision of chemotherapy regimen was taken by the Tumor Board. Results Thirty-one patients had all five AMH, MOV and AFCs results. There was a statistically significant negative correlation between 1st - 5th AMH levels (p=0.006) and 1st - 5th AFCs during the follow-up period (p<0.0001). However pre- and post-chemotherapy measurements of MOVs did not demonstrate any significant correlation (p=0.799). BMI, parity, lactation, histopathology and molecular subtypes of breast cancer, alcohol intake, smoking and type of chemotherapy regimen were not significantly correlated with AMH, AFC and MOV. Conclusion Pretreatment AMH levels and AFC were shown to have a significant role in early prediction of ovarian-reserve after chemotherapy.
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Affiliation(s)
- Filiz Çelebi
- Department of Radiology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Çetin Ordu
- Department of Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Serkan Ilgün
- Department of General Surgery, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey
| | - Alper Oztürk
- Department of General Surgery, Biruni University Hospital, İstanbul, Turkey
| | - Zeynep Erdoğan Iyigün
- Department of Physical Therapy and Rehabilitation, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Tomris Duymaz
- Department of Physical Therapy and Rehabilitation, Bilgi University, İstanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Gürsel Soybir
- Department of General Surgery, Memorial Etiler Hospital, İstanbul, Turkey
| | - Bülent Baysal
- Department of Obstetrics and Gynecology, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
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9
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Duymaz T, İyigün ZE, İlgün AS, Ordu Ç, Üçüncü M, Alço G, Öztürk A, Elbüken F, Aktepe F, Özmen V. The Effect of Mini-Latissimus Dorsi Flap (MLDF) Reconstruction on Shoulder Function in Breast Cancer Patients. Eur J Breast Health 2019; 15:158-162. [PMID: 31312791 DOI: 10.5152/ejbh.2019.4727] [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: 02/05/2019] [Accepted: 04/01/2019] [Indexed: 11/22/2022]
Abstract
Objective The aim of this study is to investigate the effect of mini latissimus dorsi flap (MLDF) reconstruction on ipsilateral shoulder functions. Materials and Methods Those included in the study are the patients aged between 23 and 73, who were operated with the diagnosis of early breast cancer (cT1-3)N0). The first group includes the patients who had sentinel lymph node biopsy (SLNB) with partial mastectomy. The second group consists of the patients who had axillary lymph nodule dissection (ALND) with partial mastectomy. The third group includes the patients who had SLNB and MLDF with partial mastectomy. The fourth group includes the patients who had ALND and MLDF with partial mastectomy. Patients' Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score work model point were recorded. Results 174 patients were included in this study. According to Q-DASH score, no functional change was detected in 69.5% of the patients, whereas slight functional loss was identified in 23.6%, moderate functional loss in 5.7%, severe functional loss 1.1%. In the comparison of Q-DASH scores in surgery groups, while these four groups were being analyzed, a significant difference was determined (p=0.007). When dual analyses were made, it was also established that the difference resulted from the group to which ALND and MLDF were applied together. Conclusion We conclude that MLDF application for reconstruction purposes after breast surgery has a negative impact on shoulder functions of the patients who had both of partial mastectomy and ALND.
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Affiliation(s)
- Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, İstanbul Bilgi University School of Health Sciences, İstanbul, Turkey
| | - Zeynep Erdoğan İyigün
- Department of Physiotherapy and Rehabilitation, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Ahmet Serkan İlgün
- Department of General Surgery, Taksim Training and Research Hospital, İstanbul, Turkey
| | - Çetin Ordu
- Department of Medical Oncology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Muhammed Üçüncü
- Centre of Breast Health, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Alper Öztürk
- Department of General Surgery, Biruni University School of Medicine, İstanbul, Turkey
| | - Filiz Elbüken
- Departmment of Radiology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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10
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Ordu Ç, Pilancı KN, Alço G, Elbüken F, Köksal Üİ, İlgun S, Sarsenov D, Aydın AE, Öztürk A, Erdoğan Zİ, Ağaçayak F, Çubuk F, Tecimer C, Eralp Y, Duymaz T, Aktepe F, Özmen V. Prognostic Significance of Adjuvant Chemotherapy Induced Amenorrhea in Luminal A and B Subtypes. Eur J Breast Health 2018; 14:173-179. [PMID: 30123884 DOI: 10.5152/ejbh.2018.3808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/02/2017] [Accepted: 02/26/2018] [Indexed: 02/02/2023]
Abstract
Objective In this retrospective study, chemotherapy induced amenorrhea in patients with early stage breast cancer and its effects on survival were investigated. Materials and Methods Two hundred fifty-two patients received adjuvant chemotherapy without ovarian suppression treatment (OST) from 600 premenopausal patients were included in the study. Patients were divided into two groups; with amenorrhea and without, and compared with clinicopathologic features and survival. SPSS version 17 was used. Results Chemotherapy-induced amenorrhea (CIA) was observed in 145 (57.5%) of 252 patients who received no OST during follow-up. The 5-year OS rate of patients with CIA was significantly higher than patients without CIA (p= 0.042, 95.9% vs. 89.7% vs. 158.88 vs. 135.33 months, respectively). In the subgroup analysis, the OS in patients with hormone receptor (+) was significantly higher than in those receptor (-) in patients with CIA (p=0.011, 97.5% vs. 90.9% vs. 162.13 vs. 126.16 months, respectively). The OS was significantly longer in the luminal A molecular subtype than in those with luminal B molecular subtype, in patients with CIA, but the difference was not significant in patients without CIA (p=0.027 vs. p=0.074, respectively). Conclusion As a conclusion; survival advantage of the chemotherapy induced amenorrhea more pronounced with hormone receptor positivity, lymph node involvement, and advanced disease over patients who do not develop amenorrhea. This advantage of amenorrhea development further prolongs survival compared with luminal B in the luminal A molecular subtype.
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Affiliation(s)
- Çetin Ordu
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Kezban Nur Pilancı
- Department of Medical Oncology, Haseki Research and Training Hospital, İstanbul, Turkey
| | - Gül Alço
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Filiz Elbüken
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Ülkühan İner Köksal
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Serkan İlgun
- Department of General Surgery, Gaziosmanpaşa Research and Training Hospital, İstanbul, Turkey
| | - Dauren Sarsenov
- Department of Breast Surgery, Istanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Ayşe Esra Aydın
- Department of Breast Surgery, Istanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Alper Öztürk
- Department of General Surgery, Biruni University, İstanbul, Turkey
| | - Zeynep İyigün Erdoğan
- Department of Physical Therapy and Rehabilitation, Şişli Florence Nightingale Hospital, İstanbul, Turkey
| | - Filiz Ağaçayak
- Department of Breast Surgery, Istanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Fatmagül Çubuk
- Department of General Surgery, Gaziosmanpaşa Research and Training Hospital, İstanbul, Turkey
| | - Coşkun Tecimer
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Yeşim Eralp
- Department of Medical Oncology, Istanbul University School of Medicine, İstanbul, Turkey
| | - Tomris Duymaz
- Department of Physical Therapy and Rehabilitation, İstanbul Bilim University, İstanbul, Turkey
| | - Fatma Aktepe
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Vahit Özmen
- Department of Medical Oncology, Istanbul University School of Medicine, İstanbul, Turkey
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11
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Yıldırım NK, Özkan M, İlgün AS, Sarsenov D, Alço G, Aktepe F, Kalyoncu N, İzci F, Selamoğlu D, Ordu Ç, Pilancı KN, İyigün ZE, Eralp Y, Özmen V. Possible role of stress, coping strategies, and life style in the development of breast cancer. Int J Psychiatry Med 2018; 53:207-220. [PMID: 29292669 DOI: 10.1177/0091217417749789] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective The aim of the present study was to investigate the possibility of the effect of life long stressful events, along with coping method used, perception of social support, and life style on the development of breast cancer. Methods In this hospital-based case control study, the study group comprised 250 women with breast cancer who were followed by Florence Nightingale Breast Study Group. Control group included 250 women, who had similar sociodemographic characteristics to the study group. Data were collected with semi-structured interview form, Healthy Life Style Behavior Scale, Coping Strategy Indicator, and Stress Evaluation Form developed by us. Results In multivariate analysis, family history of cancer (OR: 1.55, 95% CI: 2.29-1.05), inadequate social support (OR: 1.83, 95% CI: 1.23-2.73), and loss of father during childhood (OR: 2.68, 95% CI: 5.52-1.30) and serious stressor within the last five years (OR: 4.72, 95% CI: 7.03-3.18) were found to be risk factors increasing the risk of breast cancer. When family history of cancer was excluded from the model, the presence of psychiatric disorder history (OR: 1.95, 95% CI: 3.26-1.17) and major life events (OR: 2.24, 95% CI: 4.07-1.24) were added to the model as risk factors. Conclusion The present study indicates that especially the stressful events experienced within the last five years plays an undeniable role in the risk of breast cancer. Social support may be as important in the period before the diagnosis as in the period after diagnosis.
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Affiliation(s)
- Nazmiye K Yıldırım
- 1 Department of Consultation Liaison Psychiatry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mine Özkan
- 1 Department of Consultation Liaison Psychiatry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ahmet S İlgün
- 2 Istanbul Florence Nightingale Hospital, Breast Health Center, Istanbul, Turkey
| | - Dauren Sarsenov
- 2 Istanbul Florence Nightingale Hospital, Breast Health Center, Istanbul, Turkey
| | - Gül Alço
- 3 Department of Radiation Oncology, Istanbul Bilim University, Istanbul, Turkey
| | - Fatma Aktepe
- 4 Department of Pathology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Nesiba Kalyoncu
- 1 Department of Consultation Liaison Psychiatry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Filiz İzci
- 5 Department of Psychiatry, Medical Faculty, Istanbul Bilim University, Istanbul, Turkey
| | - Derya Selamoğlu
- 6 Department of General Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Çetin Ordu
- 7 Radiation Oncology Center, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Kezban N Pilancı
- 8 Department of Medical Oncology, Istanbul Haseki Training and Research Hospital, Istanbul, Turkey
| | - Zeynep E İyigün
- 9 Physical Therapy and Rehabilitation Center, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Yeşim Eralp
- 10 Medical Oncology Unit, Institute of Oncology, 37516 Istanbul University , Istanbul, Turkey
| | - Vahit Özmen
- 11 Department of General Surgery, Faculty of Medicine, 37516 Istanbul University , Istanbul, Turkey
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12
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İzci F, Sarsanov D, Erdogan Zİ, İlgün AS, Çelebi E, Alço G, Kocaman N, Ordu Ç, Öztürk A, Duymaz T, Pilavcı KN, Elbüken F, Ağaçayak F, Aktepe F, Ünveren G, Özdem G, Eralp Y, Özmen V. Impact of Personality Traits, Anxiety, Depression and Hopelessness Levels on Quality of Life in the Patients with Breast Cancer. Eur J Breast Health 2018; 14:105-111. [PMID: 29774319 DOI: 10.5152/ejbh.2018.3724] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 07/13/2017] [Accepted: 12/19/2017] [Indexed: 11/22/2022]
Abstract
Objective The aim of this study was to investigate the impacts of personality traits, anxiety, depression and hopelessness levels on quality of life in the patients with breast cancer. Materials and methods The study was performed on 90 patients diagnosed with breast cancer and 90 healthy women. Sociodemographic and Clinical Data Collection Form designed by us, Beck Hopelessness Scale (BHS), Beck Anxiety Scale (BAS), Beck Depression Scale (BDS), Eysenck Personality Inventory (EPI) and Quality of Life Scale-Short Form (SF-36) were administered to patients and to control group. Results The patients with breast cancer were found to indicate higher levels of anxiety and depression, lower levels of quality of life, and higher scores of personality inventory subscales as compared to the healthy control group. In the patient group, it was identified that the quality of life subscale scores were found to be negatively correlated with anxiety, depression, hopelessness and neurotic personality scores; there was a positive correlation between neurotic personality scores and depression, anxiety and hopelessness scores. Conclusions It can be concluded that the breast cancer patients with extraversion personality traits have lower levels of anxiety and depression, keeping their quality of life better, whereas the patients with higher neuroticism scores may have more impaired quality of life. Therefore, the psychiatric evaluation of the breast cancer patients during and after the treatment cannot be ruled out.
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Affiliation(s)
- Filiz İzci
- Department of Psychiatry, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Dauren Sarsanov
- Department of General Surgery, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Zeynep İyigün Erdogan
- Department of Physical Therapy and Rehabilitation, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Ahmet Serkan İlgün
- Department of General Surgery, İstanbul Taksim Training and Research Hospital, İstanbul, Turkey
| | - Esra Çelebi
- Department of General Surgery, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Gül Alço
- Department of Nucleer Medicine, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Nazmiye Kocaman
- Department of Psyhiatry, İstanbul University School of Medicine, İstanbul, Turkey
| | - Çetin Ordu
- Department of Onchology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Alper Öztürk
- Department of General Surgery, İstanbul Biruni University School of Medicine, İstanbul, Turkey
| | - Tomris Duymaz
- Department of Physical Therapy and Rehabilitation, İstanbul Biruni University School of Medicine, İstanbul, Turkey
| | - Kezban Nur Pilavcı
- Department of Onchology, İstanbul Haseki Training and Research Hospital, İstanbul, Turkey
| | - Filiz Elbüken
- Department of Radiology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Filiz Ağaçayak
- Department of Radiology, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, İstanbul Biruni University School of Medicine, İstanbul, Turkey
| | - Gizem Ünveren
- Department of Psychology, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Gözdem Özdem
- Department of Psychology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Yeşim Eralp
- Department of Internal Medicine, İstanbul University School of Medicine, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul University School of Medicine, İstanbul, Turkey
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13
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Özkan M, Yıldırım N, Dişçi R, İlgün AS, Sarsenov D, Alço G, Aktepe F, Kalyoncu N, İzci F, Selamoğlu D, Ordu Ç, Pilancı KN, Erdoğan Zİ, Eralp Y, Özmen V. Roles of Biopsychosocial Factors in the Development of Breast Cancer. Eur J Breast Health 2017; 13:206-212. [PMID: 29082379 DOI: 10.5152/ejbh.2017.3519] [Citation(s) in RCA: 5] [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: 03/24/2017] [Accepted: 08/07/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to determine the roles of biopsychosocial risk factors in the development of breast cancer. MATERIALS AND METHODS This hospital-based case-control study included 491 women with breast cancer (study group) and 512 women who did not have cancer or other serious diseases (control group). Biological, psychological, and social risk factors were compared between the two groups. Data were collected using the semi-structured interview, the Stress Assessment Form, and the Coping Strategy Indicator to assess these factors. RESULTS When the significantly different biopsychosocial variables between the study and the control groups were evaluated together, independent breast cancer risk factors were found as follows: a stressor experienced in the last 5 years, age 40 years and older, inadequate social support perception, use of avoidance coping strategy, being a housewife, having a family history of cancer, and having a body mass index ≥25. CONCLUSION This study showed a relationship between breast cancer risk and manageable variables (obesity, stressor and coping strategy, social support, and employment status), age and family history of cancer, which are biopsychosocial factors. Biopsychosocial aspects are becoming a greater part of many different healthcare systems.
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Affiliation(s)
- Mine Özkan
- Department of Consultation Liaison Psychiatry, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Nazmiye Yıldırım
- Department of Consultation Liaison Psychiatry, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Rian Dişçi
- Department of Public Health, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Ahmet Serkan İlgün
- Breast Health Center, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Dauren Sarsenov
- Breast Health Center, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Gül Alço
- Department of Radiation Oncology, İstanbul Bilim University, İstanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Nesiba Kalyoncu
- Department of Consultation Liaison Psychiatry, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Filiz İzci
- Department of Psychiatry, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Derya Selamoğlu
- Department of General Surgery, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Çetin Ordu
- Radiation Oncology Center, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Kezban Nur Pilancı
- Department of Medical Oncology, İstanbul Haseki Training and Research Hospital, İstanbul, Turkey
| | - Zeynep İyigün Erdoğan
- Physical Therapy and Rehabilitation Center, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Yeşim Eralp
- Department of Medical Oncology, Oncology Institute, İstanbul University, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
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14
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Ordu C, Pilancı K, Elbüken F, Alço G, Köksal Ü, İlgün S, Sarsenov D, Aydın A, Öztürk A, Erdoğan Z, Ağaçayak F, Tecimer C, Eralp Y, Aktepe F, Özmen V. The prognostic impact of chemotherapy induced amenorrhea in women treated with early stage breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.022] [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: 11/14/2022] Open
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15
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Çelebi F, Pilancı KN, Ordu Ç, Ağacayak F, Alço G, İlgün S, Sarsenov D, Erdoğan Z, Özmen V. The role of ultrasonographic findings to predict molecular subtype, histologic grade, and hormone receptor status of breast cancer. Diagn Interv Radiol 2016; 21:448-53. [PMID: 26359880 DOI: 10.5152/dir.2015.14515] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The correlation between imaging findings and pathologic characteristics of tumors may provide information for diagnosis and treatment of cancer. The aim of this study is to determine whether ultrasound features of breast cancer are associated with molecular subtype, histologic grade, and hormone receptor status, as well as assess the predictive value of these features. METHODS A total of 201 consecutive invasive breast cancer patients were reviewed from the database according to the Breast Imaging and Reporting Data System (BI-RADS). Tumor margins were classified as circumscribed and noncircumscribed. Noncircumscribed group was divided into indistinct, spiculated, angular, and microlobulated. The posterior acoustic features were divided into four categories: shadowing, enhancement, no change, and mixed pattern. RESULTS Tumors with posterior shadowing were more likely to be of nontriple negative subtype (odds ratio [OR], 7.42; 95% CI, 2.10-24.99; P = 0.002), low histologic grade (grade 1 or 2 vs. grade 3: OR, 2.42; 95% CI, 1.34-4.35; P = 0.003) and having at least one positive receptor (OR, 3.36; 95% CI, 1.55-7.26; P = 0.002). Tumors with circumscribed margins were more often triple-negative subtype (OR, 6.72; 95% CI, 2.56-17.65; P < 0.001), high grade (grade 3 vs. grade 1 or 2: OR, 5.42; 95% CI, 2.66-11.00; P < 0.001) and hormone receptor negative (OR, 4.87; 95% CI, 2.37-9.99; P < 0.001). CONCLUSION Sonographic features are strongly associated with molecular subtype, histologic grade, and hormone receptor status of the tumor. These findings may separate triple-negative breast cancer from other molecular subtypes.
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Affiliation(s)
- Filiz Çelebi
- Department of Radiology, Florence Nightingale Hospital, İstanbul, Turkey.
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16
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Alço G, Igdem S, Okkan S, Dincer M, Sarsenov D, Ilgun AS, Agacayak F, Elbüken F, Ercan T, Selamoglu D, Ozmen V. Replacement of the tumor bed following oncoplastic breast-conserving surgery with immediate latissimus dorsi mini-flap. Mol Clin Oncol 2016; 5:365-371. [PMID: 27699027 PMCID: PMC5038510 DOI: 10.3892/mco.2016.984] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 11/24/2015] [Accepted: 04/25/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to evaluate the geographic variability of the tumor bed following oncoplastic breast-conserving surgery (OP-BCS), and to assess its relevance for radiotherapy planning. In this prospective study, pre- and postoperative computerized tomography (CT) scans of 22 patients with early-stage breast cancer were fused. The preoperative gross tumor volume or excisional biopsy cavity were contoured under the guidance of preoperative radiological images. Postoperative lumpectomy cavities were contoured under the guidance of surgical clips. The conformity index (CI) was calculated and defined on a scale between 0 and 1, where 0 indicated no overlap and 1 indicated 100% concordance. Associations between CI and the number of clips, time interval between surgery and CT scans, pathological tumor size and age were assessed using independent sample testing. The median CI was 0.07 (in five cases, 1, and in eight cases, 0). The lumpectomy cavity shifted from the primary location in 36.4% of the cases. Median shifts between the isocenters of pre- and postoperative volumes were measured as 1.02 cm (range, 0.4-4.43 cm) in the x, 1.07 cm (range, 0.05-5.67 cm) in the y, and 1.12 cm (range, 0-3.75 cm) in the z directions. Only the clip number was determined to be significantly associated with CI (P=0.017). Pre- and postoperative tumor bed volumes were fully superposed in five of the 22 cases. The present study has shown that the tumor bed is markedly replaced following OP-BCS with latissimus dorsi mini-flap (LDMF) reconstruction. Special care should therefore be taken when defining the lumpectomy cavity following OP-BCS with LDMF reconstruction.
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Affiliation(s)
- Gül Alço
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Sefik Igdem
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Sait Okkan
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Maktav Dincer
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Dauren Sarsenov
- Department of Breast Surgery, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Ahmet Serkan Ilgun
- Department of Breast Surgery, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Filiz Agacayak
- Department of Radiodiagnostics, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Filiz Elbüken
- Department of Radiodiagnostics, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Tulay Ercan
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Derya Selamoglu
- Department of Breast Surgery, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Vahit Ozmen
- Department of Breast Surgery, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
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Ercan T, İğdem Ş, Alço G. The effect of bladder contrast on dose calculation in volumetric modulated arc therapy planning in patients treated for postoperative prostate cancer. Jpn J Radiol 2016; 34:376-82. [PMID: 26842552 DOI: 10.1007/s11604-016-0523-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/08/2015] [Accepted: 01/19/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of contrast agent on dose calculation in volumetric modulated arc therapy (VMAT) in the post-prostatectomy setting. METHODS AND MATERIAL Ten patients were studied. Each patient received planning computed tomography (CT) images with contrast agent. All of the plans were done on virtually simulated contrast-free CT scans. The plan approved by the radiation oncologist was replicated to the contrast CT series. In both of the plans the same monitor unit was used. The doses calculated from the two plans were compared in regard to target volumes and organs at risk. A paired sample t-test was used to evaluate the differences in cumulative dose volume histogram between the two plans. RESULTS We showed that the use of contrast agent may cause significant differences in dose distribution. There was a significant decrease in doses received by planning target volume (PTV70), rectum V65 Gy, rectum V40 Gy, bladder V65 Gy, penile bulb V40 Gy in plans with contrast-enhanced CT sets. The decrease in mean, maximum and minimum doses received by PTV70 also contributed to the significant decrease in conformity index. CONCLUSIONS Using a contrast agent at the time of CT simulation may cause significant differences in dose distribution. For this reason, the plan should always be carried out on non-contrast CT data sets to avoid additional errors in the treatment planning process.
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Affiliation(s)
- Tülay Ercan
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Cemil Aslan Güder Sok 8, Floor-1, Gayrettepe, 34349, Istanbul, Turkey.
| | - Şefik İğdem
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Cemil Aslan Güder Sok 8, Floor-1, Gayrettepe, 34349, Istanbul, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Cemil Aslan Güder Sok 8, Floor-1, Gayrettepe, 34349, Istanbul, Turkey
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Çelebi F, Köksal Ü, Pilancı KN, Ordu Ç, Sarsenov D, İlgün S, Çabuk FK, Alço G, Özdil G, Erdoğan Z, Özmen V. PET-MRI Findings of Two Patients with Breast Carcinoma before Treatment. J Breast Health 2016; 12:88-90. [PMID: 28331741 DOI: 10.5152/tjbh.2016.2867] [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] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 02/09/2016] [Indexed: 11/22/2022]
Abstract
Integrated positron-emission tomography-magnetic resonance imaging (PET-MRI) is a new hybrid simultaneous imaging modality with higher soft tissue contrast and lower radiation doses compared with PET-CT. Two patients who were referred to our hospital with left breast masses that were pathologically diagnosed as invasive ductal carcinoma. The women were then scanned using the first PET-MRI system in Turkey, which was established in our department. In this case report, we aimed to determine the advantages of PET-MRI in staging, follow-up, neoadjuvant chemotherapy response, and to compare the usefulness of this modality with PET-CT and dynamic contrast-enhanced breast MRI.
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Affiliation(s)
- Filiz Çelebi
- Clinic of Radiology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Ülkühan Köksal
- Department of Oncology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Kezban Nur Pilancı
- Department of Oncology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Çetin Ordu
- Department of Oncology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Dauren Sarsenov
- Clinic of General Surgery, Florence Nightingale Hospital, İstanbul, Turkey
| | - Serkan İlgün
- Clinic of General Surgery, Florence Nightingale Hospital, İstanbul, Turkey
| | - Fatmagül Kuşku Çabuk
- Department of Pathology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Gül Alço
- Clinic of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Güzide Özdil
- Department of Radiology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Zeynep Erdoğan
- Department of Physical Therapy and Reanimation, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Vahit Özmen
- Clinic of General Surgery, Florence Nightingale Hospital, İstanbul, Turkey
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İyigün ZE, Pilancı KN, Çabuk FK, İlgün S, Ordu Ç, Duymaz T, Alço G, Çelebi F, Sarsenov D, İzci F, Öztürk A, Ağaçayak F, Köksal Üİ, Aktepe F, Eralp Y, Özmen V. The Relationship between Bone Mineral Density and Estrogen Receptor Positivity in Patients with Breast Cancer. J Breast Health 2016; 12:119-122. [PMID: 28331747 DOI: 10.5152/tjbh.2016.2961] [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] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/07/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The effect of estrogen on bone mineral density (BMD) and breast cancer has been known for a long time. The aim of this study was to compare of the BMD of patients with breast cancer and healthy individuals, and to investigate the degree of correlation of estrogen receptor (ER) with BMD. MATERIALS AND METHODS Seventy-one patients with postmenopausal breast cancer and 79 healthy dividuals were included in the study. The patient demographics (age, menopause age, body mass index, number of children, BMD, Z scores, and estrogen status for breast cancer patients) were taken from hospital records. RESULTS No significant difference was detected between the case and control groups in lumbar region Z scores (p=0.074). At the femur neck, the control group Z scores was higher than patient group (p=0.002). BMI was higher in the patients with breast cancer (p=0.001). There was no statistically significant correlation between ER positivity, BMD, and BMI in ER-positive patients (p=0.495, p=0.8, p=0.846, respectively). There was no difference between the Z scores when the patients were divided into two groups as ER positive and negative (p=0.156, p=0.335, respectively). CONCLUSION This study revealed that there is no difference in lumbar region Z scores between patients with breast cancer and heathy controls; however, the Z scores were higher in the femur neck in the control group, and the BMI was lower in the patient group. Tumor ER positivity does not positively affect BMD.
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Affiliation(s)
| | | | | | - Serkan İlgün
- Florence Nightingale Breast Study Group, İstanbul, Turkey
| | - Çetin Ordu
- Florence Nightingale Breast Study Group, İstanbul, Turkey
| | - Tomris Duymaz
- Florence Nightingale Breast Study Group, İstanbul, Turkey
| | - Gül Alço
- Florence Nightingale Breast Study Group, İstanbul, Turkey
| | - Filiz Çelebi
- Florence Nightingale Breast Study Group, İstanbul, Turkey
| | | | - Filiz İzci
- Florence Nightingale Breast Study Group, İstanbul, Turkey
| | - Alper Öztürk
- Florence Nightingale Breast Study Group, İstanbul, Turkey
| | - Filiz Ağaçayak
- Florence Nightingale Breast Study Group, İstanbul, Turkey
| | | | - Fatma Aktepe
- Florence Nightingale Breast Study Group, İstanbul, Turkey
| | - Yeşim Eralp
- Florence Nightingale Breast Study Group, İstanbul, Turkey
| | - Vahit Özmen
- Florence Nightingale Breast Study Group, İstanbul, Turkey
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Ordu C, Alço G, Pilanc K, Ilgün S, Sarsenov D, Celebi F, IyigüNun Erdoğan Z, Ağaçayak F, Demir G, Eralp Y, Tecimer C, Ozmen V. 1967 Does adjuvant chemotherapy induced amenorrhea effect survival in operated premenopausal breast cancer patients? Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30915-7] [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: 10/22/2022]
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Eralp Y, Kılıç L, Alço G, Başaran G, Doğan M, Dinçol D, Demirci S, İçli F, Onur H, Saip P, Haydaroğlu A. The Outcome of Patients with Triple Negative Breast Cancer: The Turkish Oncology Group Experience. J Breast Health 2014; 10:209-215. [PMID: 28331673 DOI: 10.5152/tjbh.2014.1904] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 06/24/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Triple negative breast cancer (TNBC) is generally considered as a poorer prognostic subgroup, with propensity for earlier relapse and visceral involvement. The aim of this study is to evaluate the outcome of non-metastatic TNBC patients from different centers in Turkey and identify clinical and pathologic variables that may effect survival. MATERIALS AND METHODS Between 1993-2007, from five different centers in Turkey, 316 nonmetastatic triple negative breast cancer patients were identified with follow-up of at least 12 months. The data was collected retrospectively from patient charts. The prognostic impact of several clinical variables were evaluated by the Kaplan-Meier and Cox multivariate anayses. RESULTS Mean age at diagnosis was 49 years (range: 24-82). The majority of the patient group had invasive ductal carcinoma (n: 260, 82.3%) and stage II disease (n: 164; 51.9%). Majority of the patients (87.7%) received adjuvant chemotherapy. 5 year overall survival (OS) and disease-free survival (DFS) rates were 84.6% and 71.6%, respectively. Univariate analysis revealed locally advanced disease (p: 0.001), advanced pathological stage (p: 0.021), larger tumor size (T1&T2 vs T3&T4) (p<0.001), nodal positivity (p: 0.006), and extensive nodal involvement (p<0.001) as significant factors for DFS; whereas, advanced pathological stage (p: 0.017), extensive nodal involvement (p<0.001) and larger tumor size (p: 0,001) and presence of breast cancer-affected member in the family (p=0.05) were identified as prognostic factors with an impact on OS. Multivariate analysis revealed larger tumor size (T3&T4 vs T1&T2) and presence of lymph node metastases (node-positive vs node-negative) as significant independent prognostic factors for DFS (Hazard ratio (HR): 3.03, 95% CI: 1.71-5.35, p<0.001 and HR: 1.77, 95% CI: 1.05-3.0, p=0.03, respectively). Higher tumor stage was the only independent factor affecting overall survival (HR: 2.81; 95% CI, 1.27-6.22, p=0.01). CONCLUSION The outcome of patients with TNBC in this cohort is comparable to other studies including TNBC patients. Tumor size and presence of lymph node metastasis are the major independent factors that have effect on DFS, however higher tumor stage was the only negative prognostic factor for OS.
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Affiliation(s)
- Yeşim Eralp
- Department of Medical Oncology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Leyla Kılıç
- Department of Medical Oncology, Fırat University Hospital, Elazığ, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, İstanbul, Turkey
| | - Gül Başaran
- Department of Medical Oncology, Acibadem University Faculty of Medicine, İstanbul, Turkey
| | - Mutlu Doğan
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Dilek Dinçol
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Senem Demirci
- Department of Radiation Oncology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Fikri İçli
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Handan Onur
- Department of Medical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Pınar Saip
- Department of Medical Oncology, İstanbul University Faculty of Medicine, İstanbul, Turkey
| | - Ayfer Haydaroğlu
- Department of Radiation Oncology, Ege University Faculty of Medicine, İzmir, Turkey
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Alço G, Iğdem SI, Ercan T, Dinçer M, Sentürk R, Atilla S, Oral Zengin F, Okkan S. Coverage of axillary lymph nodes with high tangential fields in breast radiotherapy. Br J Radiol 2011; 83:1072-6. [PMID: 21088091 DOI: 10.1259/bjr/25788274] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study is to evaluate the coverage of axillary nodal volumes with high tangent fields (HTF) in breast radiotherapy and to determine the utility of customised blocking. The treatment plans of 30 consecutive patients with early breast cancer were evaluated. The prescription dose was 50 Gy to the whole breast. Axillary level I-II lymph node volumes were delineated and the cranial border of the tangential fields was set just below the humeral head to create HTF. Dose-volume histograms (DVH) were used to calculate the doses received by axillary nodal volumes. In a second planning set, HTF were modified with multileaf collimators (MLC-HTF) to obtain an adequate dose coverage of axillary nodes. The mean doses of the axillary nodes, the ipsilateral lung and heart were compared between the two plans (HTF vs MLC-HTF) using a paired sample t-test. The doses received by 95% of the breast volumes were not significantly different for the two plans. The doses received by 95% of the level I and II axillary volumes were 16.79 Gy and 11.59 Gy, respectively, for HTF, increasing to 47.2 Gy and 45.03 Gy, respectively, for MLC-HTF. Mean lung doses and per cent volume of the ipsilateral lung receiving 20 Gy (V20) were also increased from 6.47 Gy and 10.47%, respectively, for HTF, to 9.56 Gy and 16.77%, respectively, for MLC-HTF. Our results suggest that HTF do not adequately cover the level I and II axillary lymph node regions. Modification of HTF with MLC is necessary to obtain an adequate coverage of axillary levels without compromising healthy tissue in the majority of the patients.
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Affiliation(s)
- G Alço
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul, Turkey.
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Igdem S, Hanagasi F, Solakoglu C, Alço G, Ercan T, Altun M, Turkan S, Okkan S. DOSIMETRIC AND CLINICAL EVALUATION OF BRACHIAL PLEX-OPATHY IN PATIENTS WITH HEAD AND NECK CANCER TREATED WITH INTENSITY MODULATED RADIOTHERAPY. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70042-1] [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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Igdem S, Altun M, Alço G, Ercan T, Tecimer C, Köksal G, Gürses K, Demir G, Okkan S. Whole Field Simultaneous Integrated Boost IMRT in Nasopharyngeal Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1121] [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: 10/19/2022]
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Iğdem S, Alço G, Ercan T, Unalan B, Kara B, Geceer G, Akman C, Zengin FO, Atilla S, Okkan S. The application of positron emission tomography/computed tomography in radiation treatment planning: effect on gross target volume definition and treatment management. Clin Oncol (R Coll Radiol) 2010; 22:173-8. [PMID: 20116979 DOI: 10.1016/j.clon.2010.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 12/21/2009] [Accepted: 12/23/2009] [Indexed: 10/19/2022]
Abstract
AIMS To analyse the effect of the use of molecular imaging on gross target volume (GTV) definition and treatment management. MATERIALS AND METHODS Fifty patients with various solid tumours who underwent positron emission tomography (PET)/computed tomography (CT) simulation for radiotherapy planning from 2006 to 2008 were enrolled in this study. First, F-18 fluorodeoxyglucose (FDG)-PET and CT scans of the treatment site in the treatment position and then a whole body scan were carried out with a dedicated PET/CT scanner and fused thereafter. FDG-avid primary tumour and lymph nodes were included into the GTV. A multidisciplinary team defined the target volume, and contouring was carried out by a radiation oncologist using visual methods. To compare the PET/CT-based volumes with CT-based volumes, contours were drawn on CT-only data with the help of site-specific radiologists who were blind to the PET/CT results after a median time of 7 months. RESULTS In general, our PET/CT volumes were larger than our CT-based volumes. This difference was significant in patients with head and neck cancers. Major changes (> or =25%) in GTV delineation were observed in 44% of patients. In 16% of cases, PET/CT detected incidental second primaries and metastatic disease, changing the treatment strategy from curative to palliative. CONCLUSIONS Integrating functional imaging with FDG-PET/CT into the radiotherapy planning process resulted in major changes in a significant proportion of our patients. An interdisciplinary approach between imaging and radiation oncology departments is essential in defining the target volumes.
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Affiliation(s)
- S Iğdem
- Department of Radiation Oncology, Istanbul Bilim University, School of Medicine, Cemil Aslan Güder sok 8 Gayrettepe, 34340 Istanbul, Turkey.
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Ercan T, Igdem S, Alço G, Zengin F, Ozgules R, Atilla S, Dincer M, Okkan S. DOSIMETRIC COMPARISON OF FIELD IN FIELD INTENSITY MODULATED RADIOTHERAPY TECHNIQUE WITH CONFORMAL RADIOTHERAPY TECHNIQUES IN BREAST CANCER. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)73126-2] [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: 11/29/2022]
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Igdem S, Abacioglu MU, Alço G, Ibrahimov R, Kefeli A, Çetin I, Turkan S, Okkan S. Postoperative radiotherapy for prostate cancer: Sooner or later? J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16157] [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: 11/20/2022] Open
Abstract
e16157 Background: To report our experience with adjuvant or salvage radiotherapy for prostate cancer and to assess the tolerance of the patients. Methods: The charts of 139 men who received postoperative radiotherapy (RT) after radical prostatectomy (RP) between 1997–2007 in two institutions were retrospectively analyzed. Thirty-seven percent received adjuvant RT and 63% salvage RT. The median age was 65 years (range: 43–80). Pathologic Gleason score was 2–6 in 24%, 7 in 56%, and 8–10 in 20%. Seminal vesicle involvement was reported in 34%, positive surgical margins in 72%, lymph node involvement in 7%, capsular perforation in 61%, and perineural invasion in 73% of the patients. The median PSA level before RT was 0.29ng/ml (range: 0–19ng/mL). Median time from RP to RT was 3 months (range, 1–12 months) in the adjuvant setting, and 27 months (range, 2–96 months) in the salvage setting. Nineteen percent received radiation to the pelvis, 81% to the prostate bed only. The median dose to the prostatic bed was 66.6Gy (range: 60–76Gy). Before, during or after RT 49% received androgen deprivation for a median of 6 months (range, 3–48 months). Biochemical failure is defined as a post-RT PSA level >0.2ng/mL. Results: The median follow up time was 41 months (range, 12–133 months). At 4 years, for the entire cohort biochemical control, metastasis free survival, and overall survival was 68%, 92%, and 94%, respectively. Although there was a significant difference in favor of the adjuvantly treated group for biochemical control (81% vs 60%, p = 0.03) in univariate analysis, multivariate analysis demonstrated that higher preoperative PSA level (p = 0.02), and lymph node involvement (p = 0.02) predicted for a worse PSA outcome. No grade 3 acute gastrointestinal (GI) or genitourinary (GU) toxicity was reported during the treatment. At 4 years, 4% of patients had Grade 2 late GI toxicity, 0.7% had grade 3 late GI, and 0.7% brade 4 late GI toxicity, while 16% of patients reported late grade 2 GU, and 4% had late grade 3 GU toxicity. Conclusions: Our results suggest that adjuvant RT may offer a better biochemical outcome in patients who underwent radical prostatectomy for prostate cancer. Overall, the number of high grade toxicities for postoperative RT was low. Therefore it can safely be used in appropriate setting. No significant financial relationships to disclose.
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Affiliation(s)
- S. Igdem
- Istanbul Bilim University, istanbul, Turkey; Marmara University Hospitals, Istanbul, Turkey; Florence Nightingale Gayrettepe Hospital, Istanbul, Turkey
| | - M. U. Abacioglu
- Istanbul Bilim University, istanbul, Turkey; Marmara University Hospitals, Istanbul, Turkey; Florence Nightingale Gayrettepe Hospital, Istanbul, Turkey
| | - G. Alço
- Istanbul Bilim University, istanbul, Turkey; Marmara University Hospitals, Istanbul, Turkey; Florence Nightingale Gayrettepe Hospital, Istanbul, Turkey
| | - R. Ibrahimov
- Istanbul Bilim University, istanbul, Turkey; Marmara University Hospitals, Istanbul, Turkey; Florence Nightingale Gayrettepe Hospital, Istanbul, Turkey
| | - A. Kefeli
- Istanbul Bilim University, istanbul, Turkey; Marmara University Hospitals, Istanbul, Turkey; Florence Nightingale Gayrettepe Hospital, Istanbul, Turkey
| | - I. Çetin
- Istanbul Bilim University, istanbul, Turkey; Marmara University Hospitals, Istanbul, Turkey; Florence Nightingale Gayrettepe Hospital, Istanbul, Turkey
| | - S. Turkan
- Istanbul Bilim University, istanbul, Turkey; Marmara University Hospitals, Istanbul, Turkey; Florence Nightingale Gayrettepe Hospital, Istanbul, Turkey
| | - S. Okkan
- Istanbul Bilim University, istanbul, Turkey; Marmara University Hospitals, Istanbul, Turkey; Florence Nightingale Gayrettepe Hospital, Istanbul, Turkey
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Iğdem S, Ercan T, Alço G, Zengin F, Ozgüleş R, Geceer G, Okkan S, Ober A, Turkan S. Dosimetric comparison of intensity modulated pelvic radiotherapy with 3D conformal radiotherapy in patients with gynecologic malignancies. EUR J GYNAECOL ONCOL 2009; 30:547-551. [PMID: 19899413] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Before initiating an intensity modulated radiotherapy (IMRT) program for gynecologic malignancies we prospectively evaluated the potential benefits of IMRT by dose volume histogram comparison of IMRT and 3D conformal radiotherapy plans. METHODS Plans of ten consecutive patients with cervical and endometrial cancer were evaluated. For each patient a 4-field box technique was compared to an IMRT plan. Both plans were normalized to deliver 50.4 Gy to the PTV in six patients and 45 Gy in the remaining four. Isodose distributions and dose volume histograms were compared in seven dose levels. RESULTS IMRT reduced the volume of small bowel receiving more than 45 Gy in all patients. The average absolute volume of small bowel receiving 45 Gy was significantly reduced from 318 cc to 33 cc. No significant increase in the volume of small bowel receiving less than 20 Gy was observed. Rectum, bladder and bone marrow volumes receiving high doses were also significantly reduced with IMRT. CONCLUSIONS IMRT significantly reduces the volume of normal tissues irradiated to high doses without compromising the target coverage. This may potentially lead to a reduction in treatment related toxicities.
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Affiliation(s)
- S Iğdem
- Department of Radiation Oncology, Istanbul Bilim University, School of Medicine, Istanbul, Turkey.
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