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Yilmaz MT, Gok A, Gedik ME, Caglayan A, Yedekci FY, Aydin Dilsiz S, Gunaydin G, Akyol A, Hurmuz P. The Impact of Dose Rate on the Tumor Microenvironment Using Flattening-filter-free Beams. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00110-9. [PMID: 38570205 DOI: 10.1016/j.clon.2024.03.013] [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: 12/02/2023] [Revised: 03/03/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024]
Abstract
AIMS Recently, dose delivery technology has rapidly evolved with flattening filter-free beams (FFF), and the biological effects of high dose rates are a matter of interest. We hypothesized that FFF beams at different dose rates obtained with modern linear accelerators have different effects on the TME. MATERIALS AND METHODS The B16-F10 melanoma syngeneic tumor model was established, and mice were randomized to 2 different doses (2 Gy and 10 Gy) and 3 different dose rates (1 Gy/min, 6 Gy/min, and 14 Gy/min) along with the control group. Euthanasia was performed on the seventh day after RT, and intracardiac blood was collected for a comet assay. Tumors were harvested and examined histomorphologically and immunohistochemically. Statistical analyses were performed using SPSS software version 23 (SPSS Inc., Chicago, IL, USA). RESULTS The daily growth rate was uniform, and no difference was observed between tumor volumes across all three dose rates for each dose. Deoxyribonucleic acid (DNA) damage in blood mononuclear cells was not affected by dose or dose rate. In the TME histomorphological examination, the number of mitosis is less in the 10 Gy arm, whereas the pleomorphism score was greater. Nevertheless, varying dose rates had no effect on the number of mitosis or the pleomorphism score. The severity of the inflammation, cell densities in the TME, and expression of immunohistochemical markers were comparable across all doses and dose rates. CONCLUSION In our study involving the B16-F10 syngeneic tumor model, varying dose rates obtained with FFF beams had no effect on tumor volume, blood mononuclear cell DNA damage, or TME parameters. However, in order to fully understand the biological impacts of novel techniques, our study should be validated with alternative preclinical setups.
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Affiliation(s)
- M T Yilmaz
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - A Gok
- Hacettepe University, Stem Cell Research and Application Center, Ankara, Turkey.
| | - M E Gedik
- Hacettepe University Faculty of Medicine, Basic Oncology Department, Ankara, Turkey.
| | - A Caglayan
- Hacettepe University Faculty of Pharmacy, Department of Toxicology, Ankara, Turkey.
| | - F Y Yedekci
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - S Aydin Dilsiz
- Hacettepe University Faculty of Pharmacy, Department of Toxicology, Ankara, Turkey.
| | - G Gunaydin
- Hacettepe University Faculty of Medicine, Basic Oncology Department, Ankara, Turkey.
| | - A Akyol
- Hacettepe University Faculty of Medicine, Pathology Department, Ankara, Turkey.
| | - P Hurmuz
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
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Kahvecioglu A, Kilickap S, Hurmuz P. Metastasis-directed radiotherapy for non-small cell lung cancer failured under TKI: A case report and literature review. Cancer Radiother 2023; 27:731-735. [PMID: 37827958 DOI: 10.1016/j.canrad.2023.06.002] [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: 05/31/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 10/14/2023]
Abstract
Although tyrosine kinase inhibitors (TKI) have revolutionized the treatment of anaplastic lymphoma kinase rearranged non-small cell lung cancer (ALKr-NSCLC), radiotherapy (RT) still plays an essential role for treatment of both intracranial and extracranial metastases, particularly for patients experienced a TKI-failure. We reported the case of a 38-year-old woman with metastatic ALKr-NSCLC who received whole-brain radiotherapy (RT) for multiple brain metastases (BMs), initially. After RT, alectinib was initiated and the patient had a good clinico-radiological response in both intracranial and extracranial regions. However, intracranial progression was developed and, stereotactic radiosurgery (SRS) was applied to the four progressed BMs. Two months after SRS, all BMs disappeared. While patient was using alectinib, a recurrent lung lesion, a hilar lymph node and bone metastasis were detected. Stereotactic body radiotherapy (SBRT) was applied to all metastatic sites and, alectinib was continued again. Three months after SBRT, a complete response was obtained. She has been alive with the initial systemic therapy agent for more than 4years without evidence of neither disease nor toxicity. SRS/SBRT may eradicate the TKI-resistant tumoral clones and it may prevent switching the systemic therapy, even if there is a failure.
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Affiliation(s)
- A Kahvecioglu
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, 06100 Sihhiye, Ankara, Turkey.
| | - S Kilickap
- Istinye University, Faculty of Medicine, Department of Medical Oncology, Istanbul, Turkey.
| | - P Hurmuz
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, 06100 Sihhiye, Ankara, Turkey.
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Yilmaz MT, Gok A, Gedik ME, Caglayan A, Yedekci FY, Dilsiz SA, Gunaydin G, Akyol A, Hurmuz P. The Effect of Dose Rate on Tumor Microenvironment in External Beam Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e273. [PMID: 37785031 DOI: 10.1016/j.ijrobp.2023.06.1243] [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) The fact that treatment can be given at a narrow dose rate range in external radiotherapy (ERT) applications with crude delivery techniques has caused the dose rate to be neglected for a long time. Recently dose delivery technology has rapidly evolved and with the re-introduction of FLASH-RT to the radiation oncology stage, dose rate studies escalated. It is also known that interactions within the tumor microenvironment (TME) play a significant role in tumor prognosis. Herein we aimed to investigate the effect of three different dose rates on TME. MATERIALS/METHODS To generate the tumor model, 1 million B16-F10 malignant melanoma cells were subcutaneously injected into the right flank of C57BL/6 mice. RT time was estimated to be 0.5 cm in diameter. Forty-two mice were randomly assigned to the control group, 2 different doses (2 Gy and 10 Gy), and 3 different dose rates (1 Gy/min, 6 Gy/min, and 14 Gy/min). Vernier scale measurements were taken every day to monitor the mice's tumor size. Euthanasia is induced on the seventh day after ERT. Tumor and metastatic organs were harvested, and evaluated histomorphological, and immunohistochemically. Intracardiac blood was collected for the comet assay. RESULTS After radiation, the 10 Gy arm's mean tumor size was lower than that of the 2 Gy and control arms (p = 0.01 and p = 0.007). Tumor size did not differ between the 2 Gy and control arms (p = 0.53). Additionally, there was no difference in tumor diameters between low and high doses at different dose rates (p = 0.12, p = 0.21). Blood mononuclear cells in the control arm had less DNA damage than those in the 10 Gy arm (p = 0.04). The 2 Gy and 10 Gy arms did not differ in terms of DNA damage (p = 0.65). Each dose arm was evaluated in terms of dose rates and no significant difference was found (p = 0.79, p = 0.24). The number of mitoses per 10 HPF was assessed during the histological analysis. The number of mitoses in the 10 Gy arm was less than the 2 Gy arm (p = 0.001). There was no difference at different dose rates in the 2 Gy and 10 Gy arms (p = 0.28, p = 0.97). Pleomorphism score was evaluated as mild-moderate and severe (score 1-2-3). In comparison to the 2 Gy and control arms, the 10 Gy arm had a higher pleomorphism score (p = 0.01). The 2 Gy arm and the control arm did not vary from one another (p = 0.04). Pleomorphism scores were comparable across low and high doses at different dose rates (p = 0.35, p = 0.58). Different dose rates resulted in the same staining pattern with aSMA and SOX-10. CONCLUSION In our study involving the B16-F10 syngeneic tumor model, we could not find a significant effect of three different dose rates on TME. With constantly improving treatment techniques, larger dose rates are going to be achieved. Owing to this, protocols should also list dose rate as a treatment variable. This project was supported by the TÜBİTAK, Short Term R&D Funding Program.
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Affiliation(s)
- M T Yilmaz
- Ankara Etlik City Hospital, Department of Radiation Oncology, Ankara, Turkey
| | - A Gok
- Hacettepe University, Stem Cell Research and Application Center, Ankara, Turkey
| | - M E Gedik
- Hacettepe University Faculty of Medicine, Department of Basic Oncology, Ankara, Turkey
| | - A Caglayan
- Hacettepe University Faculty of Pharmacy, Department of Toxicology, Ankara, Turkey
| | - F Y Yedekci
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - S Aydin Dilsiz
- Hacettepe University Faculty of Pharmacy, Department of Toxicology, Ankara, Turkey
| | - G Gunaydin
- Hacettepe University Faculty of Medicine, Department of Basic Oncology, Ankara, Turkey
| | - A Akyol
- Hacettepe University Faculty of Medicine, Pathology Department, Ankara, Turkey
| | - P Hurmuz
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
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Sari SY, Kahvecioglu A, Hurmuz P. In Regard to Zeng et al. Int J Radiat Oncol Biol Phys 2023; 116:690. [PMID: 37270248 DOI: 10.1016/j.ijrobp.2022.12.052] [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: 12/12/2022] [Accepted: 12/29/2022] [Indexed: 06/05/2023]
Affiliation(s)
- Sezin Yuce Sari
- Department of Radiation, Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alper Kahvecioglu
- Department of Radiation, Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pervin Hurmuz
- Department of Radiation, Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Sari SY, Kahvecioglu A, Hurmuz P. In regard to wandrey et al. Lung Cancer 2023; 179:107179. [PMID: 36989614 DOI: 10.1016/j.lungcan.2023.107179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/19/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Sezin Yuce Sari
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Turkey.
| | - Alper Kahvecioglu
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Turkey.
| | - Pervin Hurmuz
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Turkey.
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Esen CSB, Yazici G, Hurmuz P, Ozyigit G, Zorlu F. The Effect of Video-Based Education on Anxiety of Patients Receiving Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy. J Cancer Educ 2023; 38:426-430. [PMID: 35022988 DOI: 10.1007/s13187-022-02135-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 05/20/2023]
Abstract
Patients receiving stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) may have an anxiety due to unknown aspects of the treatment. We aimed to reduce patient anxiety by using video-based education. Forty patients were divided into 2 groups, with one-to-one information session (n = 20) and one-to-one information session plus video-based education (n = 20). The patients completed the State-Trait Anxiety Inventory (STAI) and visual facial anxiety scale before and after information sessions and after treatment. The setup time and disruptions during treatment sessions were recorded for patients receiving treatment with Novalis® and Cyberknife®, respectively. The patient characteristics and STAI scores before education were similar between groups. The anxiety level was significantly lower in group 1 after treatment (median 38, interquartile range (IQR) 27-45) compared to before (median 43, IQR 36-47) (p = 0.003) and after information sessions (median 42, IQR 36-47) (p = 0.004); however, any difference was not observed in anxiety levels between before and after information sessions (p = 0.317). The anxiety level was significantly lower in group 2 after video-based education (median 25, IQR 22-33) and after treatment (median 25, IQR 20-30) compared to before video-based education (median 35, IQR 31-42) (p < 0.001 for both), while there was no significant difference in anxiety levels between after video-based education and after the treatment (p = 0.407). The interruptions during treatment were observed in 9 (60%) patients in group 1 and 6 (40%) patients in group 2 (p = 0.038). Video-based educations significantly reduce patient anxiety before SRS/SBRT and increase their compliance with the treatment.
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Affiliation(s)
- Caglayan Selenge Beduk Esen
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Altındağ, Ankara, 06100, Turkey.
| | - Gozde Yazici
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Altındağ, Ankara, 06100, Turkey
| | - Pervin Hurmuz
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Altındağ, Ankara, 06100, Turkey
| | - Gokhan Ozyigit
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Altındağ, Ankara, 06100, Turkey
| | - Faruk Zorlu
- Hacettepe University, Faculty of Medicine, Department of Radiation Oncology, Altındağ, Ankara, 06100, Turkey
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Hurmuz P, Cengiz M, Ozyigit G, Yuce Sari S, Kahvecioglu A, Beduk Esen CS, Yalcin S, Zorlu F. Stereotactic Body Radiotherapy as an Effective Treatment for Pancreatic Cancer. Cureus 2023; 15:e38255. [PMID: 37252548 PMCID: PMC10225161 DOI: 10.7759/cureus.38255] [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] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) allows the delivery of an ablative radiation dose to the tumor with minimal toxicity. Although magnetic resonance imaging (MRI)-guided SBRT appears to be a promising approach in the modern era, X-ray image-guided SBRT is still used worldwide for pancreatic cancer. This study aims to evaluate the results of X-ray image-guided SBRT in patients with locally advanced pancreatic cancer (LAPC). Methodology Medical records of 24 patients with unresectable LAPC who underwent X-ray image-guided SBRT between 2009 and 2022 were retrospectively evaluated. SPSS version 23.0 (IBM Corp., Armonk, NY, USA) was utilized for all analyses. Results The median age was 64 years (range = 42-81 years), and the median tumor size was 3.5 cm (range = 2.7-4 cm). The median total dose of SBRT was 35 Gy (range = 33-50 Gy) in five fractions. After SBRT, 30% of patients showed complete and 41% showed partial response, whereas 20% had stable disease and 9% had progression. Median follow-up was 15 months (range = 6-58 months). During follow-up, four (16%) patients had local recurrence, one (4%) had a regional recurrence, and 17 (70%) had distant metastasis (DM). The two-year local control (LC), local recurrence-free survival (LRFS), overall survival (OS), and DM-free survival (DMFS) rate was 87%, 36%, 37%, and 29%, respectively. In univariate analysis, a larger tumor size (>3.5 cm) and higher cancer antigen 19-9 level (>106.5 kU/L) significantly decreased the OS, LRFS, and DMFS rates. No severe acute toxicity was observed. However, two patients had severe late toxicity as intestinal bleeding. Conclusions X-ray image-guided SBRT provides a good LC rate with minimal toxicity for unresectable LAPC. However, despite modern systemic treatments, the rate of DM remains high which plays a major role in survival.
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Affiliation(s)
- Pervin Hurmuz
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | - Mustafa Cengiz
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | - Gokhan Ozyigit
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | - Sezin Yuce Sari
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | - Alper Kahvecioglu
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
| | | | - Suayib Yalcin
- Medical Oncology, Hacettepe University Medical School, Ankara, TUR
| | - Faruk Zorlu
- Radiation Oncology, Hacettepe University Medical School, Ankara, TUR
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Yedekci Y, Hurmuz P, Ozyigit G. Effects of reconstruction methods on dose distribution for lung stereotactic body radiotherapy treatment plans. Radiat Environ Biophys 2023; 62:107-115. [PMID: 36526911 DOI: 10.1007/s00411-022-01009-w] [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] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
The aim of the present study was to investigate the effect of tumour motion on various imaging strategies as well as on treatment plan accuracy for lung stereotactic body radiotherapy treatment (SBRT) cases. The ExacTrac gating phantom and paraffin were used to investigate respiratory motion and represent a lung tumour, respectively. Four-dimensional computed tomography (4DCT) imaging was performed, while the phantom was moving sinusoidally with 4 s cycling time with three different amplitudes of 8, 16, and 24 mm. Reconstructions were done with maximum (MIP) and average intensity projection (AIP) methods. Comparisons of target density and volume were performed using two reconstruction techniques and references values. Volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) were planned based on reconstructed computed tomography (CT) sets, and it was examined how density variations affect the dose-volume histogram (DVH) parameters. 4D cone beam computed tomography (CBCT) was performed with the Elekta Versa HD linac imaging system before irradiation and compared with 3D CBCT. Thus, various combinations of 4DCT reconstruction methods and treatment alignment methods have been investigated. Point measurements as well as 2 and 3D dose measurements were done by optically stimulated luminescence (OSL), gafchromic films, and electronic portal imaging devices (EPIDs), respectively. The mean volume reduction was 7.8% for the AIP and 2.6% for the MIP method. The obtained Hounsfield Unit (HU) values were lower for AIP and higher for MIP when compared with the reference volume density. In DVH analysis, there were no statistical differences for D95%, D98%, and Dmean (p > 0.05). However, D2% was significantly affected by HU changes (p < 0.01). A positional variation was obtained up to 2 mm in moving direction when 4D CBCT was applied after 3D CBCT. Dosimetric measurements showed that the main part of the observed dose deviation was due to movement. In lung SBRT treatment plans, D2% doses differ significantly according to the reconstruction method. Additionally, it has been observed that setups based on 3D imaging can cause a positional error of up to 2 mm compared to setups based on 4D imaging. It is concluded that MIP has advantages over AIP in defining internal target volume (ITV) in lung SBRT applications. In addition, 4D CBCT and 3D EPID dosimetry are recommended for lung SBRT treatments.
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Affiliation(s)
- Yagiz Yedekci
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey.
| | - Pervin Hurmuz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
| | - Gökhan Ozyigit
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
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Cananoglu M, Hurmuz P, Yeginer M, Ozyigit G. Planning and dosimetric evaluation of three total body irradiation techniques: Standard SSD VMAT, Extended SSD VMAT and Extended SSD Field-in-Field. Radiat Environ Biophys 2023; 62:73-81. [PMID: 36269391 DOI: 10.1007/s00411-022-00999-x] [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] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
The aim of this study was to dosimetrically compare three total body irradiation (TBI) techniques which can be delivered by a standard linear accelerator, and to deduce which one is preferable. Specifically, Extended Source to Surface Distance (SSD) Field-in-Field (FiF), Extended SSD Volumetric Modulated Arc Therapy (VMAT), and Standard SSD VMAT TBI techniques were dosimetrically evaluated. Percent depth dose and dose profile measurements were made under treatment conditions for each specified technique. After having generated treatment plans with a treatment planning system (TPS), dose homogeneity and critical organ doses were investigated on a Rando phantom using radiochromic films and optically stimulated luminescence dosimeters (OSLDs). TBI dose of 12 Gy in six fractions was prescribed for each technique. The gamma index (5%/5 mm) was used for the analysis of radiochromic films. Passing rates for Extended SSD FiF, Extended SSD VMAT and Standard SSD VMAT techniques were found to be 90%, 87% and 94%, respectively. OSLD measurements were within ± 5% agreement with TPS calculations for the first two techniques whereas the agreement was found to be within ± 3% for the Standard SSD VMAT technique. TPS calculations demonstrated that mean lung doses in the first two techniques were around 8.5 Gy while it was kept around 7 Gy in Standard SSD VMAT. It is concluded that Standard SSD VMAT is superior in sparing the lung tissue while all three TBI techniques are feasible in clinical practice with acceptable dose homogeneity. In the absence of VMAT-based treatment planning, Extended SSD FiF would be a reasonable choice compared to other conventional techniques.
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Affiliation(s)
- Mert Cananoglu
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey.
| | - Mete Yeginer
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, 06100, Ankara, Turkey
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Guler OC, Oymak E, Hurmuz P, Yavas G, Tilki B, Yavas C, Ozyigit G, Onal C. Treatment Outcomes of Stereotactic Body Radiotherapy in Patients with Synchronous and Metachronous Oligometastatic Renal Cell Carcinoma. Urol Int 2023; 107:171-178. [PMID: 36455527 DOI: 10.1159/000527287] [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: 07/14/2022] [Accepted: 08/24/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the clinical outcomes of metastasis-directed therapy (MDT) using stereotactic body radiotherapy (SBRT) in patients with synchronous or metachronous oligometastatic renal cell carcinoma (RCC). METHODS The clinical data of 87 patients with 138 lesions who received MDT between February 2008 and January 2019 were retrospectively analyzed. All patients had ≤5 metastasis at diagnosis (synchronous) or during progression (metachronous) and were treated with SBRT for their metastasis. The primary endpoints were local control (LC) and progression-free survival (PFS). The secondary endpoint was overall survival (OS). RESULTS Median follow-up was 20.4 months for entire cohort and 27.2 months for survivors. Synchronous oligometastatic disease was observed in 35 patients (40.2%), and 52 patients (59.8%) had metachronous disease. Seventy-two patients (82.8%) received systemic treatment synchronously or after MDT, while 15 patients (17.2%) did not receive any systemic treatment. The 1- and 2-year OS rates were 79.4% and 58.1%, respectively, and the 1- and 2-year PFS rates were 58.6% and 15.1%, respectively. The 1- and 2-year LC rates per lesion were 96.6% and 91.4%, respectively. There were no significant differences in survival between patients with synchronous oligometastasis and those with metachronous oligometastasis. All disease progressions were observed at a median time of 31.6 months (range: 1.9-196.9 months) after the completion of SBRT. Patients with solitary oligometastasis had significantly better OS compared to patients with >1 metastasis (p = 0.04). No patients experienced grade 3 or higher acute or late toxicities. CONCLUSION SBRT is a successful treatment for oligometastatic RCC patients due to its excellent LC and minimal toxicity profile. There were no statistically significant survival differences between patients with synchronous and metachronous oligometastasis. Patients with solitary oligometastasis outlived their counterparts.
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Affiliation(s)
- Ozan Cem Guler
- Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, Adana, Turkey
| | - Ezgi Oymak
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, İskenderun, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Guler Yavas
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Burak Tilki
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cagdas Yavas
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cem Onal
- Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, Adana, Turkey.,Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
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Ozyigit G, Onal C, Beduk Esen CS, Tilki B, Hurmuz P. Treatment outcomes of postoperative ultra-hypofractionated stereotactic body radiotherapy in prostate cancer. Urol Oncol 2023; 41:252.e1-252.e8. [PMID: 36631368 DOI: 10.1016/j.urolonc.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study aimed to evaluate the safety and efficacy of ultra-hypofractionated stereotactic body radiation therapy (SBRT) to prostate bed. METHODS Sixty-six prostate cancer patients treated with postoperative ultra-hypofractionated SBRT between 2018 and 2020 were retrospectively reviewed. All patients received a total dose of 35 Gy to prostate bed in 5 fractions. Biochemical complete response (BCR), biochemical failure (BF), acute and late toxicities were assessed. RESULTS After a median follow-up of 24.2 months (range, 6.4-37.2), seven patients (10.6%) developed BF, and the 2-year freedom from BF (FFBF) rate was 88.4%. BCR was observed in 57 patients (86.4%). The 2-year FFBF in patients with pre-SBRT PSA value of <0.2 ng/mL was higher than those with pre-SBRT PSA of ≥0.2 ng/mL (100% vs. 81.4%; P = 0.04). The 2-year FFBF in patients with BCR was significantly higher than in those without BCR (94.5% vs. 58.3%; P < 0.001). In multivariate analysis, pre-SBRT PSA and post-SBRT PSA values were prognostic factors for FFBF (P = 0.009 and P = 0.01, respectively). Nine patients (13.6 %) developed acute and late grade 2 genitourinary (GU) toxicities. There was no acute or late grade ≥3 GU toxicity. Acute and late grade ≥2 gastrointestinal (GI) toxicity was observed in 9 (13.6%) and 2 (3%) patients, respectively. CONCLUSION Postoperative ultra-fractionated SBRT showed no severe acute toxicity and late toxicity rates of about 15%, in addition to excellent biochemical control rates. Pre- and post-SBRT PSA levels may be a predictor of BCR in patients receiving post-operative ultra-fractionated SBRT.
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Affiliation(s)
- Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Cem Onal
- Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, Adana, Turkey; Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | | | - Burak Tilki
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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12
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Onal C, Oymak E, Guler OC, Tilki B, Yavas G, Hurmuz P, Yavas C, Ozyigit G. Stereotactic body radiotherapy and tyrosine kinase inhibitors in patients with oligometastatic renal cell carcinoma: a multi-institutional study. Strahlenther Onkol 2022; 199:456-464. [PMID: 36450836 DOI: 10.1007/s00066-022-02026-w] [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: 08/19/2022] [Accepted: 10/20/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Few studies have determined the viability of stereotactic body radiotherapy (SBRT) and tyrosine kinase inhibitors (TKIs) in the treatment of metastatic renal cell carcinoma (mRCC). We examined the results of RCC patients who had five or fewer lesions and were treated with TKI and SBRT. METHODS The clinical data of 42 patients with 96 metastases treated between 2011 and 2020 were retrospectively evaluated. The prognostic factors predicting overall survival (OS) and progression-free survival (PFS) were assessed in uni- and multivariable analyses. RESULTS Median follow-up and time between TKI therapy and SBRT were 62.3 and 3.7 months, respectively. The 2‑year OS and PFS rates were 58.0% and 51.3%, respectively, and 2‑year local control rate was 94.1% per SBRT-treated lesion. In univariable analysis, the time between TKI therapy and SBRT and treatment response were significant prognostic factors for OS and PFS. In multivariable analysis, a time between TKI therapy and SBRT of less than 3 months and complete response were significant predictors of better OS and PFS. Only 12 patients (28.6%) had a systemic treatment change at a median of 18.2 months after SBRT, mostly in patients with a non-complete treatment response after this therapy. Two patients (4.8%) experienced grade III toxicity, and all side effects observed during metastasis-directed therapy subsided over time. CONCLUSION We demonstrated that SBRT in combination with TKIs is an effective and safe treatment option for RCC patients with ≤ 5 metastases. However, distant metastasis was observed in 60% of the patients, indicating that distant disease control still has room for improvement.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, 01120, Adana, Turkey.
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey.
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey.
| | - Ezgi Oymak
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, 01120, Adana, Turkey
| | - Burak Tilki
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Guler Yavas
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cagdas Yavas
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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13
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Guler O, Hurmuz P, Atalar B, Guney YY, Saglam E, Akyurek S, Bolukbasi Y, Güral Z, Tugrul F, Korcum A, Sen C, Yildirim BA, Oksuz D, Celik OK, Kurt M, Guzeloz Z, Yavas G, Ozyigit G, Aksu M, Onal C. The Treatment Outcomes of Oligometastatic Colorectal Cancer Patients Treated with Stereotactic Body Radiation Therapy: A Multi-Institutional Analysis TROD 02-008. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.988] [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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14
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Ozyigit G, Onal C, Hurmuz P, Esen SB, Tilki B. Treatment Outcomes of Postoperative Ultra-Hypofractionated Stereotactic Body Radiotherapy in Prostate Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1203] [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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15
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Sutera P, Deek M, Guler O, Hurmuz P, Reyhan M, Rowe S, Hrinivich W, Ren L, Song D, Kiess A, Oymak E, Pienta K, Pomper M, Feng F, Ozyigit G, Tran P, Phillips R, Onal C. Prostate-Specific Membrane Antigen PET Response Associates with Metastasis-Free Survival Following Stereotactic Ablative Radiation Therapy in Oligometastatic Castration-Sensitive Prostate Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.542] [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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16
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Affiliation(s)
- Alper Kahvecioglu
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Türkiye
| | - Melek Tugce Yilmaz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Türkiye
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Türkiye.
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17
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Sutera P, Deek M, Guler OC, Hurmuz P, Reyhan M, Rowe SP, Hrinivich W, Ren L, Kiess AP, Song DY, Oymak E, Pienta KJ, Pomper M, Feng FY, Ozyigit G, Tran PT, Phillips R, Onal HC. Prostate-specific membrane antigen PET response associates with radiographic progression-free survival following stereotactic ablative radiation therapy in oligometastatic castration-sensitive prostate cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5011] [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] [Indexed: 11/20/2022] Open
Abstract
5011 Background: Emerging data suggest metastasis-directed therapy (MDT) improves outcomes in patients with oligometastatic castration-sensitive prostate cancer (omCSPC). Prostate-specific membrane antigen positron emission tomography (PSMA-PET/CT) can detect occult metastatic disease and has been proposed as a biomarker for treatment response. Herein we identify and validate a PSMA-PET biomarker for clinical outcomes following MDT in omCSPC. Methods: This was an international multi-institutional retrospective study of two completely independent cohorts of men with omCSPC, defined as ≤3 lesions, treated with metastasis-directed stereotactic ablative radiation therapy (SABR) who underwent PSMA-PET/CT prior to and 3-6 months after treatment. Pre- and post-SABR PSMA-PET/CT standardized uptake value (SUV) was measured for all lesions and PSMA response defined discretely using a cutpoint of ≥ 30% decrease in SUVmax. PSMA-PET response was correlated with lesion local control (LLC), radiographic progression-free survival (rPFS) defined using conventional and PET imaging, and metastasis-free survival (MFS) defined by conventional imaging alone. Results: A total of 131 patients with 261 treated metastases were included in the analysis, with median follow-up of 29 months (IQR 18.5-41.3). Following SABR, 78.4% of lesions experienced a partial or complete PSMA response. Multivariable analysis demonstrated SUV response significantly associated with improved LLC (HR = 9.97, 95%CI 3.92-25.4; p < 0.01). Patients with PSMA response in all lesions experienced significantly better rPFS (HR = 0.49, 95%CI 0.26-0.92; p = 0.03) compared to their counterparts and this maintained significance within both the discovery (p < 0.01) and validation (p = 0.01) cohorts. Within the discovery cohort, patients with PSMA response in all lesions also experienced significantly improved MFS (HR = 0.24, 95%CI 0.07-0.85; p = 0.03); analysis of the independent validation cohort is ongoing. Conclusions: Following SABR, PSMA-PET response is a robust and externally validated radiographic biomarker for rPFS and appears to be associated with MFS pending validation. This approach holds promise for guiding clinical management of omCSPC.
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Affiliation(s)
| | - Matthew Deek
- Department of Radiation Oncology Rutgers Cancer Institute, New Brunswick, NJ
| | - Ozan Cem Guler
- Baskent University Department of Radiation Oncology, Adana, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Reyhan
- Baskent University, Department of Nuclear Medicine, Adana, Turkey
| | - Steven P. Rowe
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William Hrinivich
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lei Ren
- Department of Radiation Oncology, University of Maryland, Baltimore, MD
| | - Ana Ponce Kiess
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Daniel Y. Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ezgi Oymak
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Kenneth J. Pienta
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martin Pomper
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Felix Y Feng
- Department of Urology, University of California, San Francisco, CA
| | | | - Phuoc T. Tran
- University of Maryland School of Medicine, Baltimore, MD
| | - Ryan Phillips
- Department of Radiation Oncology, The Mayo Clinic, Rochester, MN
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18
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Guler O, Hurmuz P, Ozyigit G, Onal C. PO-1425 SBRT in patients with oligometastatic renal cell carcinoma: A multi-institutional analysis. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03389-8] [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: 11/24/2022]
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19
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Ozyurek Y, Sari SY, Hurmuz P. Comments on “Whole lung irradiation as a novel treatment for COVID-19: Final results of the prospective randomized trial (WINCOVID trial)”. Radiother Oncol 2022; 170:244-245. [PMID: 35259417 PMCID: PMC8897284 DOI: 10.1016/j.radonc.2022.02.035] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022]
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20
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Onal C, Hurmuz P, Guler OC, Yavas G, Tilki B, Oymak E, Yavas C, Ozyigit G. The role of stereotactic body radiotherapy in switching systemic therapy for patients with extracranial oligometastatic renal cell carcinoma. Clin Transl Oncol 2022; 24:1533-1541. [PMID: 35119653 DOI: 10.1007/s12094-022-02793-z] [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: 12/29/2021] [Accepted: 01/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Targeting oligometastatic lesions with metastasis-directed therapy (MDT) using stereotactic-body radiotherapy (SBRT) may improve treatment outcomes and postpone the need for second-line systemic therapy (NEST). We looked at the results of oligometastatic renal cell carcinoma (RCC) patients who had five or fewer lesions and were treated with SBRT. METHODS We examined the treatment outcomes of 70 extracranial metastatic RCC (mRCC) patients treated at two oncology centers between 2011 and 2020. The clinical parameters of patients with and without NEST changes were compared. The prognostic factors for overall survival (OS), progression-free survival (PFS), and NEST-free survival were evaluated. RESULTS Median age was 67 years (range 31-83 years). Lung and bone metastasis were found in 78.4% and 12.6% of patients, respectively. With a median follow-up of 21.1 months, median OS was 49.1 months and the median PFS was 18.3 months. Histology was a prognostic factor for OS, BED, and treatment switch for PFS in univariate analysis. In multivariate analysis, the significant predictor of poor OS was clear cell histology, and a lower BED for PFS. Following SBRT for oligometastatic lesions, 19 patients (27.2%) had a median NEST change of 15.2 months after MDT completion. There were no significant differences in median OS or PFS between patients who had NEST changes and those who did not. No patient experienced grade ≥ 3 acute and late toxicities. CONCLUSIONS The SBRT to oligometastatic sites is an effective and safe treatment option for ≤ 5 metastases in RCC patients by providing favorable survival and delaying NEST change.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, 01120, Adana, Turkey. .,Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey.
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, 01120, Adana, Turkey
| | - Guler Yavas
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Burak Tilki
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Oymak
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey
| | - Cagdas Yavas
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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21
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Duru Birgi S, Akgun Z, Hurmuz P, Akyurek S, Kaytan Saglam E, Yilmaz MT, Bakirarar B, Cengiz M. Definitive Chemoradiotherapy Results in Synchronous Oligometastatic Non-small Cell Lung Cancer Patients: Turkish Society for Radiation Oncology Group Study (TROD 10-003). Am J Clin Oncol 2022; 45:40-47. [PMID: 34857699 DOI: 10.1097/coc.0000000000000881] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE It is aimed to investigate the survival outcomes and prognostic factors after curative treatment of patients diagnosed with synchronous oligometastatic non-small cell lung carcinoma. MATERIALS AND METHODS Fifty-two patients from 3 centers diagnosed between 2014 and 2019 were analyzed. The treatment results of thoracic and oligometastatic regions were retrospectively evaluated. The Kaplan-Meier method was used to determine the overall survival (OS) and progression-free survival (PFS) and log-rank tests for the factors affecting survival. Cox regression analysis was employed for multivariate analysis. RESULTS Of the 52 patients, 46 (88%) had <2 organ involvement at diagnosis. Treatment of oligometastasis was radiotherapy (RT) in 37, surgery in 4, and surgery with RT in 11 patients. Median 60 Gy were administered to the thoracic tumor. Median RT dose for oligometastasis was 30 Gy in median 5 fractions with either stereotactic body radiation therapy or conventional RT. The median follow-up was 18 months. The median OS and PFS were 35 and 20 months, respectively. The 1-, 2-, and 3-year OS rates were 80.5%, 60.2%, and 41.2%, while the corresponding PFS rates were 75%, 42.5%, and 21.5%, respectively. Multivariate Cox regression analysis revealed that the Eastern Cooperative Oncology Group performance status of "0" and thoracic RT dose over 60 Gy were significant prognostic factors for both the OS and PFS. CONCLUSIONS Definitive chemoradiotherapy to the thoracic tumor and treatment of oligometastasis region indicate promising survival outcomes.
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Affiliation(s)
| | - Zuleyha Akgun
- Department of Radiation Oncology, Memorial Sisli Hospital, Istanbul, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara
| | | | - Esra Kaytan Saglam
- Department of Radiation Oncology, Memorial Sisli Hospital, Istanbul, Turkey
| | - Melek Tugce Yilmaz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara
| | | | - Mustafa Cengiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara
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22
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Onal C, Ozyigit G, Oymak E, Guler O, Hurmuz P, Tilki B, Reyhan M, Tuncel M, Akyol F. PH-0662 Clinical parameters and nomograms for predicting lymphnode metastasis detected with 68Ga-PSMA-PET/CT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07394-1] [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: 11/28/2022]
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23
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Sezen D, Verma V, He K, Abana CO, Barsoumian H, Ning MS, Tang C, Hurmuz P, Puebla-Osorio N, Chen D, Tendler I, Comeaux N, Nguyen QN, Chang JY, Welsh JW. Considerations for Clinical Trials Testing Radiotherapy Combined With Immunotherapy for Metastatic Disease. Semin Radiat Oncol 2021; 31:217-226. [PMID: 34090648 DOI: 10.1016/j.semradonc.2021.02.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Metastatic cancer is inherently heterogeneous, and patients with metastatic disease can experience vastly different oncologic outcomes depending on several patient- and disease-specific characteristics. Designing trials for such a diverse population is challenging yet necessary to improve treatment outcomes for metastatic-previously thought to be incurable-disease. Here we review core considerations for designing and conducting clinical trials involving radiation therapy and immunotherapy for patients with metastatic cancer.
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Affiliation(s)
- Duygu Sezen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Koc University School of Medicine, Istanbul, Turkey
| | - Vivek Verma
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kewen He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Chike O Abana
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hampartsaum Barsoumian
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew S Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nahum Puebla-Osorio
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dawei Chen
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Irwin Tendler
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nathan Comeaux
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Onal C, Ozyigit G, Oymak E, Guler OC, Hurmuz P, Tilki B, Reyhan M, Tuncel M, Akyol F. Clinical parameters and nomograms for predicting lymph node metastasis detected with 68 Ga-PSMA-PET/CT in prostate cancer patients candidate to definitive radiotherapy. Prostate 2021; 81:648-656. [PMID: 33949694 DOI: 10.1002/pros.24142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Defining the extent of disease spread with imaging modalities is crucial for therapeutic decision-making and definition of treatment. This study aimed to investigate whether clinical parameters and nomograms predict prostate-specific membrane antigen (PSMA)-positive lymph nodes in treatment-naïve nonmetastatic prostate cancer (PC) patients. MATERIALS AND METHODS The clinical data of 443 PC patients (83.3% high-risk and 16.7% intermediate-risk) were retrospectively analyzed. Receiver operating characteristic (ROC) curves with areas under the curve (AUC) were generated to evaluate the accuracy of clinical parameters (prostate-specific antigen [PSA], T stage, Gleason score [GS], International Society of Urological Pathology [ISUP] grade) and nomograms (Roach formula [RF], Yale formula [YF], and a new formula [NF]) in predicting lymph node metastasis. The AUCs of the various parameters and clinical nomograms were compared using ROC and precision-recall (PR) curves. RESULTS A total of 288 lymph node metastases were identified in 121 patients (27.3%) using 68 Ga-PSMA-11-positron emission tomography (PET)/computed tomography (CT). Most PSMA-avid lymph node metastases occurred in external or internal iliac lymph nodes (142; 49.3%). Clinical T stage, PSA, GS, and ISUP grade were significantly associated with PSMA-positive lymph nodes according to univariate logistic regression analysis. The PSMA-positive lymph nodes were more frequently detected in patients with PSA >20 ng/ml, GS ≥7 or high risk disease compared to their counterparts. The clinical T stage, serum PSA level, GS, and ISUP grade showed similar accuracy in predicting PSMA-positive metastasis, with AUC values ranging from 0.675 to 0.704. The median risks for PSMA-positive lymph nodes according to the RF, YF, and NF were 31.3% (range: 12.3%-100%), 22.3% (range: 4.7%-100%), and 40.5% (range: 12.3%-100%), respectively. The AUC values generated from ROC and PR curve analyses were similar for all clinical nomograms, although the RF and YF had higher accuracy compared to NF. CONCLUSION The clinical T stage, PSA, GS, and ISUP grade are independent predictors of PSMA-positive lymph nodes. The RF and YF can be used to identify patients who can benefit from 68 Ga-PSMA-11 PET/CT for the detection of lymph node metastasis. Together with nomograms, 68 Ga-PSMA-11 PET/CT images help to localize PSMA-positive lymph node metastases and can thus assist in surgery and radiotherapy planning.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University, Adana, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ezgi Oymak
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, İskenderun, Hatay, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University, Adana, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burak Tilki
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Reyhan
- Department of Nuclear Medicine, Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University, Adana, Turkey
| | - Murat Tuncel
- Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fadil Akyol
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Onal C, Ozyigit G, Akgun Z, Atalar B, Igdem S, Oymak E, Agaoglu F, Selek U, Guler OC, Hurmuz P, Mustafayev TZ, Akyol F. Oligometastatic Bone Disease in Castration-Sensitive Prostate Cancer Patients Treated With Stereotactic Body Radiotherapy Using 68Ga-PSMA PET/CT: TROD 09-004 Study. Clin Nucl Med 2021; 46:465-470. [PMID: 33661210 DOI: 10.1097/rlu.0000000000003558] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
PURPOSE To evaluate the outcomes of metastasis-directed treatment (MDT) using stereotactic body radiotherapy (SBRT) for bone-only oligometastasis (OM) detected with gallium prostate-specific membrane antigen (68Ga-PSMA) PET/CT in castration-sensitive prostate cancer (PC) patients. METHODS In this multi-institutional study, clinical data of 74 PC patients with 153 bone lesions who were undergoing MDT were retrospectively evaluated. Twenty-seven patients (36.5%) had synchronous, and 47 (63.5%) had metachronous OM. All patients had PC with 5 metastases or fewer detected by 68Ga-PSMA PET/CT and treated using SBRT with a median dose of 20 Gy. The prognostic factors for PC-specific survival (PCSS) and progression-free survival (PFS) were analyzed. RESULTS The median follow-up was 27.3 months. Patients with synchronous OM were older and received higher rates of androgen deprivation therapy after SBRT compared with patients with metachronous OM. The 2-year PCSS and PFS rates were 92.0% and 72.0%, respectively. A prostate-specific antigen (PSA) decline was observed in 56 patients (75.7%), and 48 (64.9%) had a PSA response defined as at least 25% decrease of PSA after MDT. The 2-year local control rate per lesion was 95.4%. In multivariate analysis, single OM and PSA response after MDT were significant predictors for better PCSS and PFS. In-field recurrence was observed in 4 patients (6.5%) with 10 lesions at a median of 13.1 months after MDT completion. No serious late toxicity was observed. CONCLUSIONS We demonstrated that SBRT is an efficient and well-tolerated treatment option for PC patients with 5 bone-only oligometastases or fewer detected with 68Ga-PSMA PET/CT.
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Affiliation(s)
- Cem Onal
- From the Department of Radiation Oncology, Adana Dr Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, Adana
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara
| | - Zuleyha Akgun
- Division of Radiation Oncology, Memorial Sisli Hospital
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem MAA University Maslak Hospital
| | - Sefik Igdem
- Department of Radiation Oncology, Istanbul Bilim University, Istanbul
| | - Ezgi Oymak
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay
| | - Fulya Agaoglu
- Department of Radiation Oncology, Acibadem MAA University Atakent Hospital
| | - Ugur Selek
- Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey
| | - Ozan Cem Guler
- From the Department of Radiation Oncology, Adana Dr Turgut Noyan Research and Treatment Center, Baskent University Faculty of Medicine, Adana
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara
| | | | - Fadil Akyol
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara
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Onal C, Kose F, Ozyigit G, Aksoy S, Oymak E, Muallaoglu S, Guler OC, Tilki B, Hurmuz P, Akyol F. Stereotactic body radiotherapy for oligoprogressive lesions in metastatic castration-resistant prostate cancer patients during abiraterone/enzalutamide treatment. Prostate 2021; 81:543-552. [PMID: 33905131 DOI: 10.1002/pros.24132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/30/2021] [Accepted: 04/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Metastasis-directed therapy (MDT) utilizing stereotactic body radiotherapy (SBRT) for oligoprogressive lesions could provide a delay in next-line systemic treatment (NEST) change while undergoing androgen receptor-targeted agents (ARTA) treatment. We evaluated prognostic factors for prostate cancer-specific survival (PCSS) and progression-free survival (PFS) to characterize patients receiving treatment with ARTA who may benefit from MDT for oligoprogressive lesions. The impact of MDT on delaying NEST and the predictive factors for NEST-free survival (NEST-FS) were also assessed. MATERIALS AND METHODS The clinical data of 54 metastatic castration-resistant prostate cancer patients with 126 oligoprogressive lesions receiving abiraterone (1 g/day) or enzalutamide (160 mg/day) before or after systemic chemotherapy were analyzed. A median of three lesions (range: 1-5) were treated with MDT. The primary endpoints were PCSS and PFS. The secondary endpoints were time to switch to NEST and NEST-FS. RESULTS The median follow-up time was 19.1 months. Univariate analysis showed that the number of oligoprogressive lesions treated with SBRT and the time between the start of ARTA treatment and oligoprogression were significant prognostic factors for PCSS, and the timing of ARTA treatment (before or after chemotherapy) and the prostate-specific antigen (PSA) response after MDT were significant prognostic factors for PFS. Multivariate analysis showed that early MDT for oligoprogressive lesions delivered less than 6 months after the beginning of ARTA and higher PSA levels after MDT were significant predictors of worse PCSS and PFS. The median total duration of ARTA treatment was 13.8 months. The median time between the start of ARTA treatment and the start of MDT for oligoprogressive lesions was 5.2 months, and MDT extended the ARTA treatment by 8.6 months on average. Thirty-two (59.3%) patients continued ARTA treatment after MDT. ARTA treatment after chemotherapy, early oligoprogression requiring MDT, and lower radiation doses for MDT were independent predictors of NEST-FS in multivariate analysis. CONCLUSIONS MDT for oligoprogressive lesions is effective and may provide several benefits compared to switching from ARTA treatment to NEST. Patients with early progression while on ARTAs and inadequate PSA responses after MDT have a greater risk of rapid disease progression and poor survival, which necessitates intensified treatment.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Fatih Kose
- Division of Medical Oncology, Faculty of Medicine, Baskent University, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sercan Aksoy
- Division of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ezgi Oymak
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Iskenderun, Hatay, Turkey
| | - Sadik Muallaoglu
- Division of Medical Oncology, Iskenderun Gelisim Hospital, Iskenderun, Hatay, Turkey
| | - Ozan C Guler
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Burak Tilki
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fadil Akyol
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Hurmuz P, Cengiz M, Esen CSB, Yedekci Y, Yildiz Z, Ozyigit G, Zorlu F, Akyol F. Factors affecting post-treatment radiation-induced lung disease in patients receiving stereotactic body radiotherapy to lung. Radiat Environ Biophys 2021; 60:87-92. [PMID: 33099668 DOI: 10.1007/s00411-020-00878-3] [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] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
The aim of the study is to investigate factors that may cause radiation-induced lung disease (RILD) in patients undergoing stereotactic body radiotherapy (SBRT) for lung tumors. Medical records of patients treated between May 2018 and June 2019 with SBRT were retrospectively evaluated. All patients should have a diagnosis of either primary non-small cell lung cancer (NSCLC) or less than three metastases to lung from another primary. The median treatment dose was 50 Gy in 4-5 fractions. Tumor response and RILD were evaluated in thoracic computer tomography (CT) using RECIST criteria. 82 patients with 97 lung lesions were treated. The median age was 68 years (IQR = 62-76). With a median follow-up of 7.2 months (3-18 months), three patients had grade 3 radiation pneumonitis (RP). RILD was observed in 52% of cases. Patients who had RILD had a higher risk of symptomatic RP (p = 0.007). In multivariate analyses older age, previous lung radiotherapy history, and median planning treatment volume (PTV) D95 value of ≥ 48 Gy were associated with RILD. Local recurrence (LR) was observed in 5.1% of cases. There was no difference in overall survival and LR with the presence of RILD. Older age, previous lung radiotherapy history, and median PTV D95 value of ≥ 48 Gy seems to be associated with post-SBRT RILD.
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Affiliation(s)
- Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
| | - Mustafa Cengiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | | | - Yagiz Yedekci
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Zehra Yildiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Faruk Zorlu
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Fadil Akyol
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
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Hurmuz P, Cengiz M, Ozyigit G, Akkas EA, Yuce D, Yilmaz MT, Yildiz D, Zorlu F, Akyol F. Stereotactic body radiotherapy in patients with early-stage non-small cell lung cancer: Does beam-on time matter? Jpn J Clin Oncol 2020; 50:1182-1187. [PMID: 32542318 DOI: 10.1093/jjco/hyaa093] [Citation(s) in RCA: 4] [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: 04/02/2020] [Accepted: 05/25/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) is an effective treatment option for patients with early-stage non-small cell lung cancer (NSCLC). In this study, we evaluated the treatment results using two different SBRT techniques and the effect of beam-on time (BOT) on treatment outcomes. METHODS Between July 2007 and January 2018, 142 patients underwent SBRT for primary NSCLC. We have delivered SBRT using either respiratory tracking system (RTS) or internal-target-volume (ITV)-based motion management techniques. The effect of age, tumor size, pretreatment tumor SUVmax value, presence of tissue diagnosis, histopathological subtype, operability status, tumor location, motion management technique, BED10 value, BOT on overall survival (OS), loco-regional control (LRC), event-free survival (EFS) and primary tumor control (PTC) were evaluated. RESULTS Median age of the patients was 70 years (range, 39-91 years). Most of the patients were inoperable (90%) at the time of SBRT. Median BED10 value was 112.5 Gy. With a median follow-up of 25 months, PTC was achieved in 91.5% of the patients. Two-year estimated OS, LRC, PTC and EFS rates were 68, 63, 63 and 53%, respectively. For the entire group, OS was associated with BOT (P = 0.027), and EFS was associated with BOT (P = 0.027) and tumor size (P = 0.015). For RTS group, OS was associated with age (P = 0.016), EFS with BOT (P = 0.05) and tumor size (P = 0.024), LRC with BOT (P = 0.008) and PTC with BOT (P = 0.028). The treatment was well tolerated in general. CONCLUSION SBRT is an effective and safe treatment with high OS, LRC, EFS and PTC rates in patients with primary NSCLC. Protracted BOT might deteriorate SBRT outcomes.
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Affiliation(s)
- Pervin Hurmuz
- Radiation Oncology, Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cengiz
- Radiation Oncology, Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gokhan Ozyigit
- Radiation Oncology, Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Atasever Akkas
- Department of Radiation Oncology, Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara
| | - Deniz Yuce
- Department of Preventive Oncology, Hacettepe University Faculty of Medicine, Ankara
| | - Melek Tugce Yilmaz
- Radiation Oncology, Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Demet Yildiz
- Radiation Oncology, Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Faruk Zorlu
- Radiation Oncology, Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fadil Akyol
- Radiation Oncology, Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Onal C, Ozyigit G, Oymak E, Guler O, Hurmuz P, Tilki B, Torun N, Tuncel M, Reyhan M, Caglar M, Yapar A, Akyol F. Interpreting Clinical Parameters and Nomograms for Predicting Lymph Node Metastasis Detected with 68Ga-PSMA-PET/CT in prostate cancer patients. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.505] [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: 11/27/2022]
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Gumustepe E, Yavas G, Korkmaz Kıraklı E, Yilmaz M, Özler T, Hurmuz P, Baysan C, Akyurek S. Evaluation of Prognostic Biomarkers in Stage III Non-Small Cell Lung Cancer Turkish Radiation Oncology Group Lung Cancer Studying Group. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1220] [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: 10/23/2022]
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31
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Onal C, Demiral A, Atalar B, Yalman D, Dagoglu R, Hurmuz P, Erpolat P, Akyurek S, Gul SK, Berber T, Guler O, Umay C, Sert F, Saglam E, Eray K, Birgi SD, Yaprak G. National, Observational, Multicentric Retrospective Study to Understand Treatment Patterns, Patient Journey and Characteristics with Stage III Non-Small Cell Lung Cancer Patients in Turkey: Stone Trial. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1347] [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: 10/23/2022]
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Güler O, Hurmuz P, Tilki B, Ozyigit G, Yildirim B, Akyol F, Onal C. PO-1212: SBRT in patients with oligometastatic renal cell carcinoma in the era of immunotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01230-5] [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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Onal C, Ozyigit G, Guler OC, Hurmuz P, Torun N, Tuncel M, Dolek Y, Yedekci Y, Oymak E, Tilki B, Akyol F. Role of 68-Ga-PSMA-PET/CT in pelvic radiotherapy field definitions for lymph node coverage in prostate cancer patients. Radiother Oncol 2020; 151:222-227. [DOI: 10.1016/j.radonc.2020.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
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Ozyigit G, Hurmuz P, Akinci D, Esen SCB, Yilmaz MT, Akdogan B, Akyol FH. Hyaluronic acid spacer in focal prostate reirradiation: A single centre experience. Cancer Radiother 2020; 24:805-811. [PMID: 32565071 DOI: 10.1016/j.canrad.2020.03.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/25/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The optimal management of locally recurrent prostate cancer after curative radiotherapy is still unknown. In this study, we evaluated the preliminary results of reirradiation using stereotactic body radiotherapy for locally recurrent prostate cancer after initial definitive local radiotherapy. MATERIALS AND METHODS Between April 2016 and February 2019, 11 patients with recurrent disease at the previously irradiated prostate were treated. Local recurrence was detected by radiological with or without functional imaging modalities including prostate multiparametric/pelvic MRI or positron-emission tomography-computerised tomography with (68Ga)-labelled prostate-specific membrane antigen performed after rising prostate specific antigen serum level during follow-up. All patients received stereotactic body radiotherapy to the recurrent nodule to a total dose of 30Gy in five fractions. Hyaluronic acid spacer was injected between prostate and rectum in seven patients to decrease the rectal dose. Acute toxicity was evaluated by using Common Terminology Criteria for Adverse Events version 4.0, and late toxicity was evaluated by using Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring schema. RESULTS At the diagnosis, the median age was 64 years, and the mean prostate specific antigen serum concentration was 17.7ng/mL. The median interval time between local recurrence and initial definitive radiotherapy was 63 months. Mean prostate specific antigen concentration nadir value during follow-up was 0.43ng/mL. With a median follow up of 19 months, three patients developed either local or distant relapse. One patient had grade 3 acute rectal toxicity, and one patient had grade 2 late urinary toxicity. We did not observe any acute or late toxicity due to hyaluronic acid spacer injection. CONCLUSION Reirradiation after local recurrence following initial definitive radiotherapy together with hyaluronic acid spacer use seems to be effective and safe.
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Affiliation(s)
- G Ozyigit
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - P Hurmuz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - D Akinci
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - S C B Esen
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - M T Yilmaz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - B Akdogan
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - F H Akyol
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Yilmaz MT, Hurmuz P. Comments on "Risk factors for vertebral compression fracture after spine stereotactic body radiation therapy: Long-term results of a prospective phase 2 study". Radiother Oncol 2020; 145:127. [PMID: 31962254 DOI: 10.1016/j.radonc.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 12/16/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Melek Tugce Yilmaz
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - Pervin Hurmuz
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
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Yilmaz MT, Hurmuz P, Yazici G. FLASH-radiotherapy: A new perspective in immunotherapy era? Radiother Oncol 2020; 145:137. [PMID: 31962256 DOI: 10.1016/j.radonc.2019.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/27/2019] [Accepted: 12/17/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Melek Tugce Yilmaz
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey.
| | - Pervin Hurmuz
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - Gozde Yazici
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
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Ozyigit G, Hurmuz P, Yuce D, Akyol F. Prognostic significance of castrate testosterone levels for patients with intermediate and high risk prostate cancer. World J Clin Oncol 2019; 10:283-292. [PMID: 31528544 PMCID: PMC6717705 DOI: 10.5306/wjco.v10.i8.283] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/05/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Testosterone level of < 50 ng/dL has been used to define castrate level after surgery or after androgen deprivation treatment (ADT) in metastatic prostate cancer (PC).
AIM To evaluate the effect of two different castrate testosterone levels, < 50 and < 20 ng/dL, on biochemical relapse free survival (BRFS) in patients with non-metastatic intermediate and high risk PC receiving definitive radiotherapy (RT) and ADT.
METHODS Between April 1998 and February 2011; 173 patients with intermediate and high risk disease were treated. Radiotherapy was delivered by either three-dimensional-conformal technique to a total dose of 73.4 Gy at the ICRU reference point or intensity modulated radiotherapy technique to a total dose of 76 Gy. All the patients received 3 mo of neoadjuvant ADT followed by RT and additional 6 mo of ADT. ASTRO Phoenix definition was used to define biochemical relapse.
RESULTS Median follow up duration was 125 months. Ninety-six patients (56%) had castrate testosterone level < 20 ng/dL and 139 patients (80%) had castrate testosterone level < 50 ng/dL. Both values are valid at predicting BRFS. However, patients with testosterone < 20 ng/dL have significantly better BRFS compared to other groups (P = 0.003). When we compare two values, it was found that using 20 ng/dL is better than 50 ng/dL in predicting the BRFS (AUC = 0.63 vs 0.58, respectively).
CONCLUSION Castrate testosterone level of less than 20 ng/dL is associated with better BRFS and is better in predicting the BRFS. Further studies using current standard of care of high dose IMRT and longer ADT duration might support these findings.
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Affiliation(s)
- Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey M.D
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey M.D
| | - Deniz Yuce
- Department of Preventive Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey
| | - Fadil Akyol
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey M.D
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Yilmaz MT, Hurmuz P, Cengiz M. In Regard to Videtic et al. Int J Radiat Oncol Biol Phys 2019; 104:466-467. [PMID: 31047631 DOI: 10.1016/j.ijrobp.2019.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 01/24/2019] [Accepted: 02/06/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Melek Tugce Yilmaz
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - Pervin Hurmuz
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
| | - Mustafa Cengiz
- Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Turkey
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Ozyigit G, Onal C, Igdem S, Alicikus ZA, Iribas A, Akin M, Yalman D, Cetin I, Aksu MG, Atalar B, Dincbas F, Hurmuz P, Guler OC, Aydin B, Sert F, Yildirim C, Gorken IB, Agaoglu FY, Korcum AF, Yuce D, Ozkok S, Darendeliler E, Akyol F. Treatment outcomes of prostate cancer patients with Gleason score 8-10 treated with definitive radiotherapy : TROD 09-001 multi-institutional study. Strahlenther Onkol 2019; 195:882-893. [PMID: 31143994 DOI: 10.1007/s00066-019-01476-z] [Citation(s) in RCA: 5] [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: 02/25/2019] [Accepted: 05/10/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To validate the clinical outcomes and prognostic factors in prostate cancer (PCa) patients with Gleason score (GS) 8-10 disease treated with external beam radiotherapy (EBRT) + androgen deprivation therapy (ADT) in the modern era. METHODS Institutional databases of biopsy proven 641 patients with GS 8-10 PCa treated between 2000 and 2015 were collected from 11 institutions. In this multi-institutional Turkish Radiation Oncology Group study, a standard database sheet was sent to each institution for patient enrollment. The inclusion criteria were, T1-T3N0M0 disease according to AJCC (American Joint Committee on Cancer) 2010 Staging System, no prior diagnosis of malignancy, at least 70 Gy total irradiation dose to prostate ± seminal vesicles delivered with either three-dimensional conformal RT or intensity-modulated RT and patients receiving ADT. RESULTS The median follow-up time was 5.9 years (range 0.4-18.2 years); 5‑year overall survival (OS), biochemical relapse-free survival (BRFS) and distant metastases-free survival (DMFS) rates were 88%, 78%, and 79%, respectively. Higher RT doses (≥78 Gy) and longer ADT duration (≥2 years) were significant predictors for improved DMFS, whereas advanced stage was a negative prognosticator for DMFS in patients with GS 9-10. CONCLUSIONS Our results validated the fact that oncologic outcomes after radical EBRT significantly differ in men with GS 8 versus those with GS 9-10 prostate cancer. We found that EBRT dose was important predictive factor regardless of ADT period. Patients receiving 'non-optimal treatment' (RT doses <78 Gy and ADT period <2 years) had the worst treatment outcomes.
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Affiliation(s)
- Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey.
| | - Cem Onal
- Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University, Adana, Turkey
| | - Sefik Igdem
- Department of Radiation Oncology, İstanbul Bilim University, Faculty of Medicine, Istanbul, Turkey
| | - Zumre Arican Alicikus
- Department of Radiation Oncology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Ayca Iribas
- Istanbul Oncology Institute, Department of Radiation Oncology, İstanbul University, Istanbul, Turkey
| | | | - Deniz Yalman
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Ilknur Cetin
- Department of Radiation Oncology, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Melek Gamze Aksu
- Department of Radiation Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem University, Faculty of Medicine, Istanbul, Turkey
| | - Fazilet Dincbas
- Cerrahpasa Faculty of Medicine, Department of Radiation Oncology, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
| | - Ozan Cem Guler
- Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Baskent University, Adana, Turkey
| | - Barbaros Aydin
- Department of Radiation Oncology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Fatma Sert
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Cumhur Yildirim
- Cerrahpasa Faculty of Medicine, Department of Radiation Oncology, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ilknur Birkay Gorken
- Department of Radiation Oncology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Fulya Yaman Agaoglu
- Istanbul Oncology Institute, Department of Radiation Oncology, İstanbul University, Istanbul, Turkey
| | - Aylin Fidan Korcum
- Department of Radiation Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Deniz Yuce
- Department of Prevantive Oncology, Hacettepe University, Hacettepe Cancer Institute, Ankara, Turkey
| | - Serdar Ozkok
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Emin Darendeliler
- Istanbul Oncology Institute, Department of Radiation Oncology, İstanbul University, Istanbul, Turkey
| | - Fadil Akyol
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, 06100, Ankara, Turkey
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Affiliation(s)
- Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Ozyigit G, Hurmuz P, Yuce D, Akyol F. PO-0838 Castrate testosterone predicts biochemical relapse free survival in non-metastatic prostate cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31258-7] [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: 11/26/2022]
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Ozyigit G, Onal H, Hurmuz P, Iribas A, Cetin I, Gorken I, Yalman D, Akyol F. EP-1534 Clinical Outcomes for Patients with Gleason Score 10 Prostate Adenocarcinoma: TROD 09-004 Study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31954-1] [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: 10/26/2022]
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Sari SY, Yazici G, Gultekin M, Hurmuz P, Gurkaynak M, Ozyigit G. Sarcoma. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_8] [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: 11/24/2022] Open
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Gultekin M, Sari SY, Yazici G, Hurmuz P, Yildiz F, Ozyigit G. Gynecological Cancers. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_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: 11/30/2022] Open
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Hurmuz P, Yazici G, Gultekin M, Sari SY, Cengiz M, Ozyigit G. Gastrointestinal System Cancers. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_5] [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: 11/24/2022] Open
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Abstract
PURPOSE Complementary and alternative medicine (CAM) has been popular among patients with cancer for several decades. The objectives of this study were to evaluate the prevalence of CAM use and to identify the factors affecting CAM use in a large patient cohort seen at a comprehensive cancer center in Turkey. PATIENTS AND METHODS An investigator-designed survey was completed by volunteer patients who visited the outpatient clinic in the medical oncology department. CAM use encompassed pharmacologic agents including vitamins, dietary supplements, and herbal products or nonpharmacologic methods like prayer, meditation, hypnosis, massage, or acupuncture. RESULTS Of 1,499 patients who answered the survey, 1,433 (96%) used nonpharmacologic CAM and 60 (4%) used pharmacologic CAM (pCAM). The most frequent types of CAM used were prayer (n = 1,433) followed by herbal products (n = 42). pCAM use was not significantly associated with age ( P = .63), sex ( P = .15), diagnosis ( P = .15), or income level ( P = .09). However, it was significantly associated with the level of education ( P = .0067) and employment status ( P < .001). Patients with higher education levels used more pCAM products ( P = .025). Among 60 pCAM users, six patients (10%) used pCAM for more than 2 years and 22 (36%) did not consult their physicians about their pCAM use. Only nine patients (15%) reported unpleasant adverse effects related to pCAM. CONCLUSION Although CAM use was high among our patients, prevalence of pCAM use was lower than expected. Patients with higher education levels tended to use more pCAM.
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Affiliation(s)
- Suayib Yalcin
- Suayib Yalcin and Pervin Hurmuz, Hacettepe
University School of Medicine, Ankara, Turkey; and Lacey McQuinn
and Aung Naing, University of Texas MD Anderson Cancer Center,
Houston, TX
| | - Pervin Hurmuz
- Suayib Yalcin and Pervin Hurmuz, Hacettepe
University School of Medicine, Ankara, Turkey; and Lacey McQuinn
and Aung Naing, University of Texas MD Anderson Cancer Center,
Houston, TX
| | - Lacey McQuinn
- Suayib Yalcin and Pervin Hurmuz, Hacettepe
University School of Medicine, Ankara, Turkey; and Lacey McQuinn
and Aung Naing, University of Texas MD Anderson Cancer Center,
Houston, TX
| | - Aung Naing
- Suayib Yalcin and Pervin Hurmuz, Hacettepe
University School of Medicine, Ankara, Turkey; and Lacey McQuinn
and Aung Naing, University of Texas MD Anderson Cancer Center,
Houston, TX
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Hurmuz P, Ozyigit G. In Regard to Nantavithya et al. Int J Radiat Oncol Biol Phys 2018; 101:744-745. [PMID: 29893285 DOI: 10.1016/j.ijrobp.2018.03.044] [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: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Affiliation(s)
- Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cengiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Faruk Zorlu
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fadil Akyol
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Canbolat A, Zorlu F, Hurmuz P, Yeginer M, Ozyigit G. Investigating the surface dose contribution of intrafractional kV imaging in CyberKnife-based stereotactic radiosurgery. Med Dosim 2017; 42:304-309. [PMID: 28739211 DOI: 10.1016/j.meddos.2017.06.005] [Citation(s) in RCA: 2] [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: 02/27/2017] [Revised: 04/16/2017] [Accepted: 06/23/2017] [Indexed: 11/24/2022]
Abstract
CyberKnife treatment consists of hundreds of noncoplanar beams and numerous intrafractional images that can be taken during a single treatment fraction; thus, doses because of imaging should be considered in this technique. The aim of this study is to investigate the in-field and out-of-field surface doses induced from kV imaging system during stereotactic radiosurgery (SRS) treatment. The imaging-induced surface doses were measured at the center of the imaging field and within ±15-cm distance from the center in both craniocaudal and lateral directions. TLD100H thermoluminescence dosimeters and EBT2 gafchromic films were used to take the measurements at the locations of 0, ±5, ±10, and ±15 cm in the 2 orthogonal directions on abdominal region of a Rando phantom. The surface dose contributions of imaging system for the 4 most commonly used energy options of 90, 100, 110, and 120 kVp with 3 mAs options of 10, 30, and 90 mAs were measured and compared. Imaging dose values have a positive correlation with both parameters of energy and mAs. The energy options of 100, 110, and 120 kVp, in average, induced 60%, 101%, and 141% more doses per mAs than 90 kVp energy in the imaging field center. A threefold increase in mAs values, i.e., from 10 mAs to 30 mAs and from 30 mAs to 90 mAs, caused higher dose in field center with a factor of 2.53 ± 0.08 when the energy value was kept constant. The in-field dose distributions within ±10 cm in both directions showed a flat pattern with a standard deviation lower than 5%, whereas the out-of-field doses at ±15-cm distance from the field center suddenly dropped to almost half of the central doses. Although a single imaging attempt causes a very low dose compared with the therapeutic dose level, one should be aware of the cumulative surface dose increase with higher imaging number. Proper patient setup, fiducial usage, and reduction of both the mAs values and the imaging numbers should be, therefore, considered to keep the cumulative surface dose in a lower level.
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Affiliation(s)
- Abdulmecit Canbolat
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Faruk Zorlu
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mete Yeginer
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Akyol F, Hurmuz P, Ozyigit G. PO-0731: Comparison of two fractionation schemes in prostate cancer patients treated with robotic SBRT. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31168-4] [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: 11/28/2022]
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