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Özkaya Toraman K, Meral R, Karadeniz AN, Kaval G, Başaran M, Ekenel M, Altun M. Cisplatin-docetaxel induction chemotherapy for patients with nasopharyngeal carcinoma in a non-endemic cohort. J Chemother 2024; 36:133-142. [PMID: 37211862 DOI: 10.1080/1120009x.2023.2215090] [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: 12/01/2022] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
This is the report on our clinic's 15 years of experience (2004-2018) on nasopharyngeal carcinoma (NPC), treated with induction chemotherapy (IC) and subsequent concomitant chemoradiotherapy (CCRT), comprising population characteristics and treatment outcomes of 203 patients with non-metastatic NPC. IC comprised docetaxel (75 mg/m2) and cisplatin (75 mg/m2) combination (TP). Concurrent cisplatin (P) was applied either weekly (40 mg/m2, 32 cases) or every-3-week (100 mg/m2, 171 cases). The median follow-up duration was 85 months (range, 5-204 months). Overall and distant failure rates were observed in 27.1% (n = 55) and 13.8% (n = 28) patients, respectively. The 5-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) rates were 84.1%, 86.4%, 75%, and 78.7% respectively. The overall stage was an independent prognostic factor for the LRRFS, DMFS, DFS, and OS. The WHO histological type was a prognostic factor for the LRRFS, DFS, and OS. Age was a prognostic factor for the DMFS, DFS, and OS. Concurrent P schedule was independent prognostic only the LRRFS.
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Affiliation(s)
- Kübra Özkaya Toraman
- Department of Radiation Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Rasim Meral
- Department of Radiation Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Ahmet Nafiz Karadeniz
- Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gizem Kaval
- Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mert Başaran
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Meltem Ekenel
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Musa Altun
- Department of Radiation Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
- Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Meral R, Selcukbiricik OS, Uzum AK, Sahin S, Okutan M, Barburoglu M, Dolas I, Altun M, Yarman S, Kadıoglu P. Promising Outcomes in Acromegaly Patients Receiving CyberKnife Stereotactic Hypofractionated Radiotherapy. Cureus 2023; 15:e47936. [PMID: 37908695 PMCID: PMC10613787 DOI: 10.7759/cureus.47936] [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: 10/29/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The primary treatment for patients with acromegaly has traditionally been transsphenoidal surgery, with decreasing reliance on radiotherapy (RT) due to advancements in pharmacotherapy (PT). Despite these advancements, a substantial portion of patients still face persistent acromegaly, necessitating novel treatment approaches. This study investigates the role of CyberKnife Stereotactic Hypofractionated Radiotherapy (CK-HFRT) in persistent acromegaly. OBJECTIVE The primary objective was to assess the impact of CK-HFRT on endocrine remission (ER) rates while maintaining acceptable toxicity levels. METHODS The study retrospectively analyzed 31 consecutive patients with acromegaly who received CK-HFRT following multiple unsuccessful surgeries and prolonged PT without ER. Various CK-HFRT dose fractionation regimes were administered, and dose volume histograms were evaluated. Tumor control, cured disease (CD), endocrine remission (ER) rates, and overall survival were estimated at a median follow-up of 62 months. Acute and late toxicity, including pituitary insufficiency and radiation-induced optic neuropathy (RION), were also assessed. RESULTS At 62 months of follow-up, the study group demonstrated excellent tumor control with 100% nonprogressive adenomas. Endocrine remission was achieved in 86.7% of patients, with a 22.4% CD rate at five years. Pituitary insufficiency occurred in 32.3% of patients, and no cases of RION were reported. The study observed three deaths related to cardiovascular diseases, all in patients receiving PT. Overall survival at five years was 79.2%. CONCLUSION CyberKnife stereotactic hypofractionated radiotherapy, as an adjunct to PT, provides a viable treatment option for patients with persistent acromegaly following unsuccessful surgeries. The therapy results in substantial ER rates and tumor control while minimizing the risk of permanent radiation-induced optic neuropathy. However, the decision to administer CK-HFRT should be individualized, considering the patient's overall condition and treatment history.
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Affiliation(s)
- Rasim Meral
- Department of Clinical Oncology, Istanbul University Institute of Oncology, Istanbul, TUR
- Department of Radiation Oncology, Istanbul University School of Medicine, Istanbul, TUR
| | | | - Ayse K Uzum
- Department of Endocrinology, Istanbul University School of Medicine, Istanbul, TUR
| | - Serdar Sahin
- Department of Endocrinology, Istanbul University - Cerrahpasa School of Medicine, Istanbul, TUR
| | - Murat Okutan
- Department of Medical Physics, Istanbul University Institute of Oncology, Istanbul, TUR
| | - Mehmet Barburoglu
- Department of Radiology, Istanbul University School of Medicine, Istanbul, TUR
| | - Ilyas Dolas
- Department of Neurological Surgery, Istanbul University School of Medicine, Istanbul, TUR
| | - Musa Altun
- Department of Radiation Oncology, Istanbul University School of Medicine, Istanbul, TUR
| | - Sema Yarman
- Department of Endocrinology, Istanbul University School of Medicine, Istanbul, TUR
| | - Pinar Kadıoglu
- Department of Endocrinology, Istanbul University - Cerrahpasa School of Medicine, Istanbul, TUR
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Meral R, Kutlu N, Alav A, Kılınççeker O. The possibilities of using quinoa flour in the production of chicken meat patties. J HELL VET MED SOC 2023. [DOI: 10.12681/jhvms.29784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In this study, the mixtures obtained by mixing quinoa flour with wheat flour in different proportions were added to chicken meat patties and their effects on some quality characteristics were investigated. The yields of the meatballs prepared with the mixes containing 50% and 100% quinoa flour were higher than those of other meatballs (69.59% and 69.71%, respectively). The moisture retention of the fried meatballs prepared with mixtures containing 50%, 70% and 100% quinoa flour was found to be 45.80%, 45.97% and 51.09%, respectively. The results indicated that the moisture retention of these meatballs was higher than those of meatballs containing 30 and 0% quinoa flour. In contrast, oil absorption rates in the fried samples were in the range of 4.46-5.65% for all quinoa-containing samples and were lower compared to the control sample. Firmness decreased in meat patties prepared with mixtures containing high quinoa rates. It was observed that quinoa flour did not have a negative effect on quality factors. It was concluded that especially the mixtures containing 30% and 50% quinoa flour can be recommended.
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Kebudi R, Buyukkapu SB, Gorgun O, Ozkaya K, Meral R, Ayan I, Altun M. Nasopharyngeal carcinoma in children: Multimodal treatment and long-term outcome of 92 patients in a single center over a 28-year period. Pediatr Blood Cancer 2021; 68:e29372. [PMID: 34582092 DOI: 10.1002/pbc.29372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the long-term outcome and late effects in pediatric patients with nasopharyngeal carcinoma (NPC) treated with neoadjuvant chemotherapy (NACT), followed by radiotherapy (RT). METHODS Ninety-two children (65 male, 27 female) diagnosed with NPC between 1989 and 2017 in the Istanbul University, Institute of Oncology were evaluated retrospectively. NACT consisted of three cycles of cisplatin-containing regimen every 3 weeks, followed by RT. RESULTS The median age was 13 years (5-18 years). Most had locoregionally advanced disease (stage III/IVA/IVB) and five had distant metastases at presentation. At a median follow-up of 108 months (3-332 months), 5- and 10-year overall survival rates and event-free survival rates were 87.5%, 79.7% and 82.1%, 78.9%, respectively. Three patients with distant metastasis are long-term survivors. Thirteen patients relapsed at a median of 8 months (2-23 months). Hypothyroidism (36%) and xerostomia (25%) were the most frequent long-term treatment-related toxicities. Nine second malignancies developed in eight patients, eight in the irradiated field at a median of 14 years (range 5-26 years), five of whom are long-term survivors after curative surgery. CONCLUSIONS Three courses of cisplatin-containing NACT, followed by RT lead to high survival and locoregional control rate in advanced stage NPC in children. Patients with distant metastasis should also be treated with curative intent by systemic chemotherapy and locoregional radiotherapy. Patients should be followed closely for recurrences and long-term morbidities including second malignancies, which may be treated with curative surgeries if diagnosed early.
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Affiliation(s)
- Rejin Kebudi
- Division of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Sema Bay Buyukkapu
- Division of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Omer Gorgun
- Division of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Kübra Ozkaya
- Division of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Rasim Meral
- Division of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Inci Ayan
- Division of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Musa Altun
- Division of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey.,Department of Radiation Oncology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Apaydin T, Ozkaya HM, Durmaz SM, Meral R, Kadioglu P. Efficacy and Safety of Stereotactic Radiotherapy in Cushing's Disease: A Single Center Experience. Exp Clin Endocrinol Diabetes 2020; 129:482-491. [PMID: 32767284 DOI: 10.1055/a-1217-7365] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of stereotactic radiotherapy (RT) in patients with Cushing's disease (CD). METHODS The study included 38 patients [31 patients who received gamma knife radiosurgery (GKS) and 7 patients who received cyberknife hypofractionated RT (HFRT)] with CD. Hormonal remission was considered if the patient had suppressed cortisol levels after low dose dexamethasone, normal 24-hour urinary free cortisol (UFC), and lack or regression of clinical features. RESULTS Biochemical control after RT was observed in 52.6% of the patients with CD and median time to hormonal remission was 15 months. Tumor size control was obtained in all of the patients. There was no significant relationship between remission rate and laboratory, radiological and pathological variables except for preoperative UFC. Remission rate was higher in patients with lower preoperative UFC. Time to remission increased in parallel to postoperative cortisol and 1mg DST level. Although medical therapy before RT did not affect the rate of- and time to remission, medical therapy after RT prolonged the time to hormonal remission. CONCLUSION In this current single center experience, postoperative cortisol and 1mg DST levels were found as the determinants of time to remission. Although medical therapy before RT did not affect the rate of- and time to remission, medical therapy after RT prolonged the time to biochemical control . This latter finding might suggest a radioprotective effect of cortisol lowering medication use on peri-RT period.
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Affiliation(s)
- Tugce Apaydin
- Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sebnem Memis Durmaz
- Department of Radiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Rasim Meral
- Deparment of Radiation Oncology, Istanbul Medical School, Institute of Oncology, Istanbul University, Istanbul, Turkey
| | - Pinar Kadioglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Kaval G, Altun M, Ibis K, Ozkaya K, Meral R, Karadeniz A, Sarı M, Ekenel M, Basaran M, Bavbek S. Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Altun M, Kaval G, Ibis K, Ozkaya K, Meral R, Karadeniz AN, Sari M, Ekenel M, Basaran M, Bavbek SE. Induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma(NPC) patients treated between 2004 and 2016: Patient and treatment characteristics and long term outcome. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e17507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17507 Background: Standard treatment of locoregionally advanced nasopharyngeal carcinoma (LRA-NPC) is CCRT with or without adjuvant chemotherapy (CT). The value of adding IC to CCRT in LRA-NPC is unclear. We aimed to retrospectively evaluate LRA-NPC patients treated with IC followed by CCRT and analyse patient, tumor, treatment characteristics and outcome. Methods: Between 2004 and 2016, 202 patients with nonmetastatic LRA-NPC (stage 3-4), 144 males and 58 females ranging from 17 to 75 (median 49) years old were treated with IC followed by CCRT. Eleven (%5.4) patients had keratinised (WHO I), and 191 (%94.6) had nonkeratinised or undiffrentiated (WHO II-III) carcinoma. Cumulative radiation dose to primary tumor ranged from 60 to 74 (median 70) Gy. Ninety-one (%45) of the patients received 2-dimensional and 111 (%55) received intensity modulated radiotherapy (IMRT). IC consisted of taxane (T)(75 mg/ m2) and platinum (P)(75 mg/m2) combination (199 patients) or P and fluoruracil or epirubicine (3 patients) combination and 188 of the patients received 3 cycles of IC. Concomittant P was used either weekly (40 mg/m2, 25 patients) or every 3-weekly (100 mg/m2, 177 patients) application. Follow-up ranged from 5 to 167 months (median, 72.5 months). Results: Treatment failure was observed in 52 (%25.7) of the patients (21 local, 13 regional and 27 distant failures). Distant failure rate of all the patients exceeds 13%. Five and 10 years disease free survival (DFS) rates are 75.2% and 70.4% and overall survival (OS) rates are 78.9% and 64% respectively. In univariate analysis patient age favoring those below 49 and stage of disease favoring WHO II-III were all significant predictors of DFS and OS. In addition pathology was a significant predictor of DFS. Conclusions: LRA-NPC patients treated with IC followed by CCRT have a high locoregional control rate. Despite the use of systemic (induction) chemotherapy distant control remains insufficient and continues to be a challenge in NPC treatment. Besides improving locoregional control more effective systemic therapy is needed. [Table: see text]
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Affiliation(s)
- Musa Altun
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
| | - Gizem Kaval
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
| | - Kamuran Ibis
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
| | - Kubra Ozkaya
- Afyon Kocatepe University, Department of Radiation Oncology, Afyon, Turkey
| | - Rasim Meral
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
| | - Ahmet Nafiz Karadeniz
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
| | - Murat Sari
- Istanbul University, Oncology Institute, Department of Medical Oncology, Istanbul, Turkey
| | - Meltem Ekenel
- Istanbul University, Oncology Institute, Department of Medical Oncology, Istanbul, Turkey
| | - Mert Basaran
- Istanbul University, Oncology Institute, Department of Medical Oncology, Istanbul, Turkey
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Meral R, Köse YE. The effect of bread-making process on the antioxidant activity and phenolic profile of enriched breads. Quality Assurance and Safety of Crops & Foods 2019. [DOI: 10.3920/qas2018.1350] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- R. Meral
- Van Yüzüncü Yıl University, Faculty of Engineering, Department of Food Engineering, 65080 Van, Turkey
| | - Y. Erim Köse
- Van Yüzüncü Yıl University, Faculty of Engineering, Department of Food Engineering, 65080 Van, Turkey
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Kebudi R, Altun M, Bay Buyukkapu S, Gorgun O, Meral R, Ayan I, Zulfikar B, Yaman Agaoglu F, Darendeliler E. Nasopharengeal carcinoma in children: Demographic, clinical, therapeutic characteristics and long term outcome of 97 patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rejin Kebudi
- Istanbul University, Cerrahpasa Faculty of Medicine and Oncology Institute, Pediatric Hematology-Oncology, Istanbul, Turkey
| | - Musa Altun
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
| | - Sema Bay Buyukkapu
- Istanbul University, Oncology Institute, Pediatric Hematology-Oncology, Istanbul, Turkey
| | - Omer Gorgun
- Istanbul University, Cerrahpasa Faculty of Medicine and Oncology Institute, Pediatric Hematology-Oncology, Istanbul, Turkey
| | - Rasim Meral
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
| | - Inci Ayan
- Istanbul University, Oncology Institute, Pediatric Hematology-Oncology, Istanbul, Turkey
| | - Bulent Zulfikar
- Istanbul University, Cerrahpasa Faculty of Medicine and Oncology Institute, Pediatric Hematology-Oncology, Istanbul, Turkey
| | - Fulya Yaman Agaoglu
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
| | - Emin Darendeliler
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
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Demir Doğan M, Can G, Meral R. Effectiveness of Black Mulberry Molasses in Prevention of Radiotherapy-Induced Oral Mucositis: A Randomized Controlled Study in Head and Neck Cancer Patients. J Altern Complement Med 2017; 23:971-979. [PMID: 28677999 DOI: 10.1089/acm.2016.0425] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Radiation-induced oral mucositis is one of the problems experienced by 70%-80% of patients receiving radiation therapy (RT). This randomized controlled trial assessed the effectiveness of black mulberry molasses in the prevention of oral mucositis in head and neck cancer patients receiving RT. INTERVENTIONS AND OUTCOME MEASURES Eighty head and neck cancer patients scheduled to undergo RT to the oropharyngeal mucosa were randomly assigned to receive RT (42) or RT plus mulberry molasses (38). The research data were collected with a Patient Description Form, Common Terminology Criteria for Adverse Events, version 4.0, an Oral Assessment Guide, and the University of Washington Quality of Life Assessment Questionnaire. RESULTS The incidence and severity of oral mucositis were lower in the black mulberry molasses group. However, black mulberry molasses usage was an only independent and significant factor in prevention of mucositis [HR 0.63 (%95 GI 0.40-0.98)]. There were no differences between the quality of life scores of experimental and control groups. CONCLUSIONS This randomized controlled study showed that black mulberry molasses usage is an effective intervention in the prevention of the radiation-induced mucositis of head and neck cancer patients. However, to confirm these results, further studies are needed.
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Affiliation(s)
| | - Gulbeyaz Can
- 2 Nursing Faculty, Istanbul University , Istanbul, Turkey
| | - Rasim Meral
- 3 Institute of Oncology, Istanbul University , Istanbul, Turkey
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Meral R, Gurdal N, Kemikler G, Okutan M, Sahin D, Ahmedova A, Altun M, Sencer A, Uzum A, Hatipoglu E. Radiation Dose to Hippocampus With Increasing Planning Target Volume in Patients With Pituitary Adenoma Treated With Hypofractionated Radiation Therapy. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bektas-Kayhan K, Karagoz G, Kesimli MC, Karadeniz AN, Meral R, Altun M, Unur M. Carcinoma of the tongue: a case-control study on etiologic factors and dental trauma. Asian Pac J Cancer Prev 2014; 15:2225-9. [PMID: 24716961 DOI: 10.7314/apjcp.2014.15.5.2225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carcinoma of the tongue is the most common intra-oral malignancy in Western countries. Incidence and mortality rates have increased in recent years, and survival has not improved. This study aimed to determine etiologic factors for tongue cancer with age-sex matched case-control data. MATERIALS AND METHODS 47 patients with carcinoma of the tongue referred to our oral medicine clinic between years 2005-2006 were analyzed and compared with control group data. The medical records , including family history of cancer, dental trauma, and history of abuse of alcohol and tobacco products was recorded for all subjects. Chi square comparison tests and linear regression analysis were performed using the SPSS program for statistics. RESULTS Patient and randomly selected control groups each consisted of 30 male and 17 female subjects with mean ages 53.2 (± 12.6) and 52.6 (± 11.5) years respectively. Smoking and alcohol abuse proportions were significantly higher in the patient group (p=0.0001, p<0.0001 respectively). Chronic mechanical trauma was observed in 44.7% of the patients and 17.0% of the control group (p=0.004). Similarly, family history of cancer of any type (for the first degree relatives) was found to be more common in the patient group (p=0.009). On regression analysis, alcohol abuse, family history of cancer, smoking, chronic mechanical traumas appeared as significant etiologic factors (p=0.0001). CONCLUSIONS We believe that field cancerization may become evident in oral and oropharyngeal mucosa with multiple steps of molecular changes starting from the first sign of dysplasia with chronic exposure to etiological factors. Chronic trauma cases need particular attention to search for very early signs of cancer.
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Affiliation(s)
- Kivanc Bektas-Kayhan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey E-mail :
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Kebudi R, Meral R, Gorgun O, Cakir FB, Celikarslan S, Agaoglu FY, Zulfikar OB, Darendeliler E, Ayan I, Altun M. Nasopharengeal carcinoma in children and adolescents: Clinical and therapeutical characteristics and long-term outcome. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e21012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rejin Kebudi
- Istanbul University, Cerrahpasa Medical Faculty and Oncology Institute, Pediatric Hematology-Oncology, Istanbul, Turkey
| | - Rasim Meral
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
| | - Omer Gorgun
- Istanbul University, Cerrahpasa Medical Faculty and Oncology Institute, Pediatric Hematology-Oncology, Istanbul, Turkey
| | - Fatma Betul Cakir
- Bezmialem Vakif University, Pediatric Hematology-Oncology, Istanbul, Turkey
| | - Sukran Celikarslan
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
| | - Fulya Yaman Agaoglu
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
| | - O. Bulent Zulfikar
- Istanbul University, Cerrahpasa Medical Faculty and Oncology Institute, Pediatric Hematology-Oncology, Istanbul, Turkey
| | - Emin Darendeliler
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
| | - Inci Ayan
- Istanbul University, Oncology Institute, Pediatric Hematology-Oncology, Istanbul, Turkey
| | - Musa Altun
- Istanbul University, Oncology Institute, Department of Radiation Oncology, Istanbul, Turkey
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Meral R, Tambas M, Guveli M, Kemikler G, Altun M, Cakır A, Okutan M, Ahmed S, Donmez N, Disci R. Side Effects of Stereotactic Fractionated Radiation Therapy for Malignant and Benign Lesions. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.2225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Meral R, Tuna S, Disci R, Karadeniz A, Altun M. Cranial Nerve Deficit Indicates Less Favorable Prognosis Than Advanced Cervical Nodal Disease In Patients With Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1045] [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: 10/15/2022]
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Ekenel M, Keskin S, Basaran M, Ozdemir C, Meral R, Altun M, Aslan I, Bavbek SE. Induction chemotherapy with docetaxel and cisplatin is highly effective for locally advanced nasopharyngeal carcinoma. Oral Oncol 2011; 47:660-4. [PMID: 21596616 DOI: 10.1016/j.oraloncology.2011.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 04/18/2011] [Indexed: 02/08/2023]
Abstract
Radiotherapy (RT) with concomitant chemotherapy (CT) has improved the therapeutic outcome of patients with locally advanced nasopharyngeal carcinoma (LANC). However, the importance of induction CT before definitive therapy is still undefined. Patients (n=59) who had LANC were included in this retrospective study. They received induction CT consisting of cisplatin and docetaxel followed by definitive RT with cisplatin. The median age was 49 years (18-68). All patients were of stages II (15%), III (63%) and IV (22%). Fifty eight patients could receive 3 cycles of CT. Except one patient, there was no grade 3 or 4 toxicity during induction CT. Chemoradiotherapy could be given to 49 patients (83%). Twelve percent of patients had complete response after induction CT and this number had increased to 95% after the completion of the therapy. Objective responses (complete and partial) were 100% after the completion of the therapy. Median follow up time was 29 months. Nine patients had relapse (2 had local only, 4 distant, 3 local and distant). Three patients who had both local and distant relapse died during follow-up. Three year overall and progression free survival rates were 94.9% and 84.7%, respectively. Induction CT with docetaxel and cisplatin is a feasible and tolerable treatment for patients with LANC.
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Affiliation(s)
- Meltem Ekenel
- Department of Medical Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
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17
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Ekenel M, Keskin S, Başsaran M, Bavbek SE, Ozdemir C, Meral R, Altun M. Clinical outcomes in patients with locally advanced nasopharyngeal cancer treated with neoadjuvant docetaxel and cisplatin followed by radiation treatment and concomitant cisplatin. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16017] [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: 11/20/2022] Open
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Bilge H, Yondem S, Kucucuk H, Cakir A, Meral R. Effects of immobilization beds on the dose in the entrance and exit dose region for Co-60, 4, 6 and 15 MV photons. J BUON 2008; 13:385-390. [PMID: 18979554] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE The aim of this study was to determine the effects of Styrofoam beds used for immobilization on build-up and exit dose regions for high energy photon beams. MATERIALS AND METHODS Build-up dose and exit dose measurements in central axis of Co-60 and 4, 6 and 15 MV photons at various field sizes and source to phantom distances were made in a water equivalent solid phantom with 2, 5 and 10 cm thick uniform Styrofoam beds at the surface. A Markus type plane-parallel ion chamber with fixed separation between collecting electrodes was used to measure the percent depth doses. RESULTS The surface dose increased almost linearly with field size for Co-60, 4, 6 and 15 MV X-ray beams. The effect of immobilization (Styrofoam beds) on the surface dose increased with the thickness and this effect was lower with higher energies. When a 2 cm thick Styrofoam bed was used for immobilization, the surface dose in a 10x10 cm field was higher (43.9, 36.8, 28.8 and 14.9% for Co-60, 4, 6 and 15 MV, respectively). CONCLUSION As the Styrofoam bed was thicker, the maximum dose point moved closer to the surface of the phantom for all energies. The exit surface dose was also enhanced with the presence of Styrofoam beds and similar to the effects on the surface dose. This enhancement was the maximum 5% for high energy photon beams and 6% for Co-60 beam. The introduction of Styrofoam beds in the radiation beam for the immobilization of the patient increases surface and exit doses to a considerable extent.
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Affiliation(s)
- H Bilge
- Istanbul University, Oncology Institute, Medical Physics Division, Radiation Oncology Department, Istanbul, Turkey
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19
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Meral R. Comment on: Mathematical modelling of survival of glioblastoma patients suggests a role for radiotherapy dose escalation and predicts poorer outcome after delay to start treatment (Burnet et al. Clin Oncol 2006;18:93-103). Clin Oncol (R Coll Radiol) 2006; 18:578-9. [PMID: 16969995 DOI: 10.1016/j.clon.2006.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Aydin A, Ozden BC, Mezdeği A, Kurul S, Meral R, Solakoğlu S. Effects of amifostine on healing of microvascular anastomoses, flap survival, and nerve regeneration with preoperative or postoperative irradiation. Microsurgery 2004; 24:392-9. [PMID: 15378586 DOI: 10.1002/micr.20054] [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] [Indexed: 11/10/2022]
Abstract
Amifostine is an organic thiophosphate compound, which has both cytoprotective and radioprotective effects. An experimental study was undertaken to investigate the effects of its use on reconstructive surgery in cancer treatment. One hundred and twenty guinea pigs were divided into three equal groups to investigate flap survival and healing, patency of microvascular anastomoses, and nerve regeneration, respectively. The groups were subdivided in such a way that they were given either preoperative or postoperative radiotherapy, with or without amifostine treatment. Macroscopic and planimetric examination, light and electron microscopy, and histomorphometric analyses were performed to evaluate flap survival and healing, patency of arterial anastomoses, and nerve regeneration. Although flap survival rates were not affected, significantly better flap healing was observed in the postoperative radiotherapy subgroup with amifostine treatment. However, amifostine treatment did not result in a statistically significant difference in terms of anastomotic patency and nerve regeneration with either preoperative or postoperative radiotherapy.
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Affiliation(s)
- Atakan Aydin
- Division of Hand Surgery, Department of Plastic and Reconstructive Surgery, Istanbul Medical Faculty, Istanbul, Turkey.
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21
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Altun M, Demiral AN, Meral R, Kaytan E, Cosar R, Disci R, Dizdar Y. Prognostic significance of hemoglobin concentration in nasopharyngeal carcinoma: does treatment-induced anemia have negative effect? In Vivo 2003; 17:483-7. [PMID: 14598613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
PURPOSE To assess the value of hemoglobin concentration (HC) in predicting treatment outcomes in nasopharyngeal carcinoma (NPC) patients treated with chemotherapy (CT) and radiotherapy (RT). PATIENTS AND METHODS Ninety-eight NPC patients treated with three courses of platinum-based neoadjuvant CT (NCT) and conventional RT were grouped as having normal HC (> or = 12.0 g/dl in females and > or = 13 g/dl in males), having mild anemia (MA) (13.0 g/dl > Hb > or = 11 g/dl in males, 12.0 g/dl > Hb > or = 11 g/dl in females) and having severe anemia (SA) (Hb < 11 g/dl). Massive decrease in HC (MDHC) was defined as > or = 1.5 g/dl decline with NCT. Along with other known risk factors (sex, age, histopathology, T stage, N stage, bilateral neck involvement, cranial nerve involvement and total RT time), the prognostic value of SA and MDHC were evaluated by Cox-regression. RESULTS SA increased from 7 to 33% with NCT (p < 0.0001). Patients with SA had lower 5-year locoregional control (LRC) (49 vs. 73%, p = 0.03), disease-free survival (DFS) (42 vs. 68%, p = 0.01) and overall survival (OS) (43 vs. 69%, p = 0.01) rates than patients with normal HC or MA. The presence of MDHC worsened 5-year LRC (p = 0.002), DFS (p = 0.001) and OS (p = 0.02) rates. In multivariate analyses, MDHC and SA had pronounced effect on LRC and survival, respectively. CONCLUSION MDHC and SA adversely affect treatment outcome in NPC patients treated with CT and RT. This may favour concomitant scheduling of RT and CT over neoadjuvant setting. Correction of HC before RT can improve the efficacy of RT and should be further evaluated.
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Affiliation(s)
- Musa Altun
- Istanbul University, Oncology Institute, Department of Radiation Oncology, 34390 Capa, Istanbul, Turkey.
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Meral R, Duranyildiz D, Tas F, Camlica H, Yasasever V, Kurul S, Dalay N. Prognostic significance of melanoma inhibiting activity levels in malignant melanoma. Melanoma Res 2001; 11:627-32. [PMID: 11725209 DOI: 10.1097/00008390-200112000-00009] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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: 10/27/2022]
Abstract
This analytic (phase II) study aimed to investigate the hypothesis that the decline in serum melanoma-inhibiting activity (MIA) levels following initiation of treatment might have prognostic value. The mean serum lactate dehydrogenase (LDH), MIA and S100 levels in patients with malignant melanoma before treatment were higher than in the control group. Patients with visceral dissemination had much higher mean serum MIA levels than patients with nodal spread only. A regression model was constructed to analyse the prognostic factors in patients with advanced stage malignant melanoma. Therapy included surgical excision or lymph node dissection, hypofractionated radiotherapy, and immunotherapy or chemotherapy. Blood samples were collected within 24 h before the initiation of systemic treatment and two or three times more at 20-28 day intervals. Overall survival was investigated by univariate analysis, and correlation with clinical factors was compared using the log-rank test. Gender, primary tumour site, surgery, radiation therapy, serum S100 levels before systemic treatment and choice of chemotherapy were not correlated with the outcome. In addition to the stage of disease, low serum LDH levels before systemic treatment and a decline in serum MIA levels following initiation of systemic treatment predicted a favourable outcome. Metastasis to visceral organs was associated with higher serum MIA levels. Persistence of high serum MIA levels despite systemic treatment predicts an unfavourable prognosis.
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Affiliation(s)
- R Meral
- Department of Clinical Oncology, University of Istanbul, Oncology Institute, Capa 34390, Istanbul, Turkey
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Altun M, Teneckeci N, Kaytan E, Meral R. In response to Dr. Ozyar. Int J Radiat Oncol Biol Phys 2001. [DOI: 10.1016/s0360-3016(00)01451-6] [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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Altun M, Tenekeci N, Kaytan E, Meral R. Locally advanced nasopharyngeal carcinoma: computed tomography findings, clinical evaluation, and treatment outcome. Int J Radiat Oncol Biol Phys 2000; 47:401-4. [PMID: 10802366 DOI: 10.1016/s0360-3016(00)00426-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 10/17/2022]
Abstract
PURPOSE We present our experience with computed tomography (CT) for delineating the extent of bone erosion in nasopharyngeal carcinoma (NPC) and propose that a new subdivision of Stage T4 disease be added to the staging criteria for cases of minimal bone disease, defined as erosion of the base of the sphenoid or the pterygoid without cranial nerve (CN) involvement. METHODS AND MATERIALS We retrospectively reviewed the clinical findings, radiological findings, and treatment outcome in 64 patients with Stage T4 NPC, diagnosed according to the American Joint Committee on Cancer 4th edition criteria. The median follow-up was 34 months (range, 3-118 months). Statistical analyses were performed using the chi-square test, the Kaplan-Meier method, and the log-rank test. RESULTS Local control was achieved in 19 (46%) of 41 patients with CN deficits and 18 (78%) of 23 patients without CN deficits (p = 0.01). Overall 5-year survival with and without CN deficits was 25% and 58%, respectively (p = 0.01). When the 16 patients with minimal bone disease were compared to the remaining 48 patients, there were significant differences in local control rates (87% vs. 48%, p = 0. 006) and 5-year survival rates (68% vs. 28%, p = 0.008). CONCLUSION Among patients with Stage T4 NPC, a subgroup of patients with only minimal bone disease may have a more favorable prognosis, which may have a considerable bearing on our approach to this patient group.
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Affiliation(s)
- M Altun
- Department ofRadiation Oncology, University of Istanbul, Istanbul, Turkey.
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Inanç SE, Meral R, Darendeliler E, Yasasever V, Onat H. Prognostic significance of marker half-life during chemotherapy in non-seminomatous germ cell testicular tumors. Acta Oncol 1999; 38:505-9. [PMID: 10418719 DOI: 10.1080/028418699432059] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 10/17/2022]
Abstract
Decrease in serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) levels is considered as a response during chemotherapy of non-seminomatous germ cell testicular tumors, but data on the prognostic significance of marker half-life remains inconclusive. Serum marker half-life was evaluated in 34 patients with elevated markers, receiving chemotherapy (CT). Marker half-life was calculated from the natural logarithm of the sequential AFP or HCG concentrations. The correlation between event-free (EFS) and overall survival (OS) with unfavorable half-lives of AFP and HCG was evaluated. Median actual half-life (AHL) AFP was 3.9 days (range, 1.4-21.5) and median AHL HCG was 4.4 days (range, 1.4-21.0); 82% of the patients had a satisfactory initial decline in AFP, and 71% had a satisfactory initial decline in HCG. There was a significant difference in EFS and OS between the two groups of patients with an AFP half-life < 7 days and > 7 days. HCG half-life did not adversely affect EFS and OS. The correlation of better EFS and OS with appropriate AFP marker half-life during chemotherapy could provide a dynamic method, which could complement the standard baseline prognostic factors, for the prediction of prognosis.
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Affiliation(s)
- S E Inanç
- Division of Medical Oncology, University of Istanbul, Institute of Gynecology, Turkey.
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