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Ugurluer G, Schneiders FL, Corradini S, Boldrini L, Kotecha R, Kelly P, Portelance L, Camilleri P, Ben-David MA, Poiset S, Marschner SN, Panza G, Kutuk T, Palacios MA, Castelluccia A, Zoto Mustafayev T, Atalar B, Senan S, Ozyar E. Factors influencing local control after MR-guided stereotactic body radiotherapy (MRgSBRT) for adrenal metastases. Clin Transl Radiat Oncol 2024; 46:100756. [PMID: 38450219 PMCID: PMC10915494 DOI: 10.1016/j.ctro.2024.100756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose Stereotactic body radiotherapy (SBRT) is an effective treatment for adrenal gland metastases, but it is technically challenging and there are concerns about toxicity. We performed a multi-institutional pooled retrospective analysis to study clinical outcomes and toxicities after MR-guided SBRT (MRgSBRT) using for adrenal gland metastases. Methods and Materials Clinical and dosimetric data of patients treated with MRgSBRT on a 0.35 T MR-Linac at 11 institutions between 2016 and 2022 were analyzed. Local control (LC), local progression-free survival (LPFS), distant progression-free survival (DPFS) and overall survival (OS) were estimated using Kaplan-Meier method and log-rank test. Results A total of 255 patients (269 adrenal metastases) were included. Metastatic pattern was solitary in 25.9 % and oligometastatic in 58.0 % of patients. Median total dose was 45 Gy (range, 16-60 Gy) in a median of 5 fractions, and the median BED10 was 100 Gy (range, 37.5-132.0 Gy). Adaptation was done in 87.4 % of delivered fractions based on the individual clinicians' judgement. The 1- and 2- year LPFS rates were 94.0 % (95 % CI: 90.7-97.3 %) and 88.3 % (95 % CI: 82.4-94.2 %), respectively and only 2 patients (0.8 %) experienced grade 3 + toxicity. No local recurrences were observed after treatment to a total dose of BED10 > 100 Gy, with single fraction or fractional dose of > 10 Gy. Conclusions This is a large retrospective multi-institutional study to evaluate the treatment outcomes and toxicities with MRgSBRT in over 250 patients, demonstrating the need for frequent adaptation in 87.4 % of delivered fractions to achieve a 1- year LPFS rate of 94 % and less than 1 % rate of grade 3 + toxicity. Outcomes analysis in 269 adrenal lesions revealed improved outcomes with delivery of a BED10 > 100 Gy, use of single fraction SBRT and with fraction doses > 10 Gy, providing benchmarks for future clinical trials.
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Affiliation(s)
- Gamze Ugurluer
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - Famke L. Schneiders
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University Munich, Germany
| | - Luca Boldrini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Patrick Kelly
- Department of Radiation Oncology, Orlando Health Cancer Institute, Orlando, FL, USA
| | | | | | - Merav A. Ben-David
- Department of Radiation Oncology, Assuta Medical Center, Tel Aviv, Israel
- Faculty of Health Science, Ben-Gurion University, Beer Sheva, Israel
| | - Spencer Poiset
- Department of Radiation Oncology, Sidney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA, USA
| | - Sebastian N. Marschner
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University Munich, Germany
| | - Giulia Panza
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo Agostino Gemelli 8, Rome, Italy
| | - Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Miguel A. Palacios
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | | | | | - Banu Atalar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
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Dincer N, Ugurluer G, Mustafayev TZ, Serkizyan A, Aydin G, Güngör G, Yapici B, Atalar B, Özyar E. Dosimetric comparison of stereotactic MR-guided radiation therapy (SMART) and HDR brachytherapy boost in cervical cancer. Brachytherapy 2024; 23:18-24. [PMID: 38000958 DOI: 10.1016/j.brachy.2023.09.007] [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: 05/21/2023] [Revised: 07/21/2023] [Accepted: 09/10/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE The standard of care in locally advanced cervical cancer (LACC) is concomitant chemoradiotherapy followed by high-dose-rate brachytherapy (HDR-BT). Although previous studies compared HDR-BT with stereotactic body radiotherapy (SBRT), there is scarce data regarding the dosimetric outcomes of stereotactic MR-guided adaptive radiation therapy (SMART) boost in lieu of HDR-BT. METHODS AND MATERIALS In this single-institutional in-silico comparative study, LACC patients who were definitively treated with external beam radiotherapy followed by HDR-BT were selected. Target volumes and organs at risk (OARs) were delineated in MRI and HDR-planning CT. An HDR-BT and a SMART boost plan were generated with a prescribed dose of 28 Gy in four fractions for all patients. The HDR-BT and SMART boost plans were compared in regard to target coverage as well OARs doses. RESULTS Mean EQD2 D90 to HR-CTV and IR-CTV for HDR-BT plans were 89.7 and 70.5 Gy, respectively. For SMART, the mean EQD2 D90 to HR-PTV, HR-CTV, and IR-CTV were 82.9, 95.4, and 70.2 Gy, respectively. The mean D2cc EQD2 of bladder, rectum, and sigmoid colon for HDR-BT plans were 86.4, 70.7, and 65.7 Gy, respectively. The mean D2cc EQD2 of bladder, rectum, and sigmoid colon for SMART plans were 81.4, 70.8, and 73.6 Gy, respectively. All dose constraints in terms of target coverage and OARs constraints were met for both HDR-BT and SMART plans. CONCLUSIONS This dosimetric study demonstrates that SMART can be applied in cases where HDR-BT is not available or ineligible with acceptable target coverage and OAR sparing. However, prospective clinical studies are needed to validate these results.
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Affiliation(s)
- Neris Dincer
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Gamze Ugurluer
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | | | - Anatolia Serkizyan
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Gokhan Aydin
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Görkem Güngör
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Bulent Yapici
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Enis Özyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.
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Aliyev V, Piozzi GN, Huseynov E, Mustafayev TZ, Kayku V, Goksel S, Asoglu O. Robotic male and laparoscopic female sphincter-preserving total mesorectal excision of mid-low rectal cancer share similar specimen quality, complication rates and long-term oncological outcomes. J Robot Surg 2023; 17:1637-1644. [PMID: 36943657 DOI: 10.1007/s11701-023-01558-2] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
The aim of this study was to compare perioperative and long-term oncological outcomes between laparoscopic sphincter-preserving total mesorectal excision in female patients (F-Lap-TME) and robotic sphincter-preserving total mesorectal excision in male patients (M-Rob-TME) with mid-low rectal cancer (RC). A retrospective analysis of a prospectively maintained database was performed. 170 cases (F-Lap-TME: 60 patients; M-Rob-TME: 110 patients) were performed by a single surgeon (January 2011-January 2020). Clinical characteristics did not differ significantly between the two groups. Operating time was longer in M-Rob-TME than in F-Lap-TME group (185.3 ± 28.4 vs 124.5 ± 35.8 min, p < 0.001). There was no conversion to open surgery in both groups. Quality of mesorectum was complete/near-complete in 58 (96.7%) and 107 (97.3%) patients of F-Lap-TME and M-Rob-TME (p = 0.508), respectively. Circumferential radial margin involvement was observed in 2 (3.3%) and 3 (2.9%) in F-Lap-TME and M-Rob-TME patients (p = 0.210), respectively. Median length of follow-up was 62 (24-108) months in the F-Lap-TME and 64 (24-108) months in the M-Rob-TME group. Five-year overall survival rates were 90.5% in the F-Lap-TME and 89.6% in the M-Rob-TME groups (p = 0.120). Disease-free survival rates in F-Lap-TME and M-Rob-TME groups were 87.5% and 86.5% (p = 0.145), respectively. Local recurrence rates were 5% (n = 3) and 5.5% (n = 6) (p = 0.210), in the F-Lap-TME and M-Rob-TME groups, respectively. The robotic technique can potentially overcome some technical challenges related to the pelvic anatomical difference between sex compared to laparoscopy. Laparoscopic and robotic approach, respectively in female and male patients provide similar surgical specimen quality, perioperative outcomes, and long-term oncological results.
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Affiliation(s)
- Vusal Aliyev
- Bogazici Academy for Clinical Sciences, Istanbul, Turkey
| | - Guglielmo Niccolò Piozzi
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Elnur Huseynov
- Department of General Surgery, Avrupa Safak Hospital, Istanbul, Turkey
| | | | - Vildan Kayku
- Department of Medical Oncology, Maslak Acibadem Hospital, Istanbul, Turkey
| | - Suha Goksel
- Department of Pathology, Maslak Acibadem Hospital, Istanbul, Turkey
| | - Oktar Asoglu
- Bogazici Academy for Clinical Sciences, Istanbul, Turkey.
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Ozkaya Akagunduz O, Etit D, Yazici G, Veral A, Cetinayak O, Sarioglu S, Guler Tezel G, Duru Birgi S, Yuksel S, Kara G, Mustafayev TZ, Tokat F, Ceylaner Bicakli B, Basak K, Esassolak M, Akman F, Ozyar E. The effect of P53 expression and smoking/alcohol in P16(+) and P16(-) oropharyngeal carcinoma and risk classification: the Turkish Society of Radiation Oncology Head & Neck Study Group 01-002. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:80-90. [PMID: 37246057 DOI: 10.1016/j.oooo.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The aim of this study is to categorize the risk groups of patients with oropharyngeal carcinoma (OPC) according to p16 and p53 status, smoking/alcohol consumption history, and other prognostic factors. STUDY DESIGN The immunostaining of p16 and p53 of 290 patients was retrospectively evaluated. The history of smoking/alcohol consumption of each patient was noted. p16 and p53 staining patterns were reviewed. The results were compared with demographic findings and prognostic factors. Risk groups have been classified for the p16 status of patients. RESULTS The median follow-up was 47 months (range 6-240). Five-year disease-free survival (DFS) rates for patients with p16 (+) and (-) were 76% and 36%, and overall survival rates were 83% vs 40%, respectively (HR = 0.34 [0.21-0.57], P < .0001), HR = 0.22 [0.12-0.40] P < .0001, respectively). p16(-), p53(+), heavy smoking/alcohol consumption, performance status; advanced T and N stages in patients with p16(-), and continuing smoking/alcohol consumption after treatment were found to be unfavorable risk factors. Five-year overall survival rates were 95%, 78%, and 36% for low, intermediate, and high-risk groups, respectively. CONCLUSIONS The results of our study have shown that p16 negativity in patients with oropharyngeal cancer was found to be an important prognostic factor, especially for those with lower p53 expression and not smoking/consuming alcohol.
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Affiliation(s)
| | - Demet Etit
- Department of Pathology, Istanbul Aydin University, Faculty of Medicine, Istanbul, Turkey
| | - Gozde Yazici
- Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ali Veral
- Department of Pathology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Oguz Cetinayak
- Dokuzeylul University, Faculty of Medicine, Izmir, Turkey
| | - Sulen Sarioglu
- Department of Pathology, Dokuzeylul University, Faculty of Medicine, Izmir, Turkey
| | - Gaye Guler Tezel
- Department of Pathology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Sumerya Duru Birgi
- Department of Radiation Oncology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Seher Yuksel
- Department of Pathology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Gulsen Kara
- Department of Radiation Oncology, Ataturk Training and Research Hospital, Izmir, Turkey
| | | | - Fatma Tokat
- Department of Pathology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
| | - Beyhan Ceylaner Bicakli
- Department of Radiation Oncology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Kayhan Basak
- Department of Pathology, Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Esassolak
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Fadime Akman
- Dokuzeylul University, Faculty of Medicine, Izmir, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University, School of Medicine, Istanbul, Turkey
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Yildirim HC, Kupik GE, Mustafayev TZ, Berber T, Yavuz B, Cetinayak O, Akagunduz O, Bıcakcı BC, Arslan SA, Soykut ED, Gundog M, Figen M, Teke F, Canyilmaz E, Birgi SD, Duzova M, İgdem S, Abakay CD, Atasoy B, Kaydihan N, Parvizi M, Uslu GH, Saginc H, Akman F, Ozyar E. A multicenter retrospective analysis of patients with nasopharyngeal carcinoma treated in IMRT era from a nonendemic population: Turkish Society for Radiation Oncology Head and Neck Cancer Group Study (TROD 01-001). Head Neck 2023; 45:1194-1205. [PMID: 36854873 DOI: 10.1002/hed.27333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND We aimed to evaluate patients with nasopharyngeal carcinoma (NPC) in a nonendemic population. METHODS In a national, retrospective, multicenteric study, 563 patients treated with intensity modulated radiotherapy at 22 centers between 2015 and 2020 were analyzed. RESULTS Median age was 48 (9-83), age distribution was bimodal, 74.1% were male, and 78.7% were stage III-IVA. Keratinizing and undifferentiated carcinoma rates were 3.9% and 81.2%. Patients were treated with concomitant chemoradiotherapy (48.9%), or radiotherapy combined with induction chemotherapy (25%) or adjuvant chemotherapy (19.5%). After 34 (6-78) months follow-up, 8.2% locoregional and 8% distant relapse were observed. Three-year overall survival was 89.5% and was lower in patients with age ≥50, male sex, keratinizing histology, T4, N3 and advanced stage (III-IVA). CONCLUSIONS Patients with NPC in Turkey have mixed clinical features of both east and west. Survival outcomes are comparable to other reported series; however, the rate of distant metastases seems to be lower.
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Affiliation(s)
- Halil Cumhur Yildirim
- Department of Radiation Oncology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gulnihan Eren Kupik
- Department of Radiation Oncology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Faculty of Medicine, Acibadem University, Istanbul, Turkey
| | - Tanju Berber
- Department of Radiation Oncology, Prof Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Berrin Yavuz
- Department of Radiation Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Oguz Cetinayak
- Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ozlem Akagunduz
- Department of Radiation Oncology, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | | | - Ela Delikgoz Soykut
- Department of Radiation Oncology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Mete Gundog
- Department of Radiation Oncology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Metin Figen
- Department of Radiation Oncology, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Fatma Teke
- Department of Radiation Oncology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Emine Canyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Teknik University, Trabzon, Turkey
| | - Sumerya Duru Birgi
- Department of Radiation Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Mursel Duzova
- Department of Radiation Oncology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Sefik İgdem
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Candan Demiroz Abakay
- Department of Radiation Oncology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Beste Atasoy
- Department of Radiation Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nuri Kaydihan
- Department of Radiation Oncology, Istanbul Bahcelievler Memorial Hospital, Istanbul, Turkey
| | - Murtaza Parvizi
- Department of Radiation Oncology, Manisa City Hospital, Manisa, Turkey
| | - Gonca Hanedan Uslu
- Department of Radiation Oncology, Trabzon Kanuni Education and Research Hospital, Trabzon, Turkey
| | - Halil Saginc
- Department of Radiation Oncology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Fadime Akman
- Department of Radiation Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Faculty of Medicine, Acibadem University, Istanbul, Turkey
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Elmali A, Akkus Yildirim B, Cengiz M, Yuce Sari S, Onal HC, Berber T, Arslantas Erken A, Zoto Mustafayev T, Atalar B, Unal I, Kaydihan N, Oner Dincbas F. Stereotactic Radiotherapy for Adrenal Metastases: A Multi-Institutional Review of Patient Characteristics and Outcomes - Turkish Society for Radiation Oncology SBRT Group Study (Trod SBRT 10-004). Oncol Res Treat 2022; 45:717-727. [PMID: 36116432 DOI: 10.1159/000527052] [Citation(s) in RCA: 2] [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: 04/11/2022] [Accepted: 09/12/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION This study aimed to report the outcomes of stereotactic body radiotherapy (SBRT) for adrenal metastasis in a retrospective multi-institutional cohort. METHODS The outcomes of 124 patients with 146 adrenal metastases who underwent SBRT within 11 years (2008-2019) were retrospectively evaluated. Survival outcomes were analyzed by the Kaplan-Meier method. Patient, tumor, and treatment characteristics and their effects on survival, local control (LC), and toxicity outcomes were analyzed by log-rank and multivariate Cox regression methods. RESULTS The median age was 60 years. The most frequent primary tumor site was the lung, followed by the gastrointestinal system and breast. The adrenal gland was the only metastatic site in 49 (40%) patients. Median biologically effective dose (BED)10 was 61 Gy. The overall LC rate was 83%, and it was positively correlated with the BED10 and fraction dose. The 1- and 2-year local recurrence-free survival, overall survival (OS), and progression-free survival (PFS) rate was 79% and 69%, 83% and 60%, and 31% and 12%, respectively. OS significantly improved with non-lung cancer and <4-cm lesion and PFS with a fraction dose ≥8 Gy, BED10 >65 Gy, and an isolated adrenal metastasis. Fourteen patients reported an acute toxicity, and late toxicity was observed in 3 patients, including one grade 5. CONCLUSION A satisfactory LC rate was achieved for adrenal metastasis via SBRT. A higher BED10 and fraction dose were positive prognostic factors for tumor control. However, the main problem is DM in these patients, and systemic treatment options are needed to be improved.
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Affiliation(s)
- Aysenur Elmali
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Mustafa Cengiz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sezin Yuce Sari
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Huseyin C Onal
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Tanju Berber
- Department of Radiation Oncology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Aysun Arslantas Erken
- Department of Radiation Oncology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | | | - Banu Atalar
- Department of Radiation Oncology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ilhami Unal
- Department of Radiation Oncology, Guven Hospital, Ankara, Turkey
| | - Nuri Kaydihan
- Department of Radiation Oncology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Fazilet Oner Dincbas
- Department of Radiation Oncology, Memorial Bahcelievler Hospital, Istanbul, Turkey.,Department of Radiation Oncology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Dincer N, Ugurluer G, Gungor G, Zoto Mustafayev T, Atalar B, Ozyar E. Magnetic Resonance Imaging-Guided Radiation Therapy for Early-Stage Gastric Mucosa-Associated Lymphoid Tissue Lymphoma. Cureus 2022; 14:e29035. [PMID: 36249646 PMCID: PMC9550217 DOI: 10.7759/cureus.29035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
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8
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Yurut Caloglu V, Akmansu M, Yalman D, Karabulut Gul S, Kocak Z, Arican Alicikus Z, Serarslan A, Akyurek S, Zoto Mustafayev T, Demiroz C, Colpan Oksuz D, Kanyilmaz G, Altinok P, Kaytan Saglam E, Yentek Balkanay A, Akboru H, Keven E, Yildirim B, Onal C, Igdem S, Ozkan E, Ozdener F, Caloglu M. Evaluation of Nutritional Status and Anxiety Levels in Patients Applying to the Radiation Oncology Outpatient Clinic during the COVID-19 Pandemic: Turkish Society for Radiation Oncology Group Study (TROD 12:02). Nutr Cancer 2022; 74:3601-3610. [DOI: 10.1080/01635581.2022.2093386] [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: 01/10/2023]
Affiliation(s)
| | - Muge Akmansu
- Department of Radiation Oncology, Gazi University, Ankara, Turkey
| | - Deniz Yalman
- Department of Radiation Oncology, Ege University, Izmir, Turkey
| | - Sule Karabulut Gul
- Department of Radiation Oncology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey
| | - Zafer Kocak
- Department of Radiation Oncology, Trakya University, Edirne, Turkey
| | | | | | - Serap Akyurek
- Department of Radiation Oncology, Ankara University, Ankara, Turkey
| | | | - Candan Demiroz
- Department of Radiation Oncology, Uludag University, Bursa, Turkey
| | - Didem Colpan Oksuz
- Department of Radiation Oncology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Gul Kanyilmaz
- Department of Radiation Oncology, Necmettin Erbakan University, Konya, Istanbul
| | - Pelin Altinok
- Department of Radiation Oncology, University of Health Sciences Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Esra Kaytan Saglam
- Department of Radiation Oncology, Istanbul University Medical Faculty, Istanbul, Turkey
| | - Ayben Yentek Balkanay
- Department of Radiation Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Halil Akboru
- Department of Radiation Oncology, University of Health Sciences, Okmeydani Hospital, Istanbul, Turkey
| | - Emine Keven
- Department of Radiation Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Berna Yildirim
- Department of Radiation Oncology, Adana Baskent University, Adana, Istanbul
| | - Cem Onal
- Department of Radiation Oncology, Adana Baskent University, Adana, Istanbul
| | - Sefik Igdem
- Department of Radiation Oncology, Istanbul Bilgi University, Istanbul, Turkey
| | - Emre Ozkan
- Medical Department, Nutricia, Advanced Medical Nutrition, Istanbul, Turkey
| | - Fatih Ozdener
- School of Medicine, Department of Pharmacology, Bahcesehir University, İstanbul, Turkey
| | - Murat Caloglu
- Department of Radiation Oncology, Trakya University, Edirne, Turkey
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Bicakci BC, Mustafayev TZ, Cetinayak O, Igdem S, Birgi SD, Meydan D, Demircioglu F, Atalar B, Ozyar E, Akman F. Outcomes of carotid sparing intensity-modulated radiotherapy for early stage glottic cancer in 201 patients: Multicenter study of Turkish Radiation Oncology Society/TROD-01-007. Head Neck 2022; 44:1825-1832. [PMID: 35596585 DOI: 10.1002/hed.27101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/22/2022] [Accepted: 05/05/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To assess and report clinical outcomes after carotid sparing intensity-modulated radiotherapy for early stage laryngeal cancer. METHODS We retrospectively analyzed 201 patients with early stage glottic laryngeal cancer treated with carotid sparing intensity-modulated radiotherapy (IMRT)/volumetric modulated arc therapy (VMAT) techniques in six TROD centers. RESULTS After a median follow-up of 31 months the actuarial 1- and 3-year local and locoregional control rates were 99.4% and 94.7%, 98.4% and 93%, respectively. T classification, anterior commissure involvement, IMRT technique, and type of fractionation were not found to be prognostic for local control. Overall, eight patients had lost their organ function due to recurrence or toxicity. Grade 3 and 4 acute laryngeal edema was seen in eight (4%) and one (0.5%) of patients, respectively. Grade 3 and 4 late laryngeal edema developed in two (1%) and one patient (0.5%), respectively. CONCLUSION Oncologic outcomes of patients treated with carotid sparing IMRT were excellent; comparable with historical series, with acceptable side effects. Longer follow-up is needed to estimate long term effect on stroke.
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Affiliation(s)
- Beyhan Ceylaner Bicakci
- Department of Radiation Oncology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Oguz Cetinayak
- Department of Radiation Oncology, Medical School, Dokuz Eylul University, Izmir, Turkey
| | - Sefik Igdem
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Sumerya Duru Birgi
- Department of Radiation Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Deniz Meydan
- Department of Radiation Oncology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Fatih Demircioglu
- Department of Radiation Oncology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Fadime Akman
- Department of Radiation Oncology, Medical School, Dokuz Eylul University, Izmir, Turkey
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Asoglu O, Goksoy B, Aliyev V, Mustafayev TZ, Atalar B, Bakir B, Guven K, Demir G, Goksel S. Watch and Wait Strategy for Rectal Cancer: How Long Should We Wait for a Clinical Complete Response? Surg Technol Int 2022; 40:130-139. [PMID: 35090178 DOI: 10.52198/22.sti.40.cr1507] [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: 06/14/2023]
Abstract
BACKGROUND The objective of this study was to determine how long to wait in locally advanced rectal tumor (LARC) patients who receive total neoadjuvant therapy (TNT) and achieve a clinical complete response (cCR), and to identify the clinical parameters that affect the waiting period for the watch-and-wait strategy (W &W). MATERIALS AND METHODS The data of patients who achieved cCR between February 2015 and June 2020 were examined retrospectively. The week in which patients with cCR at the end of TNT achieved clearance was determined by reanalyzing recorded endoscopy video images. In the assessment at the time of the initial diagnosis, tumor characteristics, such as digital rectal examination findings, MRI stage, location with respect to the puborectalis muscle, annularity, and tumor size, were recorded prospectively. RESULTS A total of 54 patients were included in this study. According to the MRI-T stage, 14 cases were cT3a, 22 were cT3b, and 18 were cT3c-T4. Forty-four percent of the cases achieved cCR at 8-10 weeks, 19% at 12-16 weeks, 20% at 16-22 weeks, and 17% at 20-26 weeks. Patients with tumors that were early MRI-T stage (cT3a), negative clinical circumferential resection margin, mobile, small (≤4 cm), located above the puborectalis muscle and showed <180 degrees annularity achieved cCR significantly earlier than those with other tumors (p<0.05). CONCLUSION In this study, cCR was achieved in less than half (44%) of the cases during the 8-10 week waiting period. In the W&W strategy, the initial assessment for cCR seems insufficient, and we may need to wait up to 26-30 weeks, especially in patients with advanced-stage tumors.
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Affiliation(s)
- Oktar Asoglu
- Bogazici Academy for Clinical Sciences of General Surgery, Istanbul, Turkey
| | - Beslen Goksoy
- Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital University of Health Sciences, Department of General Surgery, Istanbul, Turkey
| | - Vusal Aliyev
- Acibadem Maslak Hospital, Department of General Surgery, Istanbul, Turkey
| | | | - Banu Atalar
- Acibadem University Maslak Hospital, Department of Radiation Oncology, Istanbul, Turkey
| | - Baris Bakir
- Istanbul University, Istanbul Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - Koray Guven
- Acibadem University Maslak Hospital, Department of Radiology, Istanbul, Turkey
| | - Gokhan Demir
- Acibadem University Maslak Hospital, Department of Medical Oncology, Istanbul, Turkey
| | - Suha Goksel
- Acibadem Maslak Hospital, Department of Pathology, Istanbul, Turkey
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11
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Dincer N, Ugurluer G, Zoto Mustafayev T, Gungor G, Atalar B, Guven K, Ozyar E. Magnetic Resonance Image-Guided Hypofractionated Ablative Radiation Therapy for Hepatocellular Carcinoma With Tumor Thrombus Extending to the Right Atrium. Cureus 2022; 14:e23981. [PMID: 35541296 PMCID: PMC9084425 DOI: 10.7759/cureus.23981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
Hepatocellular carcinoma (HCC) presenting with tumor thrombus (TT) and inferior vena cava (IVC)/right atrium (RA) infringement point to an advanced-stage disease that is deemed inoperable. Stereotactic body radiotherapy is an emerging treatment option for this group of patients with promising outcomes in recent studies that are comparable to conventional treatment methods, namely, transarterial chemoembolization and transarterial radioembolization. Here, we report a case of HCC with RA extension through the IVC. The patient was referred to our clinic for treatment options, and he was found suitable for magnetic resonance imaging-guided radiotherapy (MRgRT). We treated the patient with MRgRT in five fractions to a total dose of 40 Gray. The tumor was tracked during the treatment sessions, and adaptive treatment planning was performed before each fraction. The patient tolerated the treatment well with no acute grade 3-4 toxicities. The last follow-up showed that the patient had a complete biochemical response and is now a candidate for an orthotopic liver transplant. To our knowledge, this report is the first to document the MRgRT treatment of an HCC with TT and RA extension. MRgRT is safe and feasible for this patient group and can be an effective bridging therapy for liver transplants.
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12
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Sayan M, Şahin B, Mustafayev TZ, Kefelioğlu EŞS, Vergalasova I, Gupta A, Balmuk A, Güngör G, Ohri N, Weiner J, Karaarslan E, Özyar E, Atalar B. Risk of symptomatic radiation necrosis in patients treated with stereotactic radiosurgery for brain metastases. ACTA ACUST UNITED AC 2021; 32:261-267. [PMID: 34743823 DOI: 10.1016/j.neucie.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/31/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTIO Stereotactic radiosurgery (SRS) is a treatment option in the initial management of patients with brain metastases. While its efficacy has been demonstrated in several prior studies, treatment-related complications, particularly symptomatic radiation necrosis (RN), remains as an obstacle for wider implementation of this treatment modality. We thus examined risk factors associated with the development of symptomatic RN in patients treated with SRS for brain metastases. PATIENTS AND METHODS We performed a retrospective review of our institutional database to identify patients with brain metastases treated with SRS. Diagnosis of symptomatic RN was determined by appearance on serial MRIs, MR spectroscopy, requirement of therapy, and the development of new neurological complaints without evidence of disease progression. RESULTS We identified 323 brain metastases treated with SRS in 170 patients from 2009 to 2018. Thirteen patients (4%) experienced symptomatic RN after treatment of 23 (7%) lesions. After SRS, the median time to symptomatic RN was 8.3 months. Patients with symptomatic RN had a larger mean target volume (p<0.0001), and thus larger V100% (p<0.0001), V50% (p<0.0001), V12Gy (p<0.0001), and V10Gy (p=0.0002), compared to the rest of the cohort. Single-fraction treatment (p=0.0025) and diabetes (p=0.019) were also significantly associated with symptomatic RN. CONCLUSION SRS is an effective treatment option for patients with brain metastases; however, a subset of patients may develop symptomatic RN. We found that patients with larger tumor size, larger plan V100%, V50%, V12Gy, or V10Gy, who received single-fraction SRS, or who had diabetes were all at higher risk of symptomatic RN.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA.
| | - Bilgehan Şahin
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | | | - Irina Vergalasova
- Department of Radiation Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Apar Gupta
- Department of Radiation Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Aykut Balmuk
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Görkem Güngör
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Nisha Ohri
- Department of Radiation Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Joseph Weiner
- Department of Radiation Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Ercan Karaarslan
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Enis Özyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
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13
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Egriboyun S, Ugurluer G, Gungor G, Zoto Mustafayev T, Cicek B, Demir G, Atalar B, Ozyar E. Magnetic resonance image-guided hypofractionated ablative radiation therapy for extrahepatic cholangiocarcinoma: Plan adaptation in changing anatomy. Med Dosim 2021; 46:435-439. [PMID: 34244041 DOI: 10.1016/j.meddos.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
Extrahepatic cholangiocarcinoma is an aggressive malignancy of biliary duct epithelium which typically has a poor prognosis. Although surgical resection improves overall survival, many patients are deemed medically inoperable or have unresectable tumors. Herein, we report a case of an 84-year-old Caucasian male who was diagnosed with medically inoperable extrahepatic cholangiocarcinoma. Magnetic resonance image-guided hypofractionated ablative radiotherapy was administered which has the advantages of superior soft tissue resolution, better visualization of the target and organ at risk, daily online adaptive planning and continuous cine MR tracking of the target during irradiation. Concomitant chemotherapy was used. On the first fraction the patient presented with a broken arm that forced the patient take a treatment position much different than the one used for simulation CT and planning. The patient was able to finish the treatment without the need of another simulation by adapting the plan according to the new anatomy. The patient is being followed up until today and is alive with no evidence of disease.
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Affiliation(s)
- Sebnem Egriboyun
- Medical Student, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Gamze Ugurluer
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Bahattin Cicek
- Department of Gastroenterology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Gokhan Demir
- Department of Medical Oncology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem MAA University School of Medicine, Istanbul 34450 Turkey.
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14
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Ugurluer G, Mustafayev TZ, Gungor G, Atalar B, Abacioglu U, Sengoz M, Agaoglu F, Demir G, Ozyar E. Stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of liver metastases in oligometastatic patients: initial clinical experience. Radiat Oncol J 2021; 39:33-40. [PMID: 33794572 PMCID: PMC8024184 DOI: 10.3857/roj.2020.00976] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose We aimed to present our initial clinical experience on the implementation of a stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of liver metastases in oligometastatic disease. Materials and Methods Twenty-one patients (24 lesions) with liver metastasis treated with SMART were included in this retrospective study. Step-and-shoot intensity-modulated radiotherapy technique was used with daily plan adaptation. During delivery, real-time imaging was used by acquiring planar magnetic resonance images in sagittal plane for monitoring and gating. Acute and late toxicities were recorded both during treatment and follow-up visits. Results The median follow-up time was 11.6 months (range, 2.2 to 24.6 months). The median delivered total dose was 50 Gy (range, 40 to 60 Gy); with a median fraction number of 5 (range, 3 to 8 fractions) and the median fraction dose was 10 Gy (range, 7.5 to 18 Gy). Ninety-three fractions (83.7%) among 111 fractions were re-optimized. No patients were lost to follow-up and all patients were alive except one at the time of analysis. All of the patients had either complete (80.9%) or partial (19.1%) response at irradiated sites. Estimated 1-year overall survival was 93.3%. Intrahepatic and extrahepatic progression-free survival was 89.7% and 73.5% at 1 year, respectively. There was no grade 3 or higher acute or late toxicities experienced during the treatment and follow-up course. Conclusion SMART represents a new, noninvasive and effective alternative to current ablative radiotherapy methods for treatment of liver metastases in oligometastatic disease with the advantages of better visualization of soft tissue, real-time tumor tracking and potentially reduced toxicity to organs at risk.
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Affiliation(s)
- Gamze Ugurluer
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Ufuk Abacioglu
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Meric Sengoz
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Fulya Agaoglu
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Gokhan Demir
- Department of Medical Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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15
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Gultekin M, Guler OC, Yuce Sari S, Akkus Yildirim B, Onal C, Celik H, Yuce K, Ayhan A, Arik Z, Kose F, Altundag O, Zoto Mustafayev T, Atalar B, Bolukbasi Y, Yildiz F. Multi-institutional validation of the ESMO-ESGO-ESTRO consensus conference risk grouping in Turkish endometrial cancer patients treated with comprehensive surgical staging. J OBSTET GYNAECOL 2021; 41:414-420. [PMID: 32347768 DOI: 10.1080/01443615.2020.1737661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this study, 683 patients with endometrial cancer (EC) after comprehensive surgical staging were classified into four risk groups as low (LR), intermediate (IR), high-intermediate (HIR) and high-risk (HR), according to the recent consensus risk grouping. Patients with disease confined to the uterus, ≥50% myometrial invasion (MI) and/or grade 3 histology were treated with vaginal brachytherapy (VBT). Patients with stage II disease, positive/close surgical margins or extra-uterine extension were treated with external beam radiotherapy (EBRT)±VBT. The median follow-up was 56 months. The overall survival (OS) was significantly different between LR and HR groups, and there was a trend between LR and HIR groups. Relapse-free survival (RFS) was significantly different between LR and HIR, LR and HR and IR and HR groups. There was no significant difference in OS and RFS rates between the HIR and HR groups. In HR patients, the OS and RFS rates were significantly higher in stage IB - grade 3 and stage II compared to stage III and non-endometrioid histology without any difference between the two uterine-confined stages and between stage III and non-endometrioid histology. The current risk grouping does not clearly discriminate the HIR and IR groups. In patients with comprehensive surgical staging, a further risk grouping is needed to distinguish the real HR group.Impact statementWhat is already known on this subject? The standard treatment for endometrial cancer (EC) is surgery and adjuvant radiotherapy (RT) and/or chemotherapy is recommended according to risk factors. The recent European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO) and European Society for Radiotherapy and Oncology (ESTRO) guideline have introduced a new risk group. However, the risk grouping is still quite heterogeneous.What do the results of this study add? This study demonstrated that the current risk grouping recommended by ESMO-ESGO-ESTRO does not clearly discriminate the intermediate risk (IR) and high-intermediate risk (HIR) groups.What are the implications of these findings for clinical practice and/or further research? Based on the results of this study, a new risk grouping can be made to discriminate HIR and IR groups clearly in patients with comprehensive surgical staging.
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Affiliation(s)
- Melis Gultekin
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Sezin Yuce Sari
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Berna Akkus Yildirim
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Cem Onal
- Department of Radiation Oncology, Baskent University Medical School, Adana, Turkey
| | - Husnu Celik
- Department of Gynecologic Oncology, Baskent University Medical School, Adana, Turkey
| | - Kunter Yuce
- Department of Gynecologic Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Ali Ayhan
- Department of Gynecologic Oncology, Baskent University Medical School, Ankara, Turkey
| | - Zafer Arik
- Department of Medical Oncology, Hacettepe University Medical School, Ankara, Turkey
| | - Fatih Kose
- Department of Medical Oncology, Baskent University Medical School, Adana, Turkey
| | - Ozden Altundag
- Department of Medical Oncology, Baskent University Medical School, Ankara, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Acibadem University Medical School, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem University Medical School, Istanbul, Turkey
| | - Yasemin Bolukbasi
- Department of Radiation Oncology, Koc University Medical School, Istanbul, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Hacettepe University Medical School, Ankara, Turkey
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16
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Ugurluer G, Atalar B, Zoto Mustafayev T, Gungor G, Aydin G, Sengoz M, Abacioglu U, Tuna MB, Kural AR, Ozyar E. Magnetic resonance image-guided adaptive stereotactic body radiotherapy for prostate cancer: preliminary results of outcome and toxicity. Br J Radiol 2021; 94:20200696. [PMID: 33095670 PMCID: PMC7774684 DOI: 10.1259/bjr.20200696] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/19/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Using moderate or ultra-hypofractionation, which is also known as stereotactic body radiotherapy (SBRT) for treatment of localized prostate cancer patients has been increased. We present our preliminary results on the clinical utilization of MRI-guided adaptive radiotherapy (MRgRT) for prostate cancer patients with the workflow, dosimetric parameters, toxicities and prostate-specific antigen (PSA) response. METHODS 50 prostate cancer patients treated with ultra-hypofractionation were included in the study. Treatment was performed with intensity-modulated radiation therapy (step and shoot) technique and daily plan adaptation using MRgRT. The SBRT consisted of 36.25 Gy in 5 fractions with a 7.25 Gy fraction size. The time for workflow steps was documented. Patients were followed for the acute and late toxicities and PSA response. RESULTS The median follow-up for our cohort was 10 months (range between 3 and 29 months). The median age was 73.5 years (range between 50 and 84 years). MRgRT was well tolerated by all patients. Acute genitourinary (GU) toxicity rate of Grade 1 and Grade 2 was 28 and 36%, respectively. Only 6% of patients had acute Grade 1 gastrointestinal (GI) toxicity and there was no Grade ≥ 2 GI toxicity. To date, late Grade 1 GU toxicity was experienced by 24% of patients, 2% of patients experienced Grade 2 GU toxicity and 6% of patients reported Grade 2 GI toxicity. Due to the short follow-up, PSA nadir has not been reached yet in our cohort. CONCLUSION In conclusion, MRgRT represents a new method for delivering SBRT with markerless soft tissue visualization, online adaptive planning and real-time tracking. Our study suggests that ultra-hypofractionation has an acceptable acute and very low late toxicity profile. ADVANCES IN KNOWLEDGE MRgRT represents a new markerless method for delivering SBRT for localized prostate cancer providing online adaptive planning and real-time tracking and acute and late toxicity profile is acceptable.
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Affiliation(s)
- Gamze Ugurluer
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Gokhan Aydin
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Meric Sengoz
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Ufuk Abacioglu
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | | | - Ali Riza Kural
- Department of Urology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acıbadem MAA University School of Medicine, Istanbul, Turkey
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Sayan M, Şahin B, Mustafayev TZ, Kefelioğlu EŞS, Vergalasova I, Gupta A, Balmuk A, Güngör G, Ohri N, Weiner J, Karaarslan E, Özyar E, Atalar B. Risk of symptomatic radiation necrosis in patients treated with stereotactic radiosurgery for brain metastases. Neurocirugia (Astur) 2020; 32:S1130-1473(20)30111-1. [PMID: 33082103 DOI: 10.1016/j.neucir.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/05/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTIO Stereotactic radiosurgery (SRS) is a treatment option in the initial management of patients with brain metastases. While its efficacy has been demonstrated in several prior studies, treatment-related complications, particularly symptomatic radiation necrosis (RN), remains as an obstacle for wider implementation of this treatment modality. We thus examined risk factors associated with the development of symptomatic RN in patients treated with SRS for brain metastases. PATIENTS AND METHODS We performed a retrospective review of our institutional database to identify patients with brain metastases treated with SRS. Diagnosis of symptomatic RN was determined by appearance on serial MRIs, MR spectroscopy, requirement of therapy, and the development of new neurological complaints without evidence of disease progression. RESULTS We identified 323 brain metastases treated with SRS in 170 patients from 2009 to 2018. Thirteen patients (4%) experienced symptomatic RN after treatment of 23 (7%) lesions. After SRS, the median time to symptomatic RN was 8.3 months. Patients with symptomatic RN had a larger mean target volume (p<0.0001), and thus larger V100% (p<0.0001), V50% (p<0.0001), V12Gy (p<0.0001), and V10Gy (p=0.0002), compared to the rest of the cohort. Single-fraction treatment (p=0.0025) and diabetes (p=0.019) were also significantly associated with symptomatic RN. CONCLUSION SRS is an effective treatment option for patients with brain metastases; however, a subset of patients may develop symptomatic RN. We found that patients with larger tumor size, larger plan V100%, V50%, V12Gy, or V10Gy, who received single-fraction SRS, or who had diabetes were all at higher risk of symptomatic RN.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA.
| | - Bilgehan Şahin
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | | | - Irina Vergalasova
- Department of Radiation Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Apar Gupta
- Department of Radiation Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Aykut Balmuk
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Görkem Güngör
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Nisha Ohri
- Department of Radiation Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Joseph Weiner
- Department of Radiation Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Ercan Karaarslan
- Department of Radiology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Enis Özyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
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Sayan M, Serbez I, Teymur B, Gur G, Zoto Mustafayev T, Gungor G, Atalar B, Ozyar E. Patient-Reported Tolerance of Magnetic Resonance-Guided Radiation Therapy. Front Oncol 2020; 10:1782. [PMID: 33072560 PMCID: PMC7537416 DOI: 10.3389/fonc.2020.01782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Magnetic resonance-guided radiation therapy (MRgRT) has been incorporated into a growing number of clinical practices world-wide, however, there is limited data on patient experiences with MRgRT. The purpose of this study was to prospectively evaluate patient tolerance of MRgRT using patient reported outcome questionnaires (PRO-Q). Methods Ninety patients were enrolled in this prospective observational study and treated with MRgRT (MRIdian Linac System, ViewRay Inc. Oakwood Village, OH, United States) between September 2018 and September 2019. Breath-hold-gated dose delivery with audiovisual feedback was completed as needed. Patients completed an in-house developed PRO-Q after the first and last fraction of MRgRT. Results The most commonly treated anatomic sites were the abdomen (47%) and pelvis (33%). Respiratory gating was utilized in 62% of the patients. Patients rated their experience as positive or at least tolerable with mean scores of 1.0–2.8. The most common complaint was the temperature in the room (61%) followed by paresthesias (57%). The degree of anxiety reported by 45% of the patients significantly decreased at the completion of treatment (mean score 1.54 vs. 1.36, p = 0.01). Forty-three percent of the patients reported some degree of disturbing noise which was improved considerably by use of music. All patients appreciated their active role during the treatment. Conclusion This evaluation of PROs indicates that MRgRT was well-tolerated by our patients. Patients’ experience may further improve with adjustment of room temperature and noise reduction.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Ilkay Serbez
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
| | - Bilgehan Teymur
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
| | - Gokhan Gur
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydınlar Acıbadem University, Istanbul, Turkey
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Sayan M, Mustafayev TZ, Atalar B, Gungor G, Ozyar E. Magnetic Resonance–Guided Radiation Therapy to Boost Cervical Cancer When Brachytherapy Is Not Available: A Case Report. Adv Radiat Oncol 2020; 5:1066-1070. [PMID: 33083668 PMCID: PMC7557129 DOI: 10.1016/j.adro.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/25/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022] Open
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Sayan M, Mustafayev TZ, Balmuk A, Mamidanna S, Kefelioglu ESS, Gungor G, Chundury A, Ohri N, Karaarslan E, Ozyar E, Atalar B. Management of symptomatic radiation necrosis after stereotactic radiosurgery and clinical factors for treatment response. Radiat Oncol J 2020; 38:176-180. [PMID: 33012145 PMCID: PMC7533401 DOI: 10.3857/roj.2020.00171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Approximately 10% of patients who received brain stereotactic radiosurgery (SRS) develop symptomatic radiation necrosis (RN). We sought to determine the effectiveness of treatment options for symptomatic RN, based on patient-reported outcomes. MATERIALS AND METHODS We conducted a retrospective review of 217 patients with 414 brain metastases treated with SRS from 2009 to 2018 at our institution. Symptomatic RN was determined by appearance on serial magnetic resonance images (MRIs), MR spectroscopy, requirement of therapy, and development of new neurological complaints without evidence of disease progression. Therapeutic interventions for symptomatic RN included corticosteroids, bevacizumab and/or surgical resection. Patient-reported therapeutic outcomes were graded as complete response (CR), partial response (PR), and no response. RESULTS Twenty-six patients experienced symptomatic RN after treatment of 50 separate lesions. The mean prescription dose was 22 Gy (range, 15 to 30 Gy) in 1 to 5 fractions (median, 1 fraction). Of the 12 patients managed with corticosteroids, 6 patients (50%) reported CR and 4 patients (33%) PR. Of the 6 patients managed with bevacizumab, 3 patients (50%) reported CR and 1 patient (18%) PR. Of the 8 patients treated with surgical resection, all reported CR (100%). Other than surgical resection, age ≥54 years (median, 54 years; range, 35 to 81 years) was associated with CR (odds ratio = 8.40; 95% confidence interval, 1.27-15.39; p = 0.027). CONCLUSION Corticosteroids and bevacizumab are commonly utilized treatment modalities with excellent response rate. Our results suggest that patient's age is associated with response rate and could help guide treatment decisions for unresectable symptomatic RN.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Aykut Balmuk
- School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Swati Mamidanna
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Gorkem Gungor
- Institute of Health Sciences, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Anupama Chundury
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Nisha Ohri
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Ercan Karaarslan
- Department of Radiology, School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Enis Ozyar
- School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Banu Atalar
- School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
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Gungor G, Korkmaz L, Kayalilar N, Aydin G, Yapici B, Zoto Mustafayev T, Atalar B, Ozyar E. Multichannel Film Dosimetry for Quality Assurance of Intensity Modulated Radiotherapy Treatment Plans Under 0.35 T Magnetic Field. Cureus 2020; 12:e7334. [PMID: 32313775 PMCID: PMC7164695 DOI: 10.7759/cureus.7334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the intensity modulated radiotherapy (IMRT) quality assurance (QA) results of the multichannel film dosimetry analysis with single scan method by using Gafchromic™ EBT3 (Ashland Inc., Covington, KY, USA) film under 0.35 T magnetic field. Methods Between September 2018 and June 2019, 70 patients were treated with ViewRay MRIdian® (ViewRay Inc., Mountain View, CA) linear accelerator (Linac). Film dosimetry QA plans were generated for all IMRT treatments. Multichannel film dosimetry for red, green and blue (RGB) channels were compared with treatment planning system (TPS) dose maps by gamma evaluation analysis. Results The mean gamma passing rates of RGB channels are 97.3% ± 2.26%, 96.0% ± 3.27% and 96.2% ± 3.14% for gamma evaluation with 2% DD/2 mm distance to agreement (DTA), respectively. Moreover, the mean gamma passing rates of RGB channels are 99.7% ± 0.41%, 99.6% ± 0.59% and 99.5% ± 0.67% for gamma evaluation with 3% DD/3 mm DTA, respectively. Conclusion The patient specific QA using Gafchromic™ EBT3 film with multichannel film dosimetry seems to be a suitable tool to implement for MR-guided IMRT treatments under 0.35 T magnetic field. Multichannel film dosimetry with Gafchromic™ EBT3 is a consistent QA tool for gamma evaluation of the treatment plans even with 2% DD/2 mm DTA under 0.35 T magnetic field presence.
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Affiliation(s)
- Gorkem Gungor
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | - Latif Korkmaz
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | | | - Gokhan Aydin
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | - Bulent Yapici
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | | | - Banu Atalar
- Radiation Oncology, Acibadem University School of Medicine, Istanbul, TUR
| | - Enis Ozyar
- Radiation Oncology, Acıbadem Hospital, Istanbul, TUR.,Radiation Oncology, Acıbadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, TUR
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Sayan M, Mamidanna S, Fuat Eren M, Daliparty V, Zoto Mustafayev T, Nelson C, Ohri N, Jabbour SK, Guven Mert A, Atalar B. New horizons from novel therapies in malignant pleural mesothelioma. Adv Respir Med 2020; 88:343-351. [PMID: 32869268 PMCID: PMC10865433 DOI: 10.5603/arm.a2020.0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/12/2020] [Indexed: 11/25/2022]
Abstract
Malignant pleural mesothelioma (MPM) is a relatively rare, but highly lethal cancer of the pleural mesothelial cells. Its pathoge-nesis is integrally linked to asbestos exposure. In spite of recent developments providing a more detailed understanding of the pathogenesis, the outcomes continue to be poor. To date, trimodality therapy involving surgery coupled with chemotherapy and/or radiotherapy remains the standard of therapy. The development of resistance of the tumor cells to radiation and several che-motherapeutic agents poses even greater challenges in the management of this cancer. Ionizing radiation damages cancer cell DNA and aids in therapeutic response, but it also activates cell survival signaling pathways that helps the tumor cells to overcome radiation-induced cytotoxicity. A careful evaluation of the biology involved in mesothelioma with an emphasis on the workings of pro-survival signaling pathways might offer some guidance for treatment options. This review focuses on the existing treatment options for MPM, novel treatment approaches based on recent studies combining the use of inhibitors which target different pro-survival pathways, and radiotherapy to optimize treatment.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA.
| | - Swati Mamidanna
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Mehmet Fuat Eren
- Radiation Oncology Clinic, Marmara University Istanbul Pendik Education and Research Hospital, Istanbul, Turkey
| | - Vasudev Daliparty
- Department of Internal Medicine, Raritan Bay Medical Center, Perth Amboy, New Jersey, USA
| | - Teuta Zoto Mustafayev
- Department of Medical Oncology, Mehmet Ali Aydınlar Acıbadem University, School of Medicine, Istanbul, Turkey
| | - Carl Nelson
- Department of Radiation Oncology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Nisha Ohri
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Aslihan Guven Mert
- Department of Radiation Oncology, Acıbadem Maslak Hospital, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, Acıbadem Maslak Hospital, Istanbul, Turkey
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Sayan M, Zoto Mustafayev T, Sahin B, Kefelioglu ESS, Wang SJ, Kurup V, Balmuk A, Gungor G, Ohri N, Weiner J, Ozyar E, Atalar B. Evaluation of response to stereotactic radiosurgery in patients with radioresistant brain metastases. Radiat Oncol J 2019; 37:265-270. [PMID: 31918464 PMCID: PMC6952719 DOI: 10.3857/roj.2019.00409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 12/03/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Renal cell carcinoma (RCC) and melanoma have been considered 'radioresistant' due to the fact that they do not respond to conventionally fractionated radiation therapy. Stereotactic radiosurgery (SRS) provides high-dose radiation to a defined target volume and a limited number of studies have suggested the potential effectiveness of SRS in radioresistant histologies. We sought to determine the effectiveness of SRS for the treatment of patients with radioresistant brain metastases. MATERIALS AND METHODS We performed a retrospective review of our institutional database to identify patients with RCC or melanoma brain metastases treated with SRS. Treatment response were determined in accordance with the Response Evaluation Criteria in Solid Tumors. RESULTS We identified 53 radioresistant brain metastases (28% RCC and 72% melanoma) treated in 18 patients. The mean target volume and coverage was 6.2 ± 9.5 mL and 95.5% ± 2.9%, respectively. The mean prescription dose was 20 ± 4.9 Gy. Forty lesions (75%) demonstrated a complete/partial response and 13 lesions (24%) with progressive/stable disease. Smaller target volume (p < 0.001), larger SRS dose (p < 0.001), and coverage (p = 0.008) were found to be positive predictors of complete response to SRS. CONCLUSION SRS is an effective management option with up to 75% response rate for radioresistant brain metastases. Tumor volume and radiation dose are predictors of response and can be used to guide the decision-making for patients with radioresistant brain metastases.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Bilgehan Sahin
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | | | - Shang-Jui Wang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Varsha Kurup
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Aykut Balmuk
- School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Nisha Ohri
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Joseph Weiner
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Enis Ozyar
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
| | - Banu Atalar
- Department of Radiation Oncology, School of Medicine, Mehmet Ali Aydinlar Acibadem University, Istanbul, Turkey
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Sahin B, Zoto Mustafayev T, Gungor G, Aydin G, Yapici B, Atalar B, Ozyar E. First 500 Fractions Delivered with a Magnetic Resonance-guided Radiotherapy System: Initial Experience. Cureus 2019; 11:e6457. [PMID: 32025388 PMCID: PMC6977582 DOI: 10.7759/cureus.6457] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives Improved soft-tissue visualization, afforded by magnetic resonance imaging integrated into a radiation therapy linear accelerator-based radiation delivery system (MR-linac) promises improved image-guidance. The availability of MR-imaging can facilitate on-table adaptive radiation planning and enable real-time intra-fraction imaging with beam gating without additional exposure to radiation. However, the novel use of magnetic resonance-guided radiation therapy (MRgRT) in the field of radiation oncology also potentially poses challenges for routine clinical implementation. Herein the early experience of a single institution, implementing the first MRgRT system in the country is reported. We aim to describe the workflow and to characterize the clinical utility and feasibility of routine use of an MR-linac system. Methods The ViewRay MRIdian MR-linac system consists of a split-magnet 0.35 T MR-imaging scanner with a double focused multi-leaf collimator (MLC) equipped 6MV linear accelerator. Unique to the system are the control console integrated on-table adaptive radiation therapy (oART) planning capabilities as well as automated beam gating based on real-time intra-fraction MR imaging. From the first day of clinical implementation, oART was performed according to physicians’ discretion when medically indicated. All fractions were delivered under real-time imaging with soft tissue-based automated beam gating with individualized gating boundary settings. Patients actively assisted in breath-hold beam gating with the help of custom designed prismatic glasses allowing sight of a computer monitor mounted on the back wall just behind the MRI system bore. Patient demographics and treatment experience, indications for MRgRT including diagnosis and disease site, radiation dose prescribed and fractionation scheme, utilization of oART, respiratory gating settings, as well as duration of each treatment phase were analyzed. Results Between September 2018 and May 2019, 72 patients with 84 tumor sites were treated with MRgRT in 500 total fractions. Median patient age was 66 years (range: 28-83 years). Among 84 tumor sites, the most frequently treated regions were upper abdominal and pelvic (n = 36, 43% and n = 29, 34%, respectively). The most common diagnosis was prostate cancer, with 14 patients treated. In 69 patients (93.2%) oART was used at least once during a treatment course. Twenty-nine targets (43.1%) with significant breathing-related motion were treated in breath-hold with patient visual feedback. Median prescribed dose was 36.25 Gy (range: 24-70 Gy) in median five fractions (range: 3-28 fractions). A gating boundary of 3 mm around a gating region of interest (gROI) was most commonly used (range: 3-5 mm) with 95% of the gROI (range: 93-97%) required to be within the gating boundary for the beam to automatically engage. Mean total treatment time was 47 min (range: 21-125 min) and mean beam-on time was 16.7 min (range: 6-62 min). Conclusions MRgRT afforded by an MR-linac system has been successfully implemented into routine clinical use at our institution as the first system of its kind in Turkey. While the overall number of patients treated and fractions delivered is still limited, we have demonstrated the feasibility of both on-table adaptive radiation therapy as well as automated real-time beam gating on a daily basis in acceptable time schedules.
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Affiliation(s)
- Bilgehan Sahin
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | | | - Gorkem Gungor
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | - Gokhan Aydin
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | - Bulent Yapici
- Radiation Oncology, Acibadem Maslak Hospital, Istanbul, TUR
| | - Banu Atalar
- Radiation Oncology, Acibadem University School of Medicine, Istanbul, TUR
| | - Enis Ozyar
- Radiation Oncology, Acibadem University School of Medicine, Acibadem Maslak Hospital, Istanbul, TUR
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Güngör G, Aydın G, Mustafayev TZ, Özyar E. Output factors of ionization chambers and solid state detectors for mobile intraoperative radiotherapy (IORT) accelerator electron beams. J Appl Clin Med Phys 2019; 20:13-23. [PMID: 30632271 PMCID: PMC6370992 DOI: 10.1002/acm2.12522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/06/2018] [Accepted: 12/09/2018] [Indexed: 11/11/2022] Open
Abstract
Purpose The electron energy characteristics of mobile intraoperative radiotherapy (IORT) accelerator LIAC® differ from commonly used linear accelerators, thus some of the frequently used detectors can give less accurate results. The aim of this study is to evaluate the output factors (OFs) of several ionization chambers (IC) and solid state detectors (SS) for electron beam energies generated by LIAC® and compare with the output factor of Monte Carlo model (MC) in order to determine the adequate detectors for LIAC®. Methods The OFs were measured for 6, 8, 10, and 12 MeV electron energies with PTW 23343 Markus, PTW 34045 Advanced Markus, PTW 34001 Roos, IBA PPC05, IBA PPC40, IBA NACP‐02, PTW 31010 Semiflex, PTW 31021 Semiflex 3D, PTW 31014 Pinpoint, PTW 60017 Diode E, PTW 60018 Diode SRS, SNC Diode EDGE, and PTW 60019 micro Diamond detectors. Ion recombination factors (ksat) of IC were measured for all applicator sizes and OFs were corrected according to ksat. The measured OFs were compared with Monte Carlo output factors (OFMC). Results The measured OFs of IBA PPC05, PTW Advanced Markus, PTW Pinpoint, PTW microDiamond, and PTW Diode E detectors are in good agreement with OFMC. The maximum deviations of IBA PPC05 OFs to OFMC are −1.6%, +1.5%, +1.5%, and +2.0%; for PTW Advanced Markus +1.0%, +1.5%, +2.0%, and +2.0%; for PTW Pinpoint +2.0%, +1.6%, +4.0%, and +2.0%; for PTW microDiamond −1.6%, +2%, +1.1%, and +1.0%; and for PTW Diode E −+1.7%, +1.7%, +1.3%, and +2.5% for 6, 8, 10, and 12 MeV, respectively. PTW Roos, PTW Markus, IBA PPC40, PTW Semiflex, PTW Semiflex 3D, SNC Diode Edge measured OFs with a maximum deviation of +5.6%, +4.5%, +5.6%, +8.1%, +4.8%, and +9.6% with respect to OFMC, while PTW Diode SRS and IBA NACP‐02 were the least accurate (with highest deviations −37.1% and −18.0%, respectively). Conclusion The OFs results of solid state detectors PTW microDiamond and PTW Diode E as well as the ICs with small electrode spacing distance such as IBA PPC05, PTW Advanced Markus and PTW Pinpoint are in excellent agreement with OFMC. The measurements of the other detectors evaluated in this study are less accurate, thus they should be used with caution. Particularly, PTW Diode SRS and IBA NACP‐02 are not suitable and their use should be avoided in relative dosimetry measurements under high dose per pulsed (DPP) electron beams.
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Affiliation(s)
- Görkem Güngör
- Department of Medical Physics, Medipol University Institute of Health Sciences, Istanbul, Turkey.,Department of Radiation Oncology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Gökhan Aydın
- Department of Radiation Oncology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Teuta Zoto Mustafayev
- Department of Radiation Oncology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Enis Özyar
- Department of Radiation Oncology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
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