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Permanent URI for this collectionhttps://hdl.handle.net/20.500.14288/3
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Publication Metadata only The role of neoadjuvant chemotherapy for patients with variant histology muscle invasive bladder cancer undergoing robotic cystectomy: data from the International Robotic Cystectomy Consortium(Elsevier Inc., 2024) Cooke, Ian; Abou Heidar, Nassib; Mahmood, Abdul Wasay; Ahmad, Ali; Jing, Zhe; Stöckle, Michael; Wagner, Andrew A; Roupret, Morgan; Kim, Eric; Vasdev, Nikhil; Rha, Koon Ho; Aboumohamed, Ahmed; Dasgupta, Prokar; Maatman, Thomas J.; Richstone, Lee; Wiklund, Peter; Gaboardi, Franco; Li, Qiang; Hussein, Ahmed A.; Guru, Khurshid; N/A; Balbay, Mevlana Derya; School of MedicineObjective: To assess the role of neoadjuvant chemotherapy (NAC) before robot-assisted radical cystectomy (RARC) for patients with variant histology (VH) muscle-invasive bladder cancer (MIBC). Methods: Retrospective review of 988 patients who underwent RARC (2004–2023) for MIBC. Primary outcomes included the utilization of NAC among this cohort of patients, frequency of downstaging, and discordance between preoperative and final pathology in terms of the presence of VH. Secondary outcomes included disease-specific (DSS), recurrence-free (RFS), and overall survival (OS). Results: A total of 349 (35%) had VH on transurethral resection or at RARC. The 4 most common VH subgroups were squamous (n = 94), adenocarcinoma (n = 64), micropapillary (n = 34), and sarcomatoid (n = 21). There was no difference in OS (log-rank: P = 0.43 for adenocarcinoma, P = 0.12 for micropapillary, P = 0.55 for sarcomatoid, P = 0.29 for squamous), RFS (log-rank: P = 0.25 for adenocarcinoma, P = 0.35 for micropapillary, P = 0.83 for sarcomatoid, P = 0.79 for squamous), or DSS (log-rank P = 0.91 for adenocarcinoma, P = 0.15 for micropapillary, 0.28 for sarcomatoid, P = 0.92 for squamous) among any of the VH based on receipt of NAC. Patients with squamous histology who received NAC were more likely to be downstaged on final pathology compared to those who did not (P < 0.01). Conclusion: Our data showed no significant difference in OS, RFS, or DSS for patients with VH MIBC cancer who received NAC before RARC. Patients with the squamous variant who received NAC had more pathologic downstaging compared to those who did not. The role of NAC among patients with VH is yet to be defined. Results were limited by small number in each individual group and lack of exact proportion of VH. © 2024Publication Metadata only Prognostic significance of lymph node count in surgically treated patients with T2-4 stage nonmetastatic adrenocortical carcinoma(Elsevier Inc., 2024) Assad, Anis; Barletta, Francesco; Incesu, Reha-Baris; Scheipner, Lukas; Morra, Simone; Baudo, Andrea; Garcia, Cristina Cano; Tian, Zhe; Ahyai, Sascha; Longo, Nicola; Chun, Felix K.H.; Shariat, Shahrokh F.; Briganti, Alberto; Saad, Fred; Karakiewicz, Pierre I.; N/A; Tilki, Derya; School of MedicinePurpose: The role of lymphadenectomy and the optimal lymph node count (LNC) cut-off in nonmetastatic adrenocortical carcinoma (nmACC) are unclear. Methods: Within the Surveillance, Epidemiology, and End Results (SEER) database, surgically treated nmACC patients with T2-4 stages were identified between 2004 and 2020. We tested for cancer-specific mortality (CSM) differences according to pathological N-stage (pN0 vs. pN1) and two previously recommended LNC cut-offs (≥4 vs. ≥5) were tested in pN0 and subsequently in pN1 subgroups in Kaplan-Meier plots and multivariable Cox regression models. Results: Of 710 surgically treated nmACC patients, 185 (26%) underwent lymphadenectomy and were assessable for further analyses based on available LNC data. Of 185 assessable patients, 152 (82%) were pN0 and 33 (18%) were pN1. In Kaplan-Meier analyses, CSM-free survival was 74 vs. 14 months (Δ 60 months, P ≤ 0.001) in pN0 vs. pN1 patients, respectively. In multivariable analyses, pN1 was an independent predictor of higher CSM (HR:3.13, P < 0.001). In sensitivity analyses addressing pN0, LNC cut-off of ≥4 was associated with lower CSM (multivariable hazard ratio [HR]: 0.52; P = 0.002). In sensitivity analyses addressing pN0, no difference was recorded when a LNC cut-off of ≥5 was used (HR:0.60, P = 0.09). In pN1 patients, neither of the cut-offs (≥4 and ≥5) resulted in a statistically significant stratification of CSM rate, and neither reached independent predictor status (all P > 0.05). Conclusions: Lymphadenectomy provides a prognostic benefit in nmACC patients and identifies pN1 patients with dismal prognosis. Conversely, in pN0 patients, a LNC cut-off ≥4 identifies those with particularly favorable prognosis. © 2024 Elsevier Inc.Publication Metadata only FAST- Forward radiotherapy in breast cancer patients from a Turkish cohort: a study on acute skin toxicity(Kare Publ, 2024) Bolukbasi, Yasemin; N/A; Durankuş, Nilüfer Kılıç; Sezen, Duygu; Şenyürek, Şükran; School of Medicine; Koç University HospitalOBJECTIVE This study aimed to evaluate early skin reactions in patients with breast cancer treated with the FAST-Forward radiotherapy regimen after surgery. METHODS Between December 2019 and August 2022, 60 patients with breast cancer received the FAST-Forward radiotherapy protocol: 26 Gy delivered in five fractions of 5.2 Gy each, using tangential field-in-field techniques.Treatments were administered on consecutive weekdays, and skin reactions were graded using the Radiation Therapy Oncology Group (RTOG) system in the second and sixth weeks after radiotherapy. The radiotherapy area and contralateral breast were photographed, and the patients were asked to report any breast swelling as a subjective symptom. RESULTS The median patient age was 71 years (range: 51-86). All had T1-2 and N0-1 disease and received adju-vant radiotherapy following surgery. In the second week after radiotherapy, 7 patients (11.6%) had grade 1 skin reactions and 1 patient (1.6%) had a grade 2 reaction. By the sixth week, five of the seven grade 1 reactions had resolved, with one remaining in grade 1 and one increasing to grade 2. The initial grade 2 reaction improved to a grade 1 reaction. None of the patients reported breast swelling in the second and sixth weeks after radiotherapy. CONCLUSION Considering the impact of skin reactions on the patients' quality of life, the FAST-Forward protocol appears to be a safe and comfortable option for patients who meet the appropriate criteria. Copyright (c) 2024, Turkish Society for Radiation OncologyPublication Metadata only Detector selection impact on small-field dosimetry of collecting beam data measurements among Versa HD 6 MV FFF beams: a multi-institutional variability analysis(Kare Publ, 2024) Ceylan, Cemile; Güngör, Boran; Yeşil, Abdullah; Güngör, Sinem; Yöndem İnal, Serpil; Kara, Esil; Konuk, Aykut; Özden, Özcan; Kara, Özgür; Avci, Volkan; Başer, Tamer; Uğur, Timur; Can, Sümeyra; Durmuş, İsmail Faruk; N/A; Sağlam, Yücel; School of Medicine; Koç University HospitalOBJECTIVE The objective of the present study was to assess the impact of detector type on measurements of small fields for the 6MV-FFF beam within 13 institutes of Elekta Versa HD linear accelerator users. METHODS Using various ion chambers, measurements of the percent depth dose (PDD), off-center ratio (OCR), and output factor (OF) datasets in square areas between 2×2 and 50×50 mm2 for beam modelling in Monaco TPS were collected, and dosimetric differences were compared. The types of used detectors were PTW PinPoint 31014, IBA CC04, IBA CC01, IBA CC13 and Exradin A16, respectively. The effect of the detector type on the OCR was evaluated by including penumbra width of fields, full width half maximum value (FWHM) and FFF beam specific unflatness value. The PDDs were compared using depth of dmax, d5 and d10. Also, the differences between OFs of each field and institution were analyzed with and without correction factor. RESULTS The largest observed variance in dmax was 3 mm for a few institutions, whereas the majority of institutions agreed with GBD dmax values within 2 mm. The agreement of the median PDD values with GBD was all within ±2%. The maximum deviation was under 2% for the shoulder part and 1% for the center part of the OCR profiles for all field sizes. The maximum deviation of the penumbra and FWHM value observed for all field sizes at certain institute OCR data was considered a user-dependent effect instead of a detector. The relative percent difference both the OFuncorr and the OFcorr compared with GBD for all field sizes was within ±3%. CONCLUSION The findings of this study obtained via a large multicentre study can be considered as an external cross-verification for Versa HD users doing beam data collection of Monaco and should help to offer accurate TPS modelling of small fields and minimize the uncertainty of SRS and SBRT. Our results emphasized that the use of several dosimetric systems, comparison of golden beam data, and multi-institutional review are required. © 2024, Turkish Society for Radiation Oncology.Publication Metadata only The influence of melatonin on brain tumors: a comprehensive review(Kare Publ, 2024) Becker, Aline Paixão; Becker, Valesio; N/A; Durankuş, Nilüfer Kılıç; School of MedicinePrimary brain tumors are a heterogeneous group of neoplasms, originating from glial and other cell types in the central nervous system (CNS). Despite advancements in technology and medicine, the prognosis for malignant brain tumors remains poor. This situation requires novel therapeutic approaches. Melatonin, a hormone produced by the pineal gland, regulates sleep and circadian rhythms. It also possesses various biological functions, such as antioxidant properties, immune modulation, and tumor suppression. This review analyzes existing research on the effects of melatonin on brain tumors, focusing on its therapeutic potential and mechanisms of action, and highlights melatonin's promise as a complementary therapy against adult and pediatric high-grade gliomas.Publication Metadata only Response to Deantoni et al.(Sage Publications Ltd, 2024) Topkan, Erkan; Somay, Efsun; N/A; Selek, Uğur; School of MedicineN/APublication Metadata only Differences in other-cause mortality in metastatic renal cell carcinoma according to partial vs. radical nephrectomy and age: a propensity score matched study(Elsevier Sci Ltd, 2024) Siech, Carolin; Incesu, Reha-Baris; Morra, Simone; Scheipner, Lukas; Baudo, Andrea; Jannello, Letizia Maria Ippolita; de Angelis, Mario; Goyal, Jordan A.; Tian, Zhe; Saad, Fred; Shariat, Shahrokh F.; Longo, Nicola; Carmignani, Luca; de Cobelli, Ottavio; Ahyai, Sascha; Briganti, Alberto; Mandel, Philipp; Kluth, Luis A.; Chun, Felix K. H.; Karakiewicz, Pierre I.; N/A; Tilki, Derya; School of Medicine; Koç University HospitalIntroduction: It is unknown whether the benefit from partial nephrectomy regarding lower other-cause mortality is applicable to older patients with metastatic renal cell carcinoma. Materials and methods: Using Surveillance Epidemiology and End Results database, patients with metastatic renal cell carcinoma, undergoing partial or radical nephrectomy, were stratified according to age (<60, 60-69, and >= 70 years). After propensity score matching, Kaplan-Meier survival analyses and multivariable Cox regression models were used. Results: Of 2,390 patients with metastatic renal cell carcinoma, 885 (37%) were aged <60 years, and 90 (10%) underwent partial nephrectomy; 824 (34%) were aged 60-69 years, and 61 (7%) underwent partial nephrectomy; and 681 (29%) were aged >= 70 years, and 64 (9%) underwent partial nephrectomy. After propensity score matching, in patients aged <60 years, partial nephrectomy was associated with lower other-cause mortality (hazard ratio 0.22; p = 0.02); in patients aged 60-69 years, partial nephrectomy was associated with lower othercause mortality (hazard ratio 0.38; p = 0.03); but not in patients aged >= 70 years. Discussion: In metastatic renal cell carcinoma, partial nephrectomy is associated with lower other-cause mortality in patients aged <60 years and in patients aged 60-69 years, but not in patients aged >= 70 years. In consequence, consideration of partial nephrectomy might be of great value in younger metastatic renal cell carcinoma patients.Publication Metadata only Surgically treated pelvic liposarcoma and leiomyosarcoma: the effect of tumor size on cancer-specific survival(Elsevier Ltd, 2024) Baudo, Andrea; Piccinelli, Mattia Luca; Incesu, Reha-Baris; Morra, Simone; Scheipner, Lukas; Barletta, Francesco; Tappero, Stefano; Garcia, Cristina Cano; Assad, Anis; Tian, Zhe; Acquati, Pietro; de Cobelli, Ottavio; Longo, Nicola; Briganti, Alberto; Terrone, Carlo; Chun, Felix K.H.; Ahyai, Sascha; Saad, Fred; Shariat, Shahrokh F.; Carmignani, Luca; Karakiewicz, Pierre I.; N/A; Tilki, Derya; School of Medicine; Koç University HospitalIntroduction: In soft tissue pelvic liposarcoma and leiomyosarcoma, it is unknown whether a specific tumor size cut-off may help to better predict prognosis, defined as cancer-specific survival (CSS). We tested whether different tumor size cut-offs, could improve CSS prediction. Materials and methods: Surgically treated non-metastatic soft tissue pelvic sarcoma patients were identified (Surveillance, Epidemiology, and End Results 2004–2019). Kaplan-Meier plots, univariable and multivariable Cox-regression models and receiver operating characteristic-derived area under the curve (AUC) estimates were used. Results: Overall, 672 (65 %) liposarcoma (median tumor size 11 cm, interquartile range [IQR] 7–16) and 367 (35 %) leiomyosarcoma (median tumor size 8 cm, IQR 5–12) patients were identified. The p-value derived ideal tumor size cut-off was 17.1 cm, in liposarcoma and 7.0 cm, in leiomyosarcoma. In liposarcoma, according to p-value derived cut-off, five-year CSS rates were 92 vs 83 % (≤17.1 vs > 17.1 cm). This cut-off represented an independent predictor of CSS and improved prognostic ability from 83.8 to 86.8 % (Δ = 3 %). Similarly, among previously established cut-offs (5 vs 10 vs 15 cm), also 15 cm represented an independent predictor of CSS and improved prognostic ability from 83.8 to 87.0 % (Δ = 3.2 %). In leiomyosarcoma, according to p-value derived cut-off, five-year CSS rates were 86 vs 55 % (≤7.0 vs > 7.0 cm). This cut-off represented an independent predictor of CSS and improved prognostic ability from 68.6 to 76.5 % (Δ = 7.9 %). Conclusions: In liposarcoma, the p-value derived tumor size cut-off was 17.1 cm vs 7.0 cm, in leiomyosarcoma. In both histologic subtypes, these cut-offs exhibited the optimal statistical characteristics (univariable, multivariable and AUC analyses). In liposarcoma, the 15 cm cut-off represented a valuable alternative. © 2024 Elsevier LtdPublication Metadata only Letter to the editor: radiotherapy increases aMMP-8 levels and neutrophil/lymphocyte ratio rapidly in head and neck cancer patients: a pilot study(Sage Publications Inc, 2023) Yılmaz, Büşra; Topkan, Erkan; Pehlivan, Berrin; N/A; Selek, Uğur; School of MedicinePublication Metadata only Prophylactic cranial irradiation in small and non-small-cell lung carcinoma(Springer, 2016) Topkan, Erkan; N/A; Selek, Uğur; Faculty Member; School of Medicine; 27211At initial presentation, approximately 10–14 % of small-cell lung carcinoma (SCLC) patients manifest with radiologically evident brain metastases (BM) which arises up to 69 % at 2 years. Similarly, brain failures are reported in 21–54 % of all non-small-cell lung carcinoma (NSCLC) patients, and of these, the brain is the first site of relapse in 15–30 % cases. Although significant improvements have been achieved in local and distant control of both SCLC and NSCLC as a result of implementation of aggressive treatment modalities, unfortunately such aggressive treatments proved no noteworthy viability in lessening of overall brain or brain as the first site of relapse rates. Regarding its counteractive actions on BM emergence, the potential beneficial effects of prophylactic cranial irradiation (PCI) in patients with limited-stage SCLC (LS-SCLC), extensive-stage SCLC (ES-SCLC), and locally advanced NSCLC (LA-NSCLC) have been addressed with several randomized trials and meta-analysis. Based on the results of these investigations, PCI of 25 Gy (2.5 Gy in ten fractions) should be recommended for all medically fit LS- and ES-SCLC patients with any objective response to primary therapy in order to reduce BM incidence rates and to prolong OS times. Although the PCI studies in LA-NSCLC patients suggest significant reductions in BM incidence rates with PCI, yet in the absence of an established survival benefit, it is currently quite difficult to recommend its routine use in LA-NSCLC patients. However, future studies involving high-risk patients may prove worthy in determination of the exact impact if they are needed in order to reliably comment on the issue of PCI in LA-NSCLC patients.