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Publication Metadata only Design considerations for clinical trials of radiotherapy combined with immunotherapy(İstanbul Tıp Fakültesi, 2023) Welsh, James; Sezen, Duygu; Faculty Member; School of Medicine; 170535The discovery of synergistic effects between radiation and immunotherapy in pre-clinical studies has encouraged researchers to conduct clinical trials testing the effects of combined therapy in patients. The first step in conducting any clinical trial is to define the hypothesis and core objectives. The challenge while developing trials analyzing combinations of immunotherapy and radiation therapy (RT) is to select an appropriate hypothesis that can be tested in the future research, as well as raising new questions for investigation. Here, we review some of the concerns and challenges for designing clinical trials of RT combined with immunotherapy.Publication Metadata only Evaluation of sarcopenia, malnutrition and nutritional status of patients with and without cancer treatment by age(İstanbul Ünivrsitesi, 2022) Aytulu, Tuğçe; Çalıkoğlu, Fulya; İşsever, Halim; Satman, İlhan; Selçukbiricik, Fatih; Çan, Meltem Yılmaz; Ergene, Gözde; Faculty Member; Doctor; Doctor; School of Medicine; N/A; N/A; Koç University Hospital; Koç University Hospital; 202015; N/A; N/AObjective: The aim of this study is to evaluate patients who are just starting or have started chemotherapy and also who are geriatric and nongeriatric, of sarcopenia and nutritional status. Materials and Methods: In this study, adult cancer patients who will receive chemotherapy for the first time were evaluated in terms of sarcopenia and nutritional status with patients between the 3rd month and 1st year of chemotherapy treatment. Patients were compared according to whether they were geriatric or not, and sarcopenic patients were also evaluated by classifying them according to cancer sides. The patients’ hand grip strength, bioelectrical impedance, appendicular skeletal muscle index (corrected for height), walking speed were measured and evaluated for sarcopenia. In addition, malnutrition risks, three-day food consumption records and laboratory parameters were examined. Results: A total of 123 adult patients were evaluated and 58 (47.2%) of the patients in the study were geriatric (65 years ≥). The risk of malnutrition was high in 39% of the patients and was found to be significantly higher in the geriatric group (46.6%) than in the non-geriatric group (32.3%) (p=0.029). The risk of malnutrition was found to be associated with the diagnosis groups of cancer. Compared to breast cancer, the risk of malnutrition was 18.2 times (p=0.002) higher in hepatobiliary cancers (including pancreas) and 7.6 times (p=0.018) in other cancers (head and neck, sarcoma, brain, stomach, peritoneum). Conclusion: Especially in geriatric patients, it is important to recognize and evaluate malnutrition caused by cancer at the beginning of treatment. / Amaç: Kemoterapiye yeni başlayacak veya başlamış olan, geriatrik olan ve olmayan hastalarda sarkopeninin ve beslenme durumunun değerlendirilmesidir. Gereç ve Yöntem: Bu çalışmada, ilk kez kemoterapi alacak yetişkin kanser hastalar, kemoterapi tedavisinin 3.ayı ile 1.yılı arasında olan hastalarla sarkopeni yönünden ve beslenme durumları açısından değerlendirilmiştir. Hastaların geriatrik olup olmamasına göre karşılaştırılmış ve ayrıca sarkopenik olan hastalar kanser türlerine göre sınıflandırılarak da değerlendirilmiştir. Hastaların el kavrama kuvvetleri, biyoelektrik impedans ile apendiküler iskelet kas indeksi (boya göre düzeltilmiş), yürüme hızları ölçülmüş ve sarkopenik düzeyleri, malnütrisyon riskleri, üç günlük besin tüketim kayıtları ve laboratuvar parametreleri incelenmiştir. Bulgular: Toplamda 123 yetişkin hasta değerlendirilmiştir. Çalışmadaki hastaların 58’i (%47,2’si) geriatriktir (65 yaş ≥) ve %39’unun malnütrisyon riski yüksektir. Geriatrik olan grupta (%46,6) olmayanlara göre (%32,3) anlamlı derecede malnütrisyon riski yüksek bulunmuştur (p=0,029). Malnütrisyon riski kanserin tanı gruplarıyla da ilişkili bulunmuştur. Meme kanserine göre, malnütrisyon riskinin hepatobiliyer kanserlerde (pankreas dahil) 18,2 kat (p=0,002) ve diğer kanserlerde (baş-boyun, sarkom, beyin, mide, periton) 7,6 kat (p=0,018) daha yüksek olduğu görülmüştür. Sonuç: Özellikle geriatrik hastalarda, kanserin neden olduğu malnütrisyonun, tedavinin başlangıcında farkedilmesi ve değerledirilmesi önemlidir.Publication Metadata only Minimally invasive approaches in metastatic spinal tumor surgery(Turkish Neurosurgery Society, 2015) Dalbayrak, Sedat; Yaman, Onur; Özer, Ali Fahir; Faculty Member; School of Medicine; 1022The surgical treatment of spinal metastases is still controversial. Due to developments in diagnostic imaging there has been a great evolution in minimally invasive surgical techniques for the spinal surgery. Most of the patients with spinal metastases are debilitated and under high risk of major surgical morbidity and mortality. Less perioperative pain, less blood loss, less hospitalization time, protection of the spine biomechanics, fast recovery and less morbidity in medically debilitated patients are the advantages of minimally invasive surgical techniques. Radiotherapy, chemotherapy or combining both treatments are the standard treatment options for spinal tumors following surgery. Standard open approaches are not suitable for some patients due to limited life expectancies, high surgical complication rates and decrease in quality of life. Minimal invasive techniques represent major advance in minimizing approach related morbidity in the treatment of spinal tumors. Because of the evolution of minimally invasive surgical techniques for the spinal surgery, minimally invasive techniques are alternative treatment to standard open approaches for the treatment of metastatic spinal tumors. Due to less complication rates there has been a trend toward the minimalization of spine surgery / Metastatik spinal tümörlerin cerrahi tedavisi halen tartışmalıdır. Gelişen görüntüleme yöntemleri ile spinal cerrahide kullanılan minimal invaziv tekniklerde büyük gelişmeler ortaya çıkmıştır. Spinal metastazı olan hastaların büyük bölümünde genel durum bozukluğu vardır ve cerrahi açıdan yüksek oranda mortalite ve morbidite riski taşırlar. Minimal invaziv tekniklerin belli başlı avantajları; daha az ağrılı olması, daha az kan kaybına neden olması, hastanede kalım süresinin az olması, omurga biyomekaniğinin korunması, iyileşmenin daha çabuk olması ve daha az morbidite oranına sahip olması olarak sıralanabilir. Spinal tümörlerin standart tedavisinde cerrahi sonrası radyoterapi, kemoterapi ya da ikisinin kombinasyonu uygulanmaktadır. Standart açık cerrahiler yaşam beklentisi kısa olan hastalarda yüksek komplikasyon oranları ve yaşam kalitesini düşürmesi nedeniyle uygun değildir. Minimal invaziv tekniklerin bir diğer avantajı spinal tümörlerin tedavisinde işleme bağlı morbiditeyi azaltmasıdır. Komplikasyon oranlarının az olması nedeniyle spinal cerrahide minimal invaziv tekniklere eğilim mevcuttur. Spinal cerrahi için kullanılan minimal invaziv teknik teknolojilerinin artmasıyla beraber spinal metastazlarda minimal invaziv teknikler klasik açık cerrahiye alternatif olarak kullanılmaya başlanmıştır.Publication Metadata only Perioperative and postoperative outcomes of laparoscopy and open method for surgical staging of endometrial cancer(Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim Araştırma Hastanesi, 2019) Giray, Burak; Aboalhasan, Yasemin; Vatansever, Doğan; Faculty Member; School of Medicine; 193687Objective: The aim of the study was to compare the safety of the laparoscopic and open method for endometrial cancer staging. Material and Methods: Between January 2015 and August 2017, we reviewed 121 women with endometrial cancer treated by open (n=81) or laparoscopic (n=40) approach, retrospectively. Two groups were compared in terms of operating times, intraoperative and postoperative complications, perioperative and postoperative features such as hemoglobin values, the lengths of hospital stay, and adjuvant therapy. All of the patients underwent a hysterectomy and bilateral salpingo-oophorectomy; and when indicated, omentectomy and lymphadenectomy were performed. Results: There were no significant differences between the two groups with regard to the number of parities, body mass index, menopausal status, age, the American Society of Anesthesiologists (ASA) scores, the requirement of lymphadenectomy, and hospital stay. There were significant statistical differences between groups in terms of operation time and difference of hemoglobin (p<0.001, p=0.013; respectively). Laparoscopic surgery had a longer operative time than laparotomy, and difference of hemoglobin in the laparotomy group is more than the laparoscopy group. Patients who underwent staging with laparotomy had bowel injury (1.2%), wound infection (13.6%), and postop ileus (8.6%) while in the laparoscopy group patients had wound infection (2.5%) and postop ileus (5%). There were no statistically significant differences between the two groups in terms of the intraoperative (p=1) and postoperative complications (p=0.101 for wound infection, p=0.716 for postop ileus). The groups were similar in terms of the histological grade, FIGO stage, histologic subtype, the rate of lymphovascular invasion, the depth of myometrial invasion, the total number of lymph nodes resected in lymph node dissections, the rate of lymph node metastasis, the location of the tumor, cervical stromal invasion, and the adjuvant therapy such as chemotherapy and brachytherapy. None of the patients in both groups had a recurrence and long-term lymphatic complication such as lymphocyst, lymphedema. Conclusion: Our current data demonstrated that the laparoscopic approach can be performed without loss of safety with similar complication rates in patients with endometrium cancer. Additionally, the laparoscopy was not inferior to the laparotomy in terms of efficacy. / Amaç: Endometrium kanserinin evreleme cerrahisinde laparoskopik yaklaşımın güvenirliğini laparotomi ile karşılaştırmak. Gereçler ve Yöntem: Ocak 2015 ile Ağustos 2017 tarihleri arasında laparoskopik (n=40) ve laparotomik (n=81) yöntemle tedavi edilen 121 endometrium kanserli hastanın bilgileri geriye dönük olarak değerlendirildi. İki grup operasyon süreleri, intraoperatif ve postoperatif komplikasyonlar, hemoglobin değerleri, hastanede kalış süreleri ve postoperatif ek tedavi gibi preoperatif ve postoperatif özellikleri açısından karşılaştırıldı. Bütün hastalara histerektomi ve bilateral salpingo-ooferektomi uygulandı ve gereklilik halinde lenf nodu diseksiyonu ve omentektomi yapıldı. Bulgular: Gruplar yaş, doğum sayısı, vücut kütle indeksi, menopozal durum, ASA (the American Society of Anesthesiologists) skoru, lenfadenektomi gerekliliği ve hastanede kalış süreleri açısından benzerdi. Preoperatif ve postoperatif hemoglobin değişim değerleri (p=0.013) ve operasyon süreleri (p<0.001) arasında istatistiksel olarak anlamlı fark vardı. Laparoskopi yapılan gruptaki hastaların operasyon süreleri daha fazla bulunurken, hemoglobin değişim değerleri daha az bulundu. Laparotomi yapılan grupta barsak hasarı (%1,2), yara yeri infeksiyonu (%13,6) ve postop ileus (%8,6) gelişirken, laparoskopi yapılan grupta yara yeri infeksiyonu (%2,5) ve postop ileus (%5) gelişti. Gruplar arasında intraoperatif (p=1) ve postoperatif komplikasyonlar açısından (yara yeri infeksiyonu için p=0.101; postop ileus için p=0.716) anlamlı fark yoktu. Gruplar histolojik grade, FIGO evresi, histolojik alt tip, lenfovasküler alan invazyon oranları, myometrial invazyon, çıkarılan lenf nodu miktarı, nodal metastaz oranları, tümör yerleşimi, servikal stromal invazyon ve kemoterapi ya da radyoterapi gibi ek tedavi uygulanmaları açısından benzerdi. Hiçbir hastada lenfokist ya da lenfödem gibi uzun dönem komplikasyonlar ve rekkürens gelişmedi. Sonuç: Çalışmamız laparoskopik yaklaşımın endometrium kanserli hastaların evrelemesinde laparotomiye benzer komplikasyon oranlarıyla güvenli bir şekilde uygulanabileceğini gösterdi. Ayrıca laparoskopi endometrium kanserinin evrelemesinde ve tedavisinde laparotomi kadar etkin bulunmuştur.Publication Metadata only Role of emotion regulation and fear of compassion on depression and anxiety in patients with colorectal cancer(Kartal Eğitim ve Araştırma Hastanesi, 2022) Kılıç, Özge; Dikmen, Yasemin; N/A; Özata, İbrahim Halil; Yalçınay-İnan, Merve; Tüfekçi, Tutku; Ağcaoğlu, Orhan; Kuşçu, Kemal; Balık, Emre; Teaching Faculty; Doctor; Researcher; Faculty Member; Faculty Member; Faculty Member; School of Medicine; N/A; School of Medicine; School of Medicine; School of Medicine; N/A; Koç University Hospital; N/A; N/A; N/A; 177151; N/A; 327608; 175476; N/A; 18758INTRODUCTION: Maladaptive emotion regulation (ER) styles act as transdiagnostic mechanisms that underlie many psychiatric symptoms linked to cancer. ER and fear of compassion (FC) were studied in breast cancer, but their effects on psychiatric symptoms of colorectal cancer (CRC) patients are not studied. We aim to examine the role of ER and FC on depression and anxiety in Turkish CRC patients. METHODS: This observational, cross-sectional study recruited 38 patients with CRC who were being followed up by the general surgery department of a university hospital. Emotion Regulation Questionnaire, Fear of Compassion Scale, the Exercise of Self-care Agency Scale, Hospital Anxiety and Depression Scale, Distress Thermometer, Numeric Pain Intensity Scale, and Ostomy Adjustment Inventory were applied. Multiple regression analyses were performed to identify factors affecting depression and anxiety levels. RESULTS: Twenty-nine men and 9 women (median age=56.5, 28–69), most of whom were married and highly educated, were recruited. Expressive suppression (p=0.013) and pain (p=0.010) positively (Model, R2=0.42, p<0.001) and self-care agency (p=0.021) negatively influenced anxiety levels. Expressive suppression (p=0.017) and male gender (p=0.020) positively influenced depression levels (Model, R2=0.28, p=0.003). There was no association between cognitive reappraisal and levels of depression and anxiety. Among ostomates (n=17), 11 patients had low and 6 patients had medium adaptation to an active ostomy. No patient exhibited high adjustment to an ostomy. DISCUSSION AND CONCLUSION: Findings indicate that in CRC patients, expressive suppression affects levels of anxiety and depression while cognitive reappraisal does not. FC was not found to be related to anxiety and depression. Physicians should carefully observe the patients’ and the caregivers’ ER strategies and the dynamic and interactive psychological states to understand which patients need psychological and psychiatric interventions. We suggest future studies explore the interventions that target expressive suppression patterns to prevent anxiety and depression in CRC patients. / GİRİŞ ve AMAÇ: Uyumsal olmayan emosyon düzenleme biçimleri, kanserle ilişkili psikiyatrik belirtilerin altında yatan tanılar üstü mekanizmalar olarak rol oynar. Emosyon düzenleme ve şefkat korkusu meme kanseri hastalarında incelenmiştir ancak kolorektal kanser hastalarında psikiyatrik belirtiler üzerine etkileri araştırılmamıştır. Emosyon düzenleme ve şefkat korkusunun depresyon ve anksiyete üzerindeki rolünü Türk kolorektal kanser hastalarında incelemeyi amaçladık. YÖNTEM ve GEREÇLER: Bu gözlemsel, kesitsel çalışmaya, bir üniversite hastanesinin genel cerrahi bölümü tarafından takip edilen 38 kolorektal kanser hastası alındı. Emosyon Düzenleme Ölçeği, Şefkat Korkusu Ölçeği, Özbakım Gücü Ölçeği, Hastane Anksiyete ve Depresyon Ölçeği, Distres Termometresi, Sayısal Ağrı Derecelendirme Ölçeği, ve Stomaya Uyum Envanteri uygulandı. Depresyon ve anksiyeteyi etkileyen faktörleri belirlemek için çoklu regresyon analizleri yapıldı. BULGULAR: Çalışmaya çoğu evli ve yüksek eğitimli (medyan yaş= 56.5, 28–69) olan 29 erkek, 9 kadın alındı. Anksiyete düzeyleri üzerine dışavurumu bastırma (p=0.013) ve ağrının (p=0.010) etkisi pozitif, özbakım gücünün (p=0.02) etkisi negatifti (Model, R2=0.42, p<0.001). Depresyon düzeyleri üzerineyse dışavurumu bastırma (p=0.017) ve erkek cinsiyet (p=0.020) pozitif yönde etki etmekteydi. (Model, R2=0.28, p=0.003). Bilişsel yeniden değerlendirme ile depresyon ve ve anksiyete arasında ilişki saptanmadı. Stomaya uyum aktif stomalı hastaların (n=17) 11’inde düşük, altısında ortaydı. Stomaya yüksek uyum gözlenmedi. TARTIŞMA ve SONUÇ: Sonuçlar, kolorektal kanser hastalarında dışavurumu bastırmanın anksiyete ve depresyon düzeylerini etkilediğini, bilişsel yeniden değerlendirmenin ise bu düzeyleri etkilemediğini göstermiştir. Şefkat korkusu anksiyete ve depresyonla ilişkili bulunmamıştır. Hekimler, hangi hastaların psikolojik veya psikiyatrik müdahaleye ihtiyaç duyduğunu anlamak için hasta ve bakımverenin emosyon düzenleme biçimlerini ve dinamik ve etkileşimli psikolojik durumlarını dikkatle gözlemelidir. Gelecek çalışmaların kolorektal kanser hastalarında anksiyete ve depresyonu önlemek için dışavurumu bastırma paternini hedef alan müdahaleleri araştırmasını öneririz.Publication Metadata only Studying the physical and psychological symptoms of patients with cancer(Gülhane Military Medical Academy, 2013) Sever, Neşe; DInçer, Şefika; N/A; N/A; Seven, Memnun; Akyüz, Aygül; Faculty Member; Faculty Member; School of Nursing; School of Nursing; 32470; 42416Aim: Aim of the descriptive study was to evaluate the frequency and severity of physical and psychological symptoms so as to determine palliative care needs of cancer patients. Method: Total 142 patients who were treated in oncology clinic at an university hospital were enrolled in the cross sectional research. "Descriptive Information Questionnaire" was developed by the authors and the adapted "Beck Depression Inventory (BAI)" and "Beck Anxiety Inventory (BDI)", "Edmonton Symptom Assessment System (ESAS)" to evaluate psychological and physical symptoms were used to collect data. Results: The mean age was 49.35±36.61 years and 54.9% of them were out-patients. %16.2 of the patients were diagnosed with colon and 13.4% breast cancer. The mean BDI score was 8.59±6.36 and 88.7% the patients have depressive symptoms. The mean BAI score was 11.39±7.53. The three most frequent problems were fatigue (87.3%), breathlessness (76.1%), and insomnia (67.6%). The mean of the highest-ranking problems were anorexia (6.02±2.77), fatigue (5.33±2.09) and insomnia (0.04±2.42). Conclusion: The study shows that some symptoms might be experienced by majority of the cancer patients as well as some symptoms might be felt more severe by fewer patients. Therefore, It should be assessed that both the frequency and severity of symptoms that patients experienced associated with cancer and its' treatment individually and focusing on primary care.Publication Metadata only Surgical management of bronchial carcinoid tumors: 11-year experience(Turkish Society of Cardiovacular Surgery, 2014) Dadaş, Erdoğan; Tanju, Serhan; Özkan, Berker; Bayrak, Yusuf; Kaba, Erkan; Toker, Alper; N/A; Dilege, Şükrü; Faculty Member; School of Medicine; 122573Background: This study aims to present surgical treatment, postoperative complications, and long-term outcomes in patients with a bronchial carcinoid tumor. Methods: Between January 2000 and December 2010, 57 patients (34 females, 23 males; mean age 43 years; range 13 to 83 years) underwent pulmonary resection for pre- and postoperatively pathologically confirmed bronchial carcinoid tumors. Type of surgery, histopathological types of carcinoid tumor, postoperative complications, and long-term results were evaluated. Results: Pathological examination revealed 44 (77%) typical and 13 (23%) atypical carcinoid tumors. Bronchial sleeve resection, pneumonectomy, lobectomy and sublobar resection were performed on 23 (40.3%), three (5.2%), 27 (47.3%) and four patients (7%), respectively. Eight patients (14%) had postoperative complications. There was no perioperative mortality. During the follow-up period, no mortality or local recurrence occurred. Conclusion: During long-term follow-up period, parenchyma-sparing resections (sleeve lobectomy and bronchial sleeve resection) can achieve good prognosis in patients with typical carcinoid tumor if tumor free surgical margins can be obtained. /Öz: Amaç: Bu çalışmada, bronşiyal karsinoid tümörlü hastalarda cerrahi tedavi, ameliyat sonrası komplikasyonlar ve uzun dönem sonuçlar sunuldu. Çalışma planı: Ocak 2000 - Aralık 2010 tarihleri arasında ameliyat öncesi ve sonrası patolojik olarak bronşiyal karsinoid tümör olduğu doğrulanmış 57 hastaya (34 kadın, 23 erkek; ort. yaş 43 yıl; dağılım 13-83 yıl) akciğer rezeksiyonu uygulandı. Cerrahi tipi, karsinoid tümörün histopatolojik tipi, ameliyat sonrası komplikasyonlar ve uzun dönem sonuçlar değerlendirildi. Bulgular: Patolojik muayenede 44 (%77) tipik, 13 (%23) atipik karsinoid tümör saptandı. Hastaların 23’üne (%40.3) bronşiyal sleeve reseksiyon, üçüne (%5.2) pnömonektomi, 27’sine (%47.3) lobektomi, dördüne (%7) sublobar rezeksiyon uygulandı. Sekiz hastada (%14) ameliyat sonrası komplikasyon gözlendi. Ameliyat sırası mortalite gözlenmedi. Takip döneminde hiçbir hastada ölüm ve lokal nüks olmadı. Sonuç: Parenkim koruyucu rezeksiyonlar (sleev lobektomi ve sleev bronşiyal rezeksiyon), tipik karsinoid tümörlü hastalarda, negatif cerrahi sınır elde etmek koşulu ile uzun dönem takip sürecinde iyi prognoz sağlayabilir.Publication Metadata only The impact of hybrid capture-based comprehensive genomic profiling on treatment strategies in patients with solid tumors(Türkiye Klinikleri Yayınevi, 2022) Dişel, Umut; Köse, Fatih; Bilici, Ahmet; Özgüroğlu, Mustafa; Sağlam, Sezer; Şeker, Mesut; Aksoy, Sercan; Tek, İbrahim; Mandel, Nil Molinas; Demir, Gökhan; Arslan, Çağatay; Demiray, Mutlu; Öztürk, Mehmet Akif; Salepçi, Taflan; Eralp, Yeşim; Temizaş, Gökçe; Fidan, Ebru Gül; Selçukbiricik, Fatih; Faculty Member; School of Medicine; 202015Objective: The development of bioinformatics and comprehensive genomic profiling (CGP) has provided insights into the ap-plicability and functionality of the genomic alterations (GA). In this study, we evaluated the impact of CGP on the treatment plan and outcomes in a significant number of patients. Material and Methods: We carried out a retrospective case-control study on 164 adult patients with advanced solid tumors from 15 oncology centers in Türkiye. Results: In all cases, CGP was performed within 23.8 [standard deviation (SD)±32.1] months of initial diagnosis. Non-small cell lung carcinoma, breast cancer, unknown primary carcinoma, colorectal carcinoma, and sarcoma were among the most common tumor types, accounting for 61.5% of all cases. CGP was performed immediately after the diagnosis of advanced cancer in 13 patients (7.9%). In 158 patients (96.4%), at least one GA was found as per the CGP report. Also, in the reports, the average tumor mutational burden (TMB) and GAs were 7.3 (SD±8.7) mut/Mb and 3.5 (SD±2.0), respectively. According to CGP reports, 58 patients had 79 evidence-based drug suggestions for their particular tumor type, whereas 97 patients had 153 evidence-based drug suggestions for another tumor type. After the primary oncologist interpreted the CGP reports, significant changes were made to the treatment of 35 (21.3%) patients. Conclusion: We strongly believe that in the future, high-TMB or other tumor-agnostic biomarkers will become much more afford-able, and CGP will serve as one of the major decision-making tools for the treatment of patients along with pathological, radiological or lab-oratory tests.