Researcher:
Durankuş, Nilüfer Kılıç

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Nilüfer Kılıç

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Durankuş

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Durankuş, Nilüfer Kılıç

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2018 - 201932020 - 20229

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    Case presentation: the effect of volumetric image guidance and adaptive radiotherapy on cardiac dose in a patient with esophageal cancer
    (Kare Publ, 2018) Sağlam, Yücel; Alpan, Vildan; N/A; N/A; N/A; N/A; N/A; Sezen, Duygu; Bölükbaşı, Yasemin; Durankuş, Nilüfer Kılıç; Atasoy, Ali İhsan; Selek, Uğur; Faculty Member; Faculty Member; Teaching Faculty; Other; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 170535; 216814; 148139; N/A; N/A; N/A; 27211
    We present the case of a patient with esophageal cancer whose tumor size regression prompted re-planning to decrease the cardiac dose. A 68-year-old male presented at our outpatient clinic with dysphagia. He was diagnosed with clinical T3N1 M0 adenocarcinoma located at the distal esophagus-esophagogastric junction. He was decided to have surgery after receiving neoadjuvant chemoradiotherapy. Following 4-D CT simulation, IG-IMRT with SIB technique was planned as 50 Gy in 25 fractions to iGTV and as 45 Gy to the area identified as the CIV. Daily kV and weekly CBCI were planned at the beginning of the treatment. Concurrent CT with weekly paclitaxel-carboplatin was administered. At the simulation and start of the treatment, the heart was pushed anteriorly due to the mass effect and dilatation in the mid-lower esophagus. The mass and dilatation regressed at the weekly CBCT of the patient. The third-week CBCT evaluation revealed the movement of the heart posteriorly into the PTV. Re-simulation was performed to continue with the adaptive planning for the last 10 treatment fractions. The cumulative dose received by the heart was reduced from 96% to 93% for V5Gy, from 79% to 60.8% for V10Gy, from 60% to 43.2% for V15Gy, from 35% to 21% for V20Gy, and from 29.6 to 28 Gy for the mean cardiac dose with the volumetric image-guided adaptive planning. If tumor regression is predicted during radiotherapy to possibly change doses of organs at risk, volumetric image guidance should be encouraged once per week, at least, to consider adaptive treatment when required to ensure the critical organ doses within safe limits.
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    In regard to boeri et al. 'Oligorecurrent prostate cancer treated with metastases-directed therapy or standard of care: a single-center experience'
    (Springernature) Oymak, Ezgi; Onal, Cem; N/A; Bölükbaşı, Yasemin; Durankuş, Nilüfer Kılıç; Faculty Member; Teaching Faculty; School of Medicine; School of Medicine; 216814; 148139
    N/A
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    The prognostic significance of novel pancreas cancer prognostic index in unresectable locally advanced pancreas cancers treated with definitive concurrent chemoradiotherapy
    (Dove Medical Press, 2021) Topkan, Erkan; Pehlivan, Berrin; Kucuk, Ahmet; Haksoyler, Veysel; Bölükbaşı, Yasemin; Selek, Uğur; Sezen, Duygu; Durankuş, Nilüfer Kılıç; Faculty Member; Faculty Member; Faculty Member; Teaching Faculty; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 216814; 27211; 170535; 148139
    Purpose: We evaluated the prognostic quality of the novel pancreas cancer prognostic index (PCPI), a combination of CA 19-9 and systemic inflammation response index (SIRI), on the outcomes of locally advanced pancreas adenocarcinoma (LAPAC) patients who received concurrent chemoradiotherapy (C-CRT). Methods: This retrospective analysis covered 152 unresectable LAPAC patients treated from 2007 to 2019. Receiver operating characteristic (ROC) curve analysis was used to define ideal cutoff thresholds for the pretreatment CA 19-9 and SIRI measurements, indivi-dually. The associations between the PCPI groups and progression -free-(PFS) and overall survival (OS) comprised the respective primary and secondary endpoints. Results: The ROC curve analysis distinguished the respective rounded optimal cutoffs at 91 U/m/ L (< versus >= 90) and 1.8 (< versus >= 1.8) for CA 19-9 and SIRI, arranging the study cohort into two significantly different survival groups for each, with resultant four likely groups: Group-1: CA 19-9<90 U/m/L and SIRI<1.8, Group-2: CA 19-9<90 U/m/L but SIRI >= 1.8, Group-3: CA 19-9 >= 90 U/ m/L but SIRI<1.8, and Group-4: CA 19-9 >= 90 U/m/L and SIRI >= 1.8. Since the PFS (P=0.79) and OS (P=0.86) estimates of the groups 2 and 3 were statistically indistinct, we merged them as one group and created the novel three-tiered PCPI: PCPI-1: CA 19-9<90 U/m/L and SIRI<1.8, PCPI-2: CA 19-9<90 U/m/L but SIRI >= 1.8 or CA 19-9 >= 90 U/m/L but SIRI<1.8, and PCPI-3: CA 19-9 >= 90 U/m/L and SIRI >= 1.8, respectively. Comparative analyses unveiled that the PCPI-1 and PCPI-3 groups had the respective best and worst PFS (17.0 versus 7.5 versus 4.4 months; P<0.001) and OS (26.1 versus 15.1 versus 7.4 months; P<0.001) outcomes, while the PCPI-2 group posed in between. The multivariate analysis outcomes confirmed the novel three tired PCPI's independent prognostic significance on either of the PFS [HR: 5.38 (95% confidence interval (CI): 4.96-5.80); P<0.001)] and OS [HR: 5.67 (95% CI: 5.19-6.15); P<0.001] endpoints, separately. Conclusion: The new PCPI introduced here can be used as an independent and reliable prog-nostic indicator to divide LAPAC patients into three subgroups with discrete survival results.
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    Efficacy of whole-sellar gamma knife radiosurgery for magnetic resonance imaging-negative Cushing's disease
    (Minerva Medica, 2020) Yılmaz, Meltem; Şengöz, Meriç; N/A; Durankuş, Nilüfer Kılıç; Samancı, Mustafa Yavuz; Bölükbaşı, Yasemin; Peker, Selçuk; Teaching Faculty; Faculty Member; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; Koç University Hospital; 148139; 275252; 216814; 11480
    Background: corticotroph adenoma delineation in Cushing’s disease (CD) patients with previous surgery can be challenging. This study investigated the outcome of wholesellar Gamma Knife Radiosurgery (GKRS) in MRI-negative, but hormone-active CD patients with prior failed treatment attempts. Methods: we retrospectively analyzed data of nine CD cases who underwent wholesellar GKRS between April 2008 and April 2020 at a single center. Remission was determined as normal morning serum cortisol, normal 24-hour urinary free cortisol (UFC) or extended postoperative requirement for hydrocortisone replacement. RESULTS: Median age was 35.0 years, and most of the cases were female (89%). All subjects had undergone previous surgery. The mean pre-GKRS morning serum cortisol and 24-hour UFC was 27.5 mcg/dL and 408.0 mcg, respectively. Target volume varied from 0.6 to 1.8 cc, and the median margin dose was 28 Gy. The median duration of endocrine follow-up was 105 months, and initial endocrine remission was achieved in eight subjects (89%) at a median time of 22 months. The actuarial initial remission was 44% at two years, 67% at four years, and 89% at six years. The mean recurrence-free survival was 128 months. Age and pre-GKRS morning serum cortisol were found to be predictors for initial and durable endocrine remissions. New-onset hypopituitarism was observed in two of five patients (40%). None of the patients developed new neurological deficits and had GKRS-related adverse events during the follow-up. Conclusions: whole-sellar GKRS is a safe and efficient method to manage MRInegative CD and provides similar GKRS outcome rates as in MRI-positive CD.
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    Where should radiotherapy stand in the current era of rectal cancer management?
    (Kare Publ, 2018) N/A; N/A; N/A; N/A; Sezen, Duygu; Durankuş, Nilüfer Kılıç; Bölükbaşı, Yasemin; Selek, Uğur; Faculty Member; Teaching Faculty; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; 170535; 148139; 216814; 27211
    Rectal cancer management can be defined as maximizing local tumor control and overall survival while preserving anal sphincter, bladder, and sexual functions or improving the quality of life with an overall reduction in morbidity. Appropriate preoperative or postoperative therapy is required to minimize the risks of both local and distant recurrence. Preoperative radiotherapy is the current standard for treating patients with high-risk rectal cancer owing to lower rates of local relapse and toxicity. Modern radiotherapy capabilities are well suited for any short- or long-course protocol with decreased toxicity in irradiated structures such as the small intestine, bladder, or femoral heads. As clinicians and researchers, we must aim to establish tailored treatments for these patients based on the most suitable evidence based ground in a multidisciplinary environment regarding the expectations of both our patients and team physicians. Herein, we present a review of ongoing clinical trials in order to shed light on the current debates of standard approaches for treating rectal cancer.
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    Investigation of differences of sacral and vertebral bone mineral densities before and after radiotherapy in patients with locally advanced rectal cancer
    (Elsevier, 2019) Hayar, M.; Altun, G. D.; Koçak, Z.; Uzal, M. C.; Saynak, M.; N/A; Durankuş, Nilüfer Kılıç; Teaching Faculty; School of Medicine; Koç University Hospital; 148139
    Purpose. - Radiotherapy is a treatment method performed using ionizing radiation on cancer patients either alone or with surgery and/or chemotherapy. Although modern radiotherapy techniques provide a significant advantage in protecting healthy tissues, it is inevitable that normal tissues are also located in the areas targeted by radiations. In this study, we aimed to examine the bone mineral density changes in bone structures commonly included in the irradiated area such as, L5 vertebra, sacrum, and femur heads, in patients who have received pelvic radiotherapy; and the relationship between these changes with radiation dose. Material and methods. - Patients included in the study had been previously diagnosed with rectal cancer, which were operated or not. Preoperative or postoperative pelvic radiotherapy was planned for all patients. In terms of convenience when comparing with future scans, all densitometry and CT scans were performed with the same devices. Fifteen patients were included in the study. In order to determine the dose of radiation each identified area had taken after radiotherapy, the sacrum, L5 vertebra, bilateral femoral heads, and L1 regions were contoured in the CT scans in which treatment planning was done. Sagittal cross-sectional images were taken advantage of while these regions were being contoured. Results. - Bone mineral density was evaluated with CT and dual-energy X-ray absorptiometry before and after the treatment. The regions that have theoretically been exposed to irradiation, such as L5, sacrum, left to right femur were found to have significant difference in terms of bone density. According to CT evaluation, there was a significant decrease in bone intensity of L5, sacrum, left and right femurs. Dual energy X-ray absorptiometry assessment revealed that the whole of the left femoral head, left femur neck and Ward's region were significantly affected by radiotherapy. However, there was no significant difference in the sacrum and L5 vertebra before and after radiotherapy. Conclusion. - More accurate results could be achieved if the same study was conducted on a larger patient population, with a longer follow-up period. When the reduction in bone density is at maximum or a cure is likely in a long-term period, bone mineral density could be determined by measurements performed at regular intervals. (C) 2019 Societe francaise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.
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    PublicationOpen Access
    The prognostic significance of novel pancreas cancer prognostic index in unresectable locally advanced pancreas cancers treated with definitive concurrent chemoradiotherapy
    (Dove Medical Press, 2021) Topkan, Erkan; Pehlivan, Berrin; Küçük, Ahmet; Haksöyler, Veysel; Sezen, Duygu; Selek, Uğur; Durankuş, Nilüfer Kılıç; Bölükbaşı, Yasemin; Faculty Member; Faculty Member; Faculty Member; School of Medicine; 170535; 27211; N/A; 216814
    Purpose: we evaluated the prognostic quality of the novel pancreas cancer prognostic index (PCPI), a combination of CA 19-9 and systemic inflammation response index (SIRI), on the outcomes of locally advanced pancreas adenocarcinoma (LAPAC) patients who received concurrent chemoradiotherapy (C-CRT). Methods: this retrospective analysis covered 152 unresectable LAPAC patients treated from 2007 to 2019. Receiver operating characteristic (ROC) curve analysis was used to define ideal cutoff thresholds for the pretreatment CA 19-9 and SIRI measurements, indivi-dually. The associations between the PCPI groups and progression -free-(PFS) and overall survival (OS) comprised the respective primary and secondary endpoints. Results: the ROC curve analysis distinguished the respective rounded optimal cutoffs at 91 U/m/ L (< versus >= 90) and 1.8 (< versus >= 1.8) for CA 19-9 and SIRI, arranging the study cohort into two significantly different survival groups for each, with resultant four likely groups: Group-1: CA 19-9<90 U/m/L and SIRI<1.8, Group-2: CA 19-9<90 U/m/L but SIRI >= 1.8, Group-3: CA 19-9 >= 90 U/ m/L but SIRI<1.8, and Group-4: CA 19-9 >= 90 U/m/L and SIRI >= 1.8. Since the PFS (P=0.79) and OS (P=0.86) estimates of the groups 2 and 3 were statistically indistinct, we merged them as one group and created the novel three-tiered PCPI: PCPI-1: CA 19-9<90 U/m/L and SIRI<1.8, PCPI-2: CA 19-9<90 U/m/L but SIRI >= 1.8 or CA 19-9 >= 90 U/m/L but SIRI<1.8, and PCPI-3: CA 19-9 >= 90 U/m/L and SIRI >= 1.8, respectively. Comparative analyses unveiled that the PCPI-1 and PCPI-3 groups had the respective best and worst PFS (17.0 versus 7.5 versus 4.4 months; P<0.001) and OS (26.1 versus 15.1 versus 7.4 months; P<0.001) outcomes, while the PCPI-2 group posed in between. The multivariate analysis outcomes confirmed the novel three tired PCPI's independent prognostic significance on either of the PFS [HR: 5.38 (95% confidence interval (CI): 4.96-5.80); P<0.001)] and OS [HR: 5.67 (95% CI: 5.19-6.15); P<0.001] endpoints, separately. Conclusion: the new PCPI introduced here can be used as an independent and reliable prog-nostic indicator to divide LAPAC patients into three subgroups with discrete survival results.
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    PublicationOpen Access
    Surveying the adaptations during the COVID-19 outbreak in Turkish radiotherapy practice
    (Kare Yayıncılık, 2021) Topkan, Erkan; Sezen, Duygu; Selek, Uğur; Akdemir, Eyüb Yaşar; Şenyürek, Şükran; Durankuş, Nilüfer Kılıç; Bölükbaşı, Yasemin; Faculty Member; Faculty Member; Doctor; Faculty Member; School of Medicine; Koç University Hospital; 170535; 27211; N/A; N/A; N/A; 216814
    Objective: we aimed to assess how Turkish Radiation Oncology departments responded to the COVID-19 out-break and to what extent adapted their routine practice per recent guidelines and recommendations. Methods: in late March 2020, a national survey was designed for Turkish radiation oncologists who were actively practicing and members of the Turkish Society for Radiation Oncology (TSRO). The survey created with an online survey program (www.SurveyMonkey.com), including 28 focused items. It was sent to all members of the TSRO on April 4th 2020. Results: of responders, 17% noted to already complete these arrangements even before the first case announced. All of the responders declared that their team members, including the secretaries, nurses, and radiation therapists in the clinic, worked with appropriate protective equipment. While one-third of the centers (35%) stated to implement a weekly shift, the other 1/3 (29%) chose to use daily shifts for social distancing and decreasing staff contact. Sixty-two percent of all responders indicated that multidisciplinary tumor boards discontinued, and the remaining 38% stated to continue with online video conferencing programs (65%) or meeting in large rooms with a limited number of attendees social distancing (35%). Conclusion: our survey revealed the importance of early precautions, communication by other Radiation Oncology Departments, following published guidelines during the COVID-19 pandemic, and the importance of using web-based applications for multidisciplinary tumor boards.
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    PublicationOpen Access
    Far from luck's way: a concurrence of Kaposi sarcoma and cutaneous angiosarcoma in the setting of chronic lymphocytic leukemia
    (Medknow Publications, 2020) Sezgin, Billur; Yiğit, Yeşim Esen; Tatar, Sedat; Selçukbiricik, Fatih; Durankuş, Nilüfer Kılıç; Kulaç, İbrahim; Atasoy, Pınar; Faculty Member; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; 133762; N/A; N/A; 202015; N/A; 170305; N/A
    Kaposi sarcoma and cutaneous angiosarcoma are rare forms of skin malignancies that are vascular in nature and are frequently encountered in the immunosuppressed population. Although synchronous angiosarcoma and Kaposi sarcoma have been documented, to our knowledge, the coexistence of these vascular malignancies with underlying chronic lymphocytic leukemia has not been previously reported. A 51-year-old male patient with chronic lymphocytic leukemia presented with Kaposi sarcoma located on his left ankle. Shortly after, the patient presented with de novo lesions located on the plantar region of the right foot, reported as angiosarcoma. Following a multidisciplinary decision, treatment with adjuvant chemotherapy consisting of paclitaxel and carboplatin with consolidation radiotherapy was planned. The patient's Kaposi sarcoma has remained unchanged throughout this period.In such cases, the treatment is advised to be planned around the more aggressive malignancy. These patients should also be followed-up by dermatology due to the higher risk of secondary cutaneous malignancies.
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    PublicationOpen Access
    Postchemoradiotherapy neutrophil-to-lymphocyte ratio predicts distant metastasis and survival results in locally advanced pancreatic cancers
    (Hindawi, 2022) Topkan, Erkan; Haksöyler, Veysel; Küçük, Ahmet; Pehlivan, Berrin; Selek, Uğur; Durankuş, Nilüfer Kılıç; Sezen, Duygu; Bölükbaşı, Yasemin; Faculty Member; Faculty Member; Faculty Member; School of Medicine; Koç University Hospital; 27211; N/A; 170535; 216814
    Background and objectives: in the absence of similar research, we endeavored to investigate the prognostic usefulness of posttreatment neutrophil-to-lymphocyte ratio (NLR) in patients treated with definitive concurrent chemoradiotherapy (CCRT) for locally advanced pancreatic adenocarcinoma (LAPAC). Materials and methods: our retrospective research included a sum of 126 LAPAC patients who received CCRT. The NLR was calculated for each patient based on the complete blood count test results obtained on the last day of the CCRT. The availability of optimal cutoff(s) that might dichotomize the whole cohort into two groups with significantly different clinical outcomes was searched using receiver operating characteristic (ROC) curve analysis. Primary and secondary endpoints were the potential association between the post-CCRT NLR measures and distant metastasis-free survival (DMFS) and overall survival (OS) outcomes. Results: the median follow-up duration was 14.7 months (range: 2.4-94.5). The median and 3-year OS and DMFS rates for the whole group were 15.3 months (95% confidence interval: 12.4-18.2) and 14.5%, and 8.7 months (95% CI: 6.7-10.7) and 6.3% separately. The ROC curve analysis findings separated the patients into two groups on a rounded NLR cutoff of 3.1 (area under the curve (AUC): 75.4%; sensitivity: 74.2%; specificity: 73.9%) for OS and DMFS: NLR < 3.1 (N = 62) and NLR >= 3.1 (N = 64), respectively. Comparisons between the NLR groups displayed that the median OS (11.4 vs. 21.4 months; P < 0.001) and DMFS (6.0 vs. 16.0 months; P < 0.001) lengths were significantly shorter in the NLR >= 3.1 group than its NLR < 3.1 counterparts, as well as the 3-year actuarial DM rate (79.7% vs. 50.0%; P=0.003). The N1-2 nodal stage, CA 19-9 > 90 U/mL, and NLR > 3.1 were found to be independent predictors of poor prognosis in the multivariate analysis. Conclusion: the present study found that the posttreatment NLR >= 3.1 was independently linked with a higher risk of DM and subsequent degraded survival outcomes in unresectable LAPAC patients managed with exclusive CCRT.