Intra-operative partial breast irradiation versus external whole breast irradiation for early breast cancer.

Aims: Intra-operative radiotherapy (IORT) is a new alternative way to give radiation therapy. During surgery to remove breast cancer, radiation is given as a single dose directly to the area where the tumor used to be. The aim of the study was to compare the results of IORT as partial breast irradiation and external whole breast irradiation (EBRT) for early breast cancer in elderly patients after breast-conserving surgery. The results were retrospectively analyzed from a single institution. We report 7-year results for local control. Settings and Design: Cross-sectional study. Methods and Material: Between November 2012 and December 2019, 21 Gy partial breast irradiation was applied intra-operatively to 40 selected patients. Two of these patients were excluded from the study, and 38 patients were evaluated. Also, 38 patients who had EBRT and had similar properties to that of IORT patients were selected to compare the treatment results in terms of local control. Statistical Analysis Used: SPSS version 21 was used for statistical analysis. Patient groups undergoing IORT and EBRT were analyzed with the Kolmogorov-Smirnov test. The groups were examined in terms of demographic features using t-test, and P < 0.05 was considered as statistically significant. Local recurrence rates were calculated by Kaplan-Meier analysis. Results: The median follow-up time was 58 months (range 20-95 months). The local control was 100% in both groups, and no local recurrences were observed. Conclusion: IORT seems to be a safe and effective alternative to EBRT for early breast cancer in elderly patients.

Does Total Body Irradiation Have a Favorable Impact on Thrombocyte Engraftment as per Neutrophil Engraftment in Allogeneic Stem Cell Transplantation?

INTRODUCTION: In this study, we aim to analyze the effect of total body irradiation (TBI) on neutrophil and thrombocyte engraftment durations in acute leukemia (AL) patients who achieved allogeneic hematopoietic stem cell transplantation (Allo-SCT) at our center. METHODS: The data of 193 acute leukemia patients who were performed Allo-SCT from matched-related donors were analyzed retrospectively. RESULTS: Thrombocyte engraftment duration was statistically shorter (12 days) in acute lymphoblastic leukemia (ALL) patients who received TBI-based conditioning when compared to ALL patients who received non-TBI-based conditioning (14 days; p=0.037). On the other hand, no statistically significant difference was observed between acute leukemia patients who received TBI or non-TBI-based conditioning regarding neutrophil engraftment duration. CONCLUSION: We found that TBI had a favorable impact on thrombocyte engraftment (TE) rather than neutrophil engraftment (NE) in Allo-SCT in patients with acute leukemia. TBI might have an impact on the engraftment of thrombocytes as per than neutrophils may be attributed to immune mechanisms and microenvironment in the patient's bone marrow (BM).

The evaluation of sexual functions of prostate cancer patients receiving radiotherapy.

PURPOSE: To evaluate the sexual functions of prostate cancer patients receiving radiotherapy (RT) with curative intent. METHODS: Fifty patients with low-risk prostate cancer who responded to the international index of erectile function (IIEF) questionnaire before and after RT were included in the study Results: Statistically significant decline was observed in sexual functions by the end of RT. While the average sexual desire scores of the patients before RT was 6.24, it decreased to 3.62 (p=0.001) after RT. The average of sexual satisfaction scores dropped from 8.94 to 4.6 (p=0.001), the average of erection function scores dropped from 20.14 to 11.76 (p=0.001), orgasmic function scores dropped from 9.6 to 3.9 (p=0.001) and the average of overall satisfaction scores dropped from 7.48 to 4.36 (p=0.001). CONCLUSION: Sexual functions evaluated by the IIEF questionnaire decrease by the end of RT.

Systemic Immune-inflammation Index (SII) Predicts Pathological Complete Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer.

OBJECTIVE: To determine the relationship between inflammatory markers and pathological complete response (pCR) in patients with locally advanced rectal cancer (LARC), who received neoadjuvant chemoradiotherapy (NACRT). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Medical Oncology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey from January 2014 to June 2020. METHODOLOGY: Patients older than 18 years of age, who underwent NACRT with a diagnosis of LARC, and who had no disease or drug-use that could affect inflammatory parameters, were included in the study. Inflammatory indices (neutrophil-to-lymphocyte ratio-NLR, platelet-to-lymphocyte ratio-PLR, lymphocyte monocyte ratio-LMR, systemic immune-inflammation index-SII, prognostic nutritional index-PNI) and changes in these indices, were calculated from blood samples taken before NACRT and before surgery. The relationship between pCR and calculated inflammatory indices was evaluated by comparing patients with and without pCR. RESULTS: Out of the 932 patients, who received NACRT with a diagnosis of LARC, 188 were eligible for the study. Median values of baseline SII for pCR and non-pCR groups were 729.3 (595.4-894.8) and 869.9(567.2-1145.2, p=0.049). Baseline NLR and PLR levels were lower in the pCR group than the non-pCR group in univariate analysis with a tendency to statistical significance. In the logistic regression analysis, which included NLR, PLR, and SII, only SII <748 was found to be an independent predictive factor of pCR (OR: 0.471, 95% CI; 0.224-0.991, p=0.047). CONCLUSION: Baseline SII might be an independent predictive factor for pCR in patients receiving NACRT with a diagnosis of LARC. Key Words: Locally advanced rectal cancer, Neoadjuvant chemoradiotherapy, Pathological complete response, Inflammatory index, Systemic immune-inflammation index, SII, NLR, PLR, LMR, PNI.

Intracranial meningioma: Experience with stereotactic radiotherapy.

PURPOSE: Definitive radiotherapy is a treatment option for patients with inoperable meningiomas. The purpose of this study was to evaluate the results of stereotactic radiotherapy as first-line treatment for intracranial meningiomas that were diagnosed radiologically. METHODS: Between January 2010 and June 2016, 56 patients with intracranial meningioma treated with Cyberknife- based Stereotactic Radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (hFSRT) were included. The median prescribed radiation dose was 16 Gy (range 13-18) for SRS and 25 Gy (range 18-33) for hFSRT. hFSRT doses were delivered in 3 to 5 fractions. RESULTS: Median follow-up was 58 months (range 6-97). Overall survival (OS) for the whole group was 89.2%; for SRS group it was 100% and for hFSRT group 87.5% (p=0.29). Progression free survival (PFS) for the whole group was 89.3%; for SRS group it was 87.5% and for hFSRT 89.5% at 5 years (p=0.93). CONCLUSION: SRS and hFSRT were effective with excellent local control rates and they can be an alternative treatment option for patients with inoperable meningiomas.

Whole Brain Radiotherapy Combined with Stereotactic Radiosurgery versus Stereotactic Radiosurgery Alone for Brain Metastases.

BACKGROUND: The aim of this study was to evaluate the effect of whole brain radiotherapy (WBRT) combined with streotactic radiosurgery versus stereotactic radiosurgery (SRS) alone for patients with brain metastases. MATERIALS AND METHODS: This was a retrospective study that evaluated the results of 46 patients treated for brain metastases at Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Radiation Oncology Department, between January 2012 and January 2015. Twenty-four patients were treated with WBRT+SRS while 22 patients were treated with only SRS. RESULTS: Time to local recurrence was 9.7 months in the WBRT+SRS arm and 8.3 months in SRS arm, the difference not being statistically significant (p= 0.7). Local recurrence rate was higher in the SRS alone arm but again without significance (p=0,06). CONCLUSIONS: In selected patient group with limited number (one to four) of brain metastases SRS alone can be considered as a treatment option and WBRT may be omitted in the initial treatment.

Evaluation of the radiation pneumonia development risk in lung cancer cases.

BACKGROUND: Concurrent chemo-radiotherapy is the recommended standard treatment modality for patients with locally advanced lung cancer. The purpose of three-dimensional conformal radiotherapy (3DCRT) is to minimize normal tissue damage while a high dose can be delivered to the tumor. The most common dose limiting side effect of thoracic RT is radiation pneumonia (RP). In this study we evaluated the relationship between dose-volume histogram parameters and radiation pneumonitis. This study targeted prediction of the possible development of RP and evaluation of the relationship between dose-volume histogram (DVH) parameters and RP in patients undergoing 3DCRT. MATERIALS AND METHODS: DVHs of 41 lung cancer patients treated with 3DCRT were evaluated with respect to the development of grade ≥ 2 RP by excluding gross tumor volume (GTV) and planned target volume (PTV) from total (TL) and ipsilateral (IPSI) lung volume. RESULTS: Were admitted statistically significant for p<0.05. CONCLUSIONS: The cut-off values for V5, V13, V20, V30, V45 and the mean dose of TL-GTV; and V13, V20,V30 and the mean dose of TL-PTV were statistically significant for the development of Grade ≥ 2 RP. No statistically significant results related to the development of Grade ≥ 2 RP were observed for the ipsilateral lung and the evaluation of PTV volume. A controlled and careful evaluation of the dose-volume histograms is important to assess Grade ≥ 2 RP development of the lung cancer patients treated with concurrent chemo-radiotherapy. In the light of the obtained data it can be said that RP development may be avoided by the proper analysis of the dose volume histograms and the application of optimal treatment plans.

Comparison of 2-dimensional and 3-dimensional conformal treatment plans in gastric cancer radiotherapy.

BACKGROUND: Postoperative chemoradiotherapy is accepted as standard treatment for stage IB-IV, M0 gastric cancer. Radiotherapy (RT) planning of gastric cancer is important because of the low radiation tolerance of surrounding critical organs. The purpose of this study was to compare the dosimetric aspects of 2-dimensional (2D) and 3-dimensional (3D) treatment plans, with the twin aims of evaluating the adequacy of 2D planning fields on coverage of planning target volume (PTV) and 3D conformal plans for both covering PTV and reducing the normal tissue doses. MATERIALS AND METHODS: Thirty-six patients with stage II-IV gastric adenocarcinoma were treated with adjuvant chemoradiotherapy using 3DRT. For each patient, a second 2D treatment plan was generated. The two techniques were compared for target volume coverage and dose to normal tissues using dose volume histogram (DVH) analysis. RESULTS: 3DRT provides more adequate coverage of the target volume. Comparative DVHs for the left kidney and spinal cord demonstrate lower radiation doses with the 3D technique. CONCLUSIONS: 3DRT produced better dose distributions and reduced radiation doses to left kidney and spinal cord compared to the 2D technique. For this reason it can be predicted that 3DRT will result in better tumor control and less normal tissue complications.

Gliosarcoma: a study of four cases.

Gliosarcomas (GS) are highly malignant and rare tumors of the central nervous system with a poor prognosis. We report here on four patients with GS, the median survival for whom was 9.25 months. Prognosis of GS remains poor, and a multidisciplinary approach (surgery, radiation therapy, and chemotherapy) seems to be associated with slightly more prolonged survival times.