Comparative Analysis of IDH Wild-Type Multifocal and Unifocal Glioblastomas: Prognostic Factors and Survival Outcomes in Focus.

AIM: To compare the overall survival (OS), progression-free survival (PFS), and the impact of prognostic markers in unifocal and multifocal IDH wild-type glioblastomas (GBMs). MATERIAL AND METHODS: This retrospective single-institutional study involved 177 GBM patients diagnosed between 2015 and 2022. Patients with confirmed IDH wild-type GBM were selected to assess the impact of lesion focalities on prognosis. Surgical procedures included gross total resection (GTR), subtotal resection (STR) or biopsy. Radiation therapy (RT) employed the intensitymodulated (IM)RT technique, combined with concurrent temozolomide (TMZ) treatment. Survival analyses and prognostic factors were performed accordingly. RESULTS: We examined 101 IDH wild-type glioblastoma patients, of whom 78 had unifocal and 23 had multifocal tumors. The median patient age was 60 years, comprising 37% females and 63% males. Surgical approaches included GTR (13%), STR (53%), and biopsy (34%). Positive p53 expression was seen in 65 patients. All patients received TMZ with RT. Adjuvant therapy referral was arranged for 68 patients. Progression occurred in 49% (38 unifocal, 11 multifocal cases). PFS analysis showed no significant difference between unifocal and multifocal patients. OS analysis also showed no significant difference. Univariate analysis revealed PFS factors: focalization, p53 expression, hypofractionated RT. For OS, adjuvant TMZ usage was influential. Extent of resection impacted OS-STR had 3.47-fold higher risk than GTR. CONCLUSION: This study sheds light on the management of multifocal glioblastoma, providing insights into treatment strategies and survival outcomes. Despite challenges, optimal management approaches are crucial for improving patient prognosis and quality of life.

Sonographic assessment of acute changes in plaque size and echogenicity and in intima-media thickness of carotid arteries after neck radiation therapy.

BACKGROUND: Ultrasonic assessment of acute changes in carotid artery walls before and after neck radiation therapy (RT). METHODS: Fifty cancer patients scheduled for curative neck irradiation were included and underwent sonographic examination of carotid arteries, with assessment of intima-media thickness (IMT) and plaque size and echogenicity before and immediately after completion of RT. RESULTS: IMT was linearly correlated with age and before RT (r = 0.267, p = 0.007) and increased after RT (0.68 ± 0.11 versus 0.87 ± 0.16, p < 0.001), without correlation with total RT dose and protocol. New plaques (six hypoechoic, one hyperechoic, and one calcified) were found in eight patients after RT, while 17 of the 44 plaques that were present before RT increased in size, and 8 soft and 1 dense plaques in nine patients became calcified. CONCLUSIONS: Radiation in the acute phase not only increases the IMT but also causes new plaque formation and changes in plaque size and echogenicity.

[Prognostic factors and survival rates in oral cavity cancers]. / Oral kavite kanserlerinde prognostik faktörler ve sagkalim oranlari.

OBJECTIVES: We evaluated the treatment results and prognostic factors that might affect local control and survival in patients receiving radiotherapy for oral cavity cancers. PATIENTS AND METHODS: The study included 32 patients (16 men, 16 women; mean age 62 years; range 26 to 90 years) who received radiotherapy for oral cavity cancers. All the patients had squamous cell carcinoma, which involved the tongue in 15 patients (46.9%) and the lower lip in 13 patients (40.6%). Most of the patients (n=21, 65.7%) had T1 or T2 tumors. Neck lymph nodes were positive in 11 patients (34.4%). Fifteen patients had early stage (stage I, II), 17 patients had advanced stage (stage III, IV) tumors. Sixteen patients received primary radiotherapy and 16 patients received postoperative adjuvant radiotherapy, with doses ranging from 5000 cGy to 7000 cGy. The mean follow-up period was 68 months (range 5 to 147 months). RESULTS: Two-year and five-year survival rates were 53% and 39%, respectively. Age, sex, tumor differentiation, and the total radiotherapy dose were not found to affect survival (p>0.05), whereas tumor size, positive lymph nodes, stage, and treatment modality were found as significant prognostic factors (p=0.01). CONCLUSION: Our data show that tumor size, lymph node involvement, stage, and postoperative adjuvant radiotherapy are significant parameters that affect survival in oral cavity cancers.