The results of radiotherapy for squamous cell carcinomas of the skin.

Skin cancer patients with nonmelanoma skin cancer who have the highest risk of disease-specific death are squamous cell carcinoma (SCC). The aim of this study is to determine the characteristics (age, sex), indications, and doses of lesions and radiotherapy (RT), locoregional control (LRC), relapse-free survival (RFS), and overall survival (OS) rates in SCCs of the skin patients treated and followed at our clinic. For this purpose, 153 patients treated with RT and followed between 1996, January and 2018, December were included in the study. Of the patients, 95 (62%) were men and 58 (38%) woman. The mean age was 56.4 ± 13.9 (44-93) years. The primary tumor sites were 132 (86%) head and neck, 12 (8%) extremity and 9 (6%) trunk. The 3-year LRC, RFS, and OS rates were 88% (95% confidence interval [CI]: 82-98), 87% (95% CI: 80-96), and 92% (95% CI: 88-98), respectively. Men gender received significantly worse prognosis than female sex (p = .02). The recurrence-free rate of tumors 2 cm or smaller was significantly lower than tumors larger than 2 cm (p < .001). Cosmetic results were good in 29% of the patients, fair in 50%, and poor in 21%. RT plays an integral role in the treatment of primary and postoperative SCCs.

Radiotherapy in the management of classic Kaposi's sarcoma: A single institution experience from Northeast Turkey.

Kaposi sarcoma is a rare adult neoplasm and there has been no certain consensus on standard treatment, either local or systemic. Radiotherapy is an effective, suitable treatment modality. Between 1996 and 2016, patients who were diagnosed with Kaposi sarcoma and referred to our clinic for radiotherapy were included in this retrospective study. Ninety-two patients were examined in total and it was diagnosed that all the patients had non-HIV associated Kaposi's sarcoma. There were 36 (39%) females and 56 (61%) males and female to male ratio was 2/3. Median age at presentation was 72 (30-93) years. Sixty-eight patients (77%) were treated with 8 Gy (1 fraction), 15 patients (16%) were treated with 20 Gy (2 Gy/fraction), four patients (4%) were treated 25 Gy (2.5 Gy/fraction), and five patients (6%) were treated 30 Gy (3 Gy/fraction). The median follow-up time was 72 (5-192) months. The complete response at 5 years was 91.6% with >20 Gy and 89.6% with 8 Gy. Radiotherapy is an effective, suitable treatment modality of Classic Kaposi sarcoma and usually, radiotherapy is well tolerated with minimal side effects.

Prognostic factors and clinical course of extremity soft-tissue sarcomas.

PURPOSE: Although soft tissue constitutes half of the body weight, soft-tissue sarcomas (STSs) are less common than any other types of tumors. MATERIALS AND METHODS: In this retrospective study, the prognostic factors and clinical courses of 64 patients with extremity STSs treated at our clinic between 1996 and 2012 were investigated. RESULTS: Of the 64 patients included in this study, 35 (55%) were male and 29 (45%) were female. By the end of follow-up, 29 (45%) of the patients remained alive while 35 (55%) deceased. The overall survival (OS) time of the patients was 89.1 months, and their 1-, 3-, 5-, and 10-year survival rates were 82.8%, 69.3%, 51.6%, and 39.4%, respectively. Univariate analysis revealed the following variables as prognostic factors: tumor stage (P < 0.001), surgical method applied (P = 0.009), radiotherapy (RT) application (P = 0.018), RT dose (P < 0.001), and development of metastasis during follow-up (P < 0.001). Multivariate analysis revealed only type of surgery to be a prognostic factor (P = 0.016). CONCLUSION: Besides surgery, RT plays a crucial role in the multimodal treatment of STSs and increases local control rates and OS. In our study, stage, surgery, and adjuvant RT were found to be effective factors indicating OS. However, more prospective work in this area is necessary.

Whole Brain Radiotherapy Plus Conventional Boost in Non-Small Cell Lung Cancer Patients with Brain Metastasis: A Retrospective Analysis of Overall Survival.

AIM: To evaluate the clinical characteristics and treatment outcomes of non-small cell lung cancer (NSCLC) patients with brain metastasis, who were treated by whole brain radiotherapy with a conventional boost at a single institution. MATERIAL AND METHODS: A total of 296 patients diagnosed with NSCLC with brain metastasis and referred to our clinic for radiotherapy between 2000 and 2017 were included in this retrospective study. RESULTS: The median age was 60.8 ± 12.1 years, with a range of 21-85 years. The estimated median survival time for all patients was 7.81 ± 0.66 months (95% CI: 6.52-9.11). The one-year survival, two-year survival and three-year survival rates were 18.8%, 5.8% and 2.9%, respectively. The median survival of patients with solitary brain metastasis who received 45 Gy radiotherapy was 14.70 ± 2.80 months (95% CI: 9.20-20.20). These patients had 6 and 12 months survival rates of 65.4% and 42.6%, respectively. The median survival time of patients with solitary brain metastasis who received > 45 Gy radiotherapywas 13.86 ± 2.56 months (95% CI: 8.08-18.02). These patients had 6 and 12 months survival rates of 66.2% and 27.2%, respectively. There was no significant difference between the two groups (p=0.321). The median survival duration of patients under 65 years was 9.65 ± 1.02 months. The median survival time of patients aged 65 years and overwas 5.15 ± 0.51 months. There was a statistically significant difference in the median survival rates between the groups (p < 0.001). CONCLUSION: Patients with solitary metastasis or single metastases tolerated whole brain radiotherapy with a conventional boost. Although the overall survival rates were numerically better in the high dose RT group, the difference was not statistically significant. Prospective studies with a larger sample size are needed to consolidate our results.

Zinc Sulfate and/or Growth Hormone Administration for the Prevention of Radiation-Induced Dermatitis: a Placebo-Controlled Rat Model Study.

Growth hormone (GH) and zinc (Zn) were evaluated for their potential to prevent radiation injury using a rat model of radiation-induced skin injury. Sprague-Dawley rats were divided into five groups: a control group not receiving Zn, GH, or irradiation: a radiation (RT) group receiving a single 30 Gy dose of gamma irradiation to the right hind legs; a radiation + GH group (RT + GH) receiving a single 30 Gy dose of gamma irradiation plus the subcutaneous administration of 0.01 IU kg d-1 GH; a radiation + Zn group (RT + Zn) receiving a single 30 Gy dose plus 5 mg kg d-1 Zn po; and a radiation + GH + Zn group (RT + GH + Zn) group receiving a single 30 Gy dose plus subcutaneous 0.01 IU kg d-1 GH and 5 mg kg d-1 Zn po. Acute skin reactions were assessed every 3 days by two radiation oncologists grouping. Light microscopic findings were assessed blindly by two pathologists. Groups receiving irradiation were associated with dermatitis as compared to the control group (P < 0.05). The severity of radiodermatitis in the RT + GH, RT + Zn, and RT + GH + Zn groups was significantly lower than that in the RT group (P < 0.05). Furthermore, radiodermatitis was observed earlier in the RT group than in the other treatment groups (P < 0.05). GH and Zn effectively prevented epidermal atrophy, dermal degeneration, and hair follicle atrophy. The highest level of protection against radiation dermatitis was observed in the combination group.

Prognostic Factors and Clinical Outcome in Parotid Gland Tumors: a Single Institution Experience from the Eastern Black Sea Region of Turkey.

PURPOSE: To review clinical characteristics, treatment outcomes and prognostic factors in patients with parotid gland tumors treated with surgery and postoperative radiotherapy. MATERIALS AND METHODS: We retrospectively reviewed 69 patients with parotid gland tumors, with a median follow-up of 52 months (range, 2-228 months). and a median radiotherapy dose of 60Gy (range, 30-69 Gy). RESULTS: There were 24 (35%) females and 45 (65%) males, at a ratio of 1/1.9. Median age at presentation was 58.9±17.2 (range 13-88) years. The most common histology was adenoid cystic carcinoma (33%) and mucoepidermoid carcinoma (28%). The mean overall survival (OS) was 65.3±8 (95% confidence interval [CI], 49.6-81.1) months and the median overall survival was 40.0 ± 7 (95% CI, 26.2-53.7) months. The -1, -3, -5 and -10 year OS rates were 78%, 52.4%, 35.3% and 19.6% respectively. The mean disease free survival (DFS) was 79.2±10 (95% CI, 59.3-97.1) months and the median disease free survival was 38±13 (95% CI, 7.05-88.7) months. The -1,-3,-5 and -10 year DFS rates were 71.9%, 50.1%, 43.7% and 30.1% respectively. On univariate analysis, the OS was significantly better with female sex (p<0.005), < 50 age (p<0.021), T stage (p<0.0001), absence of lymph node involvement (p<0.0001), lower tumor grade (p<0.0001), absence of lymphovascular invasion (p<0.002), absence of perineural invasion (p<0.0001), absence of extracapsuler extension (p<0.0001), surgical margin negativity (p<0.006), ≤60 Gy radiotherapy dose (p<0.0001) and absence of distant metastasis (p<0.027). CONCLUSIONS: Employing existing standards of postoperative radiotherapy is a possible treatment that was found to be mainly effective in patients with parotid gland carcinomas.

Survival and prognostic factors in limited stage small cell lung cancer: A retrospective study from northeast Turkey.

AIM OF THE STUDY: The purposes of this retrospective study were to identify survival rates for limited stage small cell lung cancer (LD-SCLC) and analyze treatment outcomes and influencing factors on survival. MATERIALS AND METHODS: We conducted data from patients diagnosed with LD.SCLC between January 1998 and December 2012 at our institution. Dermographic information, treatment modalities, pretreatment clinical asessment, were recorded. Most of the patients. (88.4%) were treated with curative intent. The survival probabilties were asessed by Kaplan.Meier analysis. Cox regression was used to assess prognostic factors on overall survival and disease.free survival. RESULTS: A total of 129 patients were examined as a LD-SCLC. The median age was 60 (range; 31-86). Median follow-up time was 9.4 (SE ± 20.5) months and the median overall survival was 13.9 months [95% cumulative incidence (CI): 10.1-17.6]. On multivariate analysis, concurrent chemotherapy [HZ: 2.7 (95% CI: (1.0-7.2)] (P = 0.037) and doses of radiation therapy (<50, ≥50) [HZ: 1.4 (95% CI: (1.0-2.2)] (P = 0.046) were statistically significant on overall survival. With regard to multivariate anlaysis age (<60, ≥60) [HZ: 2.2 (95% CI: (0.6-3.7)] (P = 0.011), doses of radiation therapy (<50, ≥50) [HZ: 2.7 (95% CI: (1.0-7.2)] (P = 0.046), precense of surgery [HZ: 15.3 (95% CI: (1.5-152)] (P = 0.020), prophilactic cranial radiation therapy (PCI) [HZ: 2.3 (95% CI: (1.1-4.5)] (P = 0.014), and presence of concurrent chemoradiotherapy [HZ: 3.0 (95% CI: (1.3-6.8)] (P = 0.008) were important variable affecting disease-free survival. CONCLUSION: For LD-SCLC patients concurrent chemoradiation therapy and 50. Gy and over doses radiation therapy provided improvement on overall and disease.free survival.

Comparison of the effects of melatonin and genistein on radiation-induced nephrotoxicity: Results of an experimental study.

The aim of the present study was to compare the effects of melatonin and genistein on radiation-induced nephrotoxicity (RIN). A total of 70 Swiss Albino mice were divided into 7 groups. Five control groups were defined, which were sham irradiation (C, G1), radiation therapy only (RT, G2), melatonin (M, G3), genistein (G, G4) and polyethylene glycol-400 (G5), respectively. The co-treatment groups were the RT plus melatonin (RT+M, G6) and RT plus genistein (RT+G, G7) groups. Irradiation was applied using a cobalt-60 teletherapy machine (80-cm fixed source-to-surface distance, 2.5-cm depth). Melatonin was administered (100 mg/kg, intraperitoneal injection) 30 min before the single dose of irradiation, whereas genistein was administered (200 mg/kg, subcutaneous injection) 1 day before the single dose of irradiation. All the mice were sacrificed 6 months after irradiation. As an end point, the extent of renal tubular atrophy for each mouse was quantified with image analysis of histological sections of the kidney. Tissue malondialdehyde (MDA) levels were also measured in each animal. In the histopathological examination of the mouse kidneys, there was a statistically significant reduction (P<0.05) in the presence of tubular atrophy between the RT+M and RT+G groups and the RT group. There was a statistically significant increase in MDA levels in the irradiated versus sham groups (RT vs. C; P<0.05); however, MDA levels were significantly decreased by co-treatment with melatonin or genistein vs. RT alone (RT+M and RT+G vs. RT; P<0.05). In conclusion, the present experimental study showed that melatonin and genistein supplementation prior to irradiation-protected mice against RIN, which may have therapeutic implications for radiation-induced injuries.

Adjuvant radiotherapy in stage 1 seminoma: Evaluation of prognostic factors and results of survival.

PURPOSE: The purpose of this study was to evaluate the prognostic factors affecting overall survival (OS), cause-specific survival (CSS), progression-free survival (PFS), and survival among patients undergoing adjuvant radiotherapy (RT) for stage-1 seminoma. MATERIALS AND METHODS: Between August 1997 and May 2013, 68 patients diagnosed with stage-1 seminoma were retrospectively evaluated. The median age was 39 (24-74) years. All patients received adjuvant RT after inguinal orchiectomy. Fifty-eight (85.3%) patients received paraaortic RT; 10 (14.7%) received dog-leg field RT. The median RT dose was 23.4 (23.4-30.6) Gy. RESULTS: The median follow-up period was 77.5 (6.7-198.5) months. During the follow-up period, two patients developed distant metastasis, and none developed local recurrence. Two patients died from seminoma, and three died for other reasons. The 5, 10, and 15-year OS rates were 94.7%, 89.6%, and 89.6%, respectively. The 5, 10, and 15-year CSS rates were 98.5%, 96%, and 96%, respectively. The 5, 10, and 15-year PFS rate was 96.1%. The univariate analysis showed that only histological subtype was significant for OS. The 10-year survival rate was 100% among patients with seminoma histology, 90.8% among patients with a classic seminoma histology, and 50% among patients with an anaplastic seminoma histology (P < 0.001). A multivariate analysis showed that the anaplastic seminoma was a negative prognostic indicator for OS (P = 0.042). CONCLUSION: Adjuvant RT resulted in excellent long-term survival and local control in patients with stage-1 seminoma after orchiectomy. During a short follow-up, secondary malignancy (SM) and late cardiovascular morbidity were not observed. Despite those results, concern of SM and late cardiovascular morbidity remains.

Evaluation of prognostic factors and survival results in gastric carcinoma: single center experience from Northeast Turkey.

OBJECTIVE: To evaluate the prognostic factors affecting overall survival (OS), disease-free survival (DFS), and survival among patients undergoing chemoradiotherapy (CRT) for locally advanced gastric carcinoma. METHODS: Between January 2001 and May 2014, 257 patients who presented to our clinic with a diagnosis of stage I-IIIC gastric cancer were evaluated. The male/female ratio of the cases was 2.02:1 and the median age was 55.16±11.8 (20-80) years. Four of the cases (1.6%) were stage IA, 13 (5.1%) were stage 1B, 41 (16%) were stage IIA, 40 (15.6%) were stage IIB, 50 (19.5%) were stage IIIA, 51 (19.8%) were stage IIIB, and 58 (22.6%) were stage IIIC. RESULTS: The mean follow-up time was 22.5 months (3.3-155.0); loco-regional recurrence was noted in 34 (13.2%) patients who underwent postoperative chemoradiotherapy, and metastases were observed in 108 (42%) patients. The median OS duration was 26.7 months (95% confidence interval, 20-33.5) and the 2-, 5-, and 10-year OS was 52.8% (standard error [S.E.] 0.032), 36.1% (S.E. 0.032), and 26.9% (S.E. 0.034) respectively. The median DFS was 53.7 months and the 2-, 5-, and 10-year DFS were 58.9% (S.E. 0.034), 47.4% (S.E. 0.037), and 40.7% (S.E. 0.042), respectively. In multivariate analysis of prognostic factors, advanced T stage (p<0.0001), advanced nodal stage (p=0.001), and surgical margin status (p<0.0001) were related to decreased OS and DFS. CONCLUSION: R1 resection, advanced T stage, and advanced nodal stage were adverse prognostic factors in gastric cancer patients who had undergone CRT after the operation.

Retrospective analysis of patients with esophageal cancer treated with radiotherapy and/or chemoradiotherapy.

AIMS AND BACKGROUND: Esophageal cancer consists of 5% of all cancers. In Eastern Anatolia region of Turkey, the rate was found to be 16%. The primary aim of the study was to evaluate effect of the localization and histologic type of tumor, stage of cancer and treatment modality, patient's sex, age and smoking status, Karnofsky performance score, and family history on survival. METHODS AND STUDY DESIGN: A total of 135 patients with locally advanced esophagus cancer were enrolled into the study. The factors (sex, age, Karnofsky performance status, localization, histology, stage of the disease, treatment modality) on survival were evaluated. RESULTS: After the end of treatment, overall survival was 20 months, median survival period was 13 months. The survival rates at 1, 3 and 5 years were 51.3%, 20.1% and 13.4%, respectively. CONCLUSIONS: For patients with esophageal cancer, age, Karnofsky performance score, stage, treatment modality applied, chemotherapy protocol, number of cures and general survival rate were found to be the prognostic factors related to survival (P <0.05) in univariate analysis. At the same time, the study showed that gender, smoking status, family history, localization of the tumor and histologic type had no effect on the survival. The best survival in patients with esophageal cancer which cannot be operated is obtained by 50.4 Gray radiotherapy with concurrent chemotherapy.

The effects of zinc sulfate on the levels of some elements and oxidative stress occurring in lenses of rats exposed to total cranium radiotherapy.

OBJECTIVE: There is currently substantial clinical interest in zinc (Zn) as an antioxidant and a protective agent against radiation-related normal tissue injury. To further assess the potential antioxidative effects, the effects of Zn were studied in rat lenses, a model of radiation-induced oxidative stress. MATERIALS AND METHODS: Sprague-Dawley rats were divided into three equal groups. Group 1 received neither Zn nor irradiation (control group). Group 2 (RT group) and 3 (RT+Zn group) were exposed to total cranium irradiation of 5 Gy in a single dose by using a cobalt-60 teletherapy unit. In addition to irradiation, group 3 was administered 10 mg/kg/day Zn. At the end of 10 days, the rats were killed. Their eyes were enucleated to measure the activities of antioxidant enzymes and the levels of iron, calcium, sodium and potassium. RESULTS: Irradiation significantly increased malondialdehyde levels as an end product of lipid peroxidation, glutathione peroxidase activity, and iron and calcium concentrations. Irradiation decreased super-oxide dismutase activities and zinc concentrations in the rat lens, indicating an increased oxidative stress generated by the decomposition of water and/or Fenton reaction. Malondialdehyde levels and iron and calcium concentrations were significantly decreased, and superoxide dismutase and glutathione peroxidase activities and zinc concentrations were increased, in the rat lenses of the RT+Zn group. No differences were detected in any final measurement of sodium and potassium in the direct comparison among all groups. CONCLUSION: Zinc, acting as an antioxidant agent, may protect the lens from radiation-induced injury by improving oxidative stress generated by the decomposition of water and/or Fenton reaction.