Utilization of radiation therapy and predictors of noncompliance among Syrian refugees in Turkey.

BACKGROUND: Access to cancer care is a problem that continues to plague refugees displaced from their home countries. The turbulent political crisis in Syria, which has led to millions of refugees seeking asylum in Turkey, merits further attention. We aimed to study the rate of utilization of radiation therapy among Syrian refugees with cancer living in Turkey in an attempt to identify the contributing factors predictive of non-compliance with prescribed RT. METHODS: In this retrospective review of 14 institutional databases, Syrian refugee patients in Turkey with a cancer diagnosis from January 2015 to December 2019 who were treated with RT were identified. The demographic data, treatment compliance rates, and toxicity outcomes in these patients were surveyed. Variable predictors of noncompliance such as age, sex, diagnosis, treatment length, and toxicity were studied. The association between these variables and patient noncompliance was determined. RESULTS: We identified 10,537 patients who were diagnosed with cancer during the study period, of whom 1010 (9.6%) patients were treated with RT. Breast cancer (30%) and lung cancer (14%) were the most common diagnoses with up to 68% of patients diagnosed at an advanced stage (Stage III, IV). 20% of the patients were deemed noncompliant. Treatment with concurrent chemoradiotherapy (OR 1.61, 95% CI 1.06-2.46, p = 0.023) and living in a refugee camp (OR 3.62, 95% CI 2.43-5.19, p < 0.001) were associated with noncompliance. Age, sex and treatment length were not significantly associated with noncompliance. CONCLUSIONS: Noncompliance with radiotherapy among Syrian refugees in Turkey remains an area of concern with a multitude of factors contributing to these alarming numbers. Further studies to better ascertain the finer nuances of this intricately complex problem and a global combination of efforts can pave the way to providing a solution.

Effect on long-term survival of psychiatric disorder, inflammation, malnutrition, and radiotherapy-related toxicity in patients with locally advanced head and neck cancer.

PURPOSE: To evaluate the effects on the long-term survival of psychiatric disorders, inflammation, malnutrition, and radiotherapy (RT)-related toxicity in patients with locally advanced head and neck cancer. METHODS: Included were 47 patients who received RT for non-metastatic locally advanced head and neck cancer. The diagnosis of psychiatric disorder was made by the Diagnostic and Statistical Manual of Mental disorders (4th edn) (DSM-IV) criteria. Malnutrition was defined as weight loss >5% of baseline during RT. Interleukin 1ß (IL-1ß), IL-6, and tumor necrosis factor-alpha (TNF-α) were analyzed by enzyme-linked immunosorbent assay (ELISA). RT-related acute toxicity was evaluated once a week using the National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 2.0. RESULTS: The mean patient age was 57.3±11.4 years (range 33-80); 42 (89.4%) patients were male. Mean disease-free (DFS) and overall survival (OS) were 53 and 55 months, respectively. Mean DFS was significantly lower in patients with psychiatric disorder compared with those without (35 vs 59 months, p=0.013) and the same applied for mean OS (41 vs 61 months, p=0.008). There was no significant difference between patients with and without malnutrition in terms of OS. Similarly, no significant difference was seen between patients with and without RT-related toxicities in terms of OS. Age, psychiatric disorder, T status, and stage differed significantly between these groups (p<0.10) in univariate analysis. The multivariate Cox regression analysis identified that the OS was significantly associated only with psychiatric disorder (odds ratio/OR: 3.22, 95% confidence interval/CI: 1.29-8.41, p=0.013). CONCLUSION: Psychiatric disorders had unfavorable effects on OS in patients with locally advanced head and neck cancer. Inflammation, malnutrition and RT-related toxicity had no significant impact on OS.

Ratio of metastatic to examined lymph nodes is a predictor of mortality in locally advanced gastric cancer treated chemo-radiotherapy.

BACKGROUND/AIMS: To evaluate whether the ratio between the number of metastatic lymph nodes and the number of total removed lymph nodes (MLR) is related survival in patients with locally advanced (stage 3) gastric cancer treated chemo-radiotherapy. METHODOLOGY: We included 179 patients with locally advanced lymph node-positive gastric cancer treated chemo-radiotherapy within this study. The cut-off values, area under curve (AUC), sensitivity, and specificity were calculated using the receiver operating characteristic (ROC) curve technique for MLR. RESULTS: The sensitivity and specificity of MLR for mortality were 71.54% and 51.79%, respectively, when the cutoff level was accepted as the ratio ≥ 0.3. The AUC for the predictive value of MLR with regard to mortality was 0.609 (95% confidence interval [CI]: 0.533-0.681, p: 0.0135). Overall survival rates were significantly lower in patients with high MLR than in those with low MLR (15 months vs. 35 months, p: 0.002, respectively). In multivariate analysis, overall survival rates were significantly associated with MLR status (low or high). CONCLUSION: The simple and easily obtainable MLR is an independent predictor for mortality in patients with locally advanced gastric cancer even if chemo-radiotherapy, which is known to increase local control, was given.

The low cross-sectional muscle index at the third cervical vertebra is a marker for sarcopenia in patients with laryngopharyngeal cancer.

BACKGROUND: Muscle loss and sarcopenia play a significant role in head and neck cancer. In this study, the value of C3 cross-sectional skeletal muscle index was investigated to evaluate sarcopenia. METHODS: Seventy-four patients were included in this retrospective study. Skeletal muscle index (SMI) was calculated using the paracervical muscles at the level of the third cervical vertebra. Survival rates and toxicities were compared. RESULTS: The 3-year overall survival rates were 33.3% in patients with low SMI (≤44.79) and 63.9% in patients with high SMI (>44.79) (P < 0.01). The 3-year progression-free survival rates were 25.9% in patients with low SMI and 63.2% in patients with high SMI (P < 0.01). Multivariate analyses found that advanced age (>65) was associated with a 2.9-fold increased risk of death and low SMI was associated with a 3.9-fold increased risk of death. CONCLUSION: Low SMI is associated with prolonged treatment time, increased toxicity, and decreased survival.

Prealbumin is a more sensitive marker than albumin to assess the nutritional status in patients undergoing radiotherapy for head and neck cancer.

AIM OF THE STUDY: The aim of this prospective study was to determine the prevalence of malnutrition and to evaluate a more sensitive marker to assess the nutritional status in patients undergoing RT for head and neck cancer. MATERIAL AND METHODS: The prospective study included 51 (mean age of 57.6 ±11.2 years) patients undergoing RT for head and neck cancer. Malnutrition was defined as weight loss > 5% of baseline. RESULTS: Forty-six (90.2%) of 51 patients were male. Malnutrition developed in 33 (64.7%) patients during RT. Mean prealbumin level was significantly lower in patients with malnutrition than in those without malnutrition (17 ±5 g/dl vs. 22 ±5 g/dl, respectively, p = 0.004). On the other hand, there was no significant difference between the two groups in terms of other nutrition parameters including total protein, albumin, total cholesterol, triglyceride, and glucose (p > 0.05). The percentage of weight loss negatively correlated with prealbumin (r = -0.430, p = 0.002), but not with other nutrition parameters including total protein, albumin, triglyceride, total cholesterol, HDL cholesterol, LDL cholesterol, and glucose (p > 0.05). CONCLUSIONS: The prevalence of malnutrition was high in patients with head and neck cancer. Prealbumin was a more sensitive marker than albumin to assess the nutritional status in these patients.

DTPA clearance test: a sensitive method for detecting radiation-induced lung fibrosis in lung cancer patients.

OBJECTIVE: The aim of this study is to analyze the frequency of lung injury and the sensitivity of the diethylenetriamine penta-acetic acid (DTPA) clearance test in detecting lung injury in patients undergoing radiotherapy (RT) to the thorax. MATERIAL AND METHOD: Twenty individuals scheduled for RT for lung cancer were included as the patient group. The healthy control group consisted of 20 age and gender-matched individuals who were nonsmokers with no history of comorbidities. We conducted follow-up with patients at 0-1-6 months, performing carbon monoxide diffusion test (DLCO), DTPA clearance test (excluding the first month), and high-resolution computed tomography of the thorax. The control group was followed up with DLCO between the baseline and 6th months. RESULTS: Ninety percent of the patient group was male, and the median age was 62 years. Seventy percent of the patients had squamous cell carcinoma and adenocarcinoma. Pneumonitis was detected in the patient group in the first month (100%) and fibrosis in the sixth month (%100) Both at the beginning and in the sixth month, the DLCO values of patients who received RT were lower than those of the control group ( P  = 0.001 and P  < 0.001, respectively). While DTPA clearance was similar between irradiated and non-radiated lungs at the beginning, there was a substantial decrease in the irradiated lung in the sixth month( P  = 0.001). There was no significant correlation between malignancy type, RT dose, and tumor size( P  > 0.05). CONCLUSION: The DTPA clearance test could be an alternative method for demonstrating radiation injury in patients receiving RT.

Adjuvant chemoradiation for gastric cancer: multicentric study of the Anatolian Society of Medical Oncology.

BACKGROUND/AIMS: The aims of this study were to report the clinical outcomes of adjuvant chemo-radiotherapy after curative resection in 637 patients with gastric cancer. METHODOLOGY: The retrospective analysis included 637 patients with resectable gastric cancer and stage IB-IV (M0) from 8 medical centers between 2003 and 2010. The patients were treated with 5FU-leucovorin and radiotherapy according to Schema for INT-0116. RESULTS: Of the 637 patients, the median of overall survival (OS) was 43.7 months and relapse free survival (RFS) was 36.6 months. OS rates were 84%, 45%, 40% while RFS rates were 81%, 45% and 35% at 1, 3 and 5-years, respectively. Hematological and gastrointestinal toxicities (grade 1-4) were observed in 35% and 36.5% of patients, respectively. In univariate analysis, according to the Lauren classification, tumor grade, T stage, N stage, type of operation (total gastrectomy or subtotal) and surgery resection margin (R0 or R1) were found as prognostic factors on RFS and OS (p<0.05). In multivariate analysis, T stage, N stage and surgical margins were found as effective factors on OS. T stage, N stage and Lauren classification were factors affecting RFS. CONCLUSIONS: Adjuvant chemo-radiotherapy after curative resection of gastric cancer was feasible, with acceptable toxicities in the Turkish population.

A comparison of cisplatin cumulative dose and cisplatin schedule in patients treated with concurrent chemo-radiotherapy in nasopharyngeal carcinoma.

INTRODUCTION: Three-weekly cisplatin dose is accepted for standard treatment for concurrent chemo-radiotherapy in nasopharyngeal carcinoma. However, different chemotherapy schedules are presented in the literature. OBJECTIVE: We intend to compare toxicity and outcomes of high dose 3-weekly cisplatin versus low dose weekly-cisplatin and cumulative dose of cisplatin in the patients with nasopharyngeal carcinoma. METHODS: 98 patients were included in the study, between 2010 and 2018. Cumulative doses of cisplatin (≥200mg/m2 and <200mg/m2) and different chemotherapy schedules (weekly and 3-weekly) were compared in terms of toxicity and survival. Besides prognostic factors including age, gender, T category, N category and radiotherapy technique were evaluated in uni-multivariate analysis. RESULTS: Median follow-up time 41.5 months (range: 2-93 months). Five year overall survival, local relapse-free survival, regional recurrence-free survival and distant metastasis-free survival rates were; 68.9% vs. 90.3% (p=0.11); 66.2% vs. 81.6% (p=0.15); 87.3% vs. 95.7% (p=0.18); 80.1% vs. 76.1% (p=0.74) for the group treated weekly and 3 weekly, respectively. There was no statistically significant difference between groups. Five year overall survival, local relapse-free survival, regional recurrence-free survival and distant metastasis-free survival rates were; 78.2% vs. 49.2% (p=0.003); 75.8% vs. 47.9% (p=0.055); 91% vs. 87.1% (p=0.46); 80% vs. 72.2% (p=0.46) for the group treated ≥200mg/m2 and <200mg/m2 cumulative dose cisplatin. There was statistically significant difference between groups for overall survival and there was close to being statistically significant difference between groups for local relapse-free survival. Age, gender, T category, N category, chemotherapy schedules were not associated with prognosis in the uni-variety analysis. Radiotherapy technique and cumulative dose of cisplatin was associated with prognosis in uni-variate analysis (HR=0.21; 95% CI: 0.071-0.628; p=0.005 and HR=0.29; 95% CI: 0.125-0.686; p=0.003, respectively). Only cumulative dose of cisplatin was found as an independent prognostic factor in multivariate analysis (HR=0.36; 95% CI: 0.146-0.912; p=0.03). When toxicities were evaluated, such as hematological toxicity, dermatitis, mucositis, nausea and vomiting, there were no statistically significant differences between cumulative dose of cisplatin groups (<200mg/m2 and ≥200mg/m2) and chemotherapy schedules (3-weekly and weekly). But malnutrition was statistically significant higher in patients treated with 3-weekly cisplatin compared with patients treated with weekly cisplatin (p=0.001). CONCLUSION: A cisplatin dose with ≥200mg/m2 is an independent prognostic factor for overall survival. Chemotherapy schedules weekly and 3-weekly have similar outcomes and adverse effects. If patients achieve ≥200mg/m2 dose of cumulative cisplatin, weekly chemotherapy schedules may be used safely and effectively in nasopharyngeal carcinoma patients.

Protective effects of caffeic acid phenethyl ester on radiation induced lung injury in rats.

PURPOSE: The prevention of radiation-induced pulmonary toxicity may help to improve radiation therapy in the cancer patient. The aim of this study was to investigate the pulmonary protective effects of caffeic acid phenethyl ester (CAPE), an antioxidant, on radiation-induced lung injury in rats. METHODS: 30 Wistar albino rats were divided into three groups and treated with saline, Radiation (RT) and RT + CAPE respectively. All rats were treated with CAPE (50 ?mol/kg i.p.) or saline. The first dose of CAPE was injected 24 h before radiation and application continued daily, with radiation in second day and 2 days more after the radiation treatment. Radiation dose was 800 cGy for total body. At 72 hr after the last radiation application, under general anesthesia using ip ketamine, the lungs were removed immediately after decapitation. After sacrification, antioxidant enzymes catalase (CAT), superoxide dismutase (SOD) activities and malondiadehyde (MDA) levels were evaluated in lung tissue. RESULTS: The level of malondialdehyde (MDA) was higher in the RT group (233.4+/-1.5 nmol/g protein) than in both the control (131.8+/-0.92) and the RT + CAPE (151.4+/-1.8) groups (P < 0.001). However, CAT activity was decreased in the RT group (7.26+/-0.27 U mg protein) compared with control (8.49+/-0.51) and increased again in the RT + CAPE group (8.31+/-0.56; P < 0.001). In accord with CAT activity, SOD activity in the RT group (0.42+/-0.07 nmol MDA/g wet tissue) was different from the control (0.78+/-0.02) and RT + CAPE (0.86+/-0.06) groups (P < 0.001). CONCLUSION: CAPE application with radiation therapy attenuated radiation induced pulmonary injury in vivo, possibly by its antioxidant effect.

Aminoguanidine ameliorates radiation-induced oxidative lung damage in rats.

PURPOSE: To investigate the possible protective effects of aminoguanidine (AG ) on lung damage in whole body irradiated rats. METHODS: To evaluate the biological damage of radiation on rat lung tissue, lipid peroxidation products were measured using biochemical parameters. Thirty Wistar albino rats were divided into three subgroups: control (C) , irradiation alone (RT), and RT + AG combined. After sacrificing the rats, antioxidant enzymes catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSHPx) activities and malondiadehyde (MDA), nitric oxide (NO) levels were evaluated in lung tissue. RESULTS: Administration of AG resulted in an increase in the activities of CAT, SOD and GSHPx in the lungs. All were reduced after radiation. In addition, AG administration resulted in a decrease in both NO and MDA levels in lung compared with the irradiated group. CONCLUSION: Amnoguanidine increased the endogenous antioxidant defence mechanism in rats and protected the animals from radiation-induced lung toxicity. Moreover, AG may protect against ionizing radiation-induced lung damage because of its antioxidant effect.

SPARC: As a prognostic biomarker in rectal cancer patients treated with chemo-radiotherapy.

BACKGROUND: The aim of this study is to search the prognostic value of SPARC expression in rectum cancer cases receiving postoperative radiotherapy. METHODS: Forty three rectal cancer patients are recruited to this retrospective study. All patients received postoperative radiotherapy which the median dose was 5040 cGy and concomitant chemotherapy. Samples taken from their paraffin blocks were examined with immunohistochemical procedures. RESULTS: When the association between SPARC expression and the clinicopathological feature was examined, there was a significant association between age and expression levels. Overall survival of patients with low expression was found to be 67 months whereas the overall survival of the patients with high expression was 32 months and the difference was statistically significant. Time to local recurrence of patients with low expression was found to be 74 months whereas time to local recurrence of the patients with high expression was 31 months. Progression free survival of the patients with low expression and high expression were 67 months and 32 months, respectively. In multivariate Cox regression analyses, high expression of SPARC was found to be associated with a statistically significant shorter overall survival and progression free survival. CONCLUSIONS: High expression of SPARC is related to worse prognosis in rectal cancer patients.

Is Human Kallikrein 11 in Non-small Cell Lung Cancer Treated Chemoradiotherapy Associated with Survival?

PURPOSE: Involvement of human kallikreins (hKs) in human cancers has been reported and several hKs are promising biomarkers of various cancers. The aim of this study was to evaluate the prognostic significance of hK11 expression in patients with non-metastatic non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: The study included 44 patients with NSCLC. hK11 expression was determined by immunohistochemical staining. RESULTS: The estimation of disease-free and overall survival by Kaplan-Meier was 11 months and 17 months, respectively. The estimation of overall survival by Kaplan-Meier was significantly higher in patients with hK11 strongly positive (2+) than in those with hK11 weakly positive (1+) (20 months vs. 11 months, p=0.032). Although not statistically different, the estimation of disease-free survival by Kaplan-Meier was higher in patients with hK11 strongly positive (2+) than in those with hK11 weakly positive (1+) (12 months vs. 9 months, p=0.113). Multivariate Cox regression analysis showed that the overall survival rates were significantly associated with response to chemoradiotherapy and the degree of staining with hK11. CONCLUSION: The stronger hK11 expression in NSCLC appears to be associated with better survival rates. hK11 may be a prognostic biomarker of NSCLC.

Cytogenetic damage of radiotherapy in long-term head and neck cancer survivors.

PURPOSE: To evaluate cytogenetic damage of radiotherapy (RT) and chemoradiotherapy (CRT) in long-term head and neck cancer survivors. MATERIALS AND METHODS: This study included 20 patients treated with RT (10 patients) or CRT (10 patients) for head and neck cancer. Nine healthy volunteers were included as control subjects. Cytochalasin B-blocked micronucleus (CBMN) assay was used to evaluate cytogenetic damage. To evaluate micronucleus (MN) by CBMN, the venous blood samples were drawn median 68 months (range 60-239 months) after the completion of treatment (RT or CRT) for head and neck cancer. RESULTS: Nuclear division index (NDI) and number of MN in mononuclear and binuclear lymphocytes were significantly higher in patients with head and neck cancer than in control subjects [1.19 (1.08-1.47) vs. 1.07 (1.04-1.14), p < 0.001; 11.0 (2.0-22.0) vs. 1.0 (0-3.0), p < 0.001 and 15.0 (5.0-45.0) vs. 9.0 (2.0-15.0), p = 0.020, respectively]. NDI and number of MN in mononuclear lymphocytes were significantly lower in control subjects compared patients received CRT and those received only RT, but there was no significant difference between patients received CRT and those received only RT. Number of MN in binuclear lymphocytes was significantly lower in control subjects compared to patients received CRT, but there was no significant difference between control subjects and those received only RT. Also there was no significant difference between patients received CRT and those received only RT in terms of number of MN in binuclear lymphocytes. CONCLUSIONS: MN frequency of mononuclear and binuclear lymphocytes in medical follow-up of patients with head and neck cancer after RT could be important in evaluating cytogenetic damage of RT. However, further investigations are needed to provide quantitative correlations between MN yields and the clinical features in post-radiotherapy period.

A comparison of cisplatin cumulative dose and cisplatin schedule in patients treated with concurrent chemo-radiotherapy in nasopharyngeal carcinoma / Comparação da dose cumulativa de cisplatina e esquema de tratamento em pacientes com carcinoma nasofaríngeo tratados concomitantemente com quimiorradioterapia

Abstract Introduction: Three-weekly cisplatin dose is accepted for standard treatment for concurrent chemo-radiotherapy in nasopharyngeal carcinoma. However, different chemotherapy schedules are presented in the literature. Objective: We intend to compare toxicity and outcomes of high dose 3-weekly cisplatin versus low dose weekly-cisplatin and cumulative dose of cisplatin in the patients with nasopharyngeal carcinoma. Methods: 98 patients were included in the study, between 2010 and 2018. Cumulative doses of cisplatin (≥200 mg/m2 and <200 mg/m2) and different chemotherapy schedules (weekly and 3-weekly) were compared in terms of toxicity and survival. Besides prognostic factors including age, gender, T category, N category and radiotherapy technique were evaluated in uni-multivariate analysis. Results: Median follow-up time 41.5 months (range: 2-93 months). Five year overall survival, local relapse-free survival, regional recurrence-free survival and distant metastasis-free survival rates were; 68.9% vs. 90.3% (p = 0.11); 66.2% vs. 81.6% (p = 0.15); 87.3% vs. 95.7% (p = 0.18); 80.1% vs. 76.1% (p = 0.74) for the group treated weekly and 3 weekly, respectively. There was no statistically significant difference between groups. Five year overall survival, local relapse-free survival, regional recurrence-free survival and distant metastasis-free survival rates were; 78.2% vs. 49.2% (p = 0.003); 75.8% vs. 47.9% (p = 0.055); 91% vs. 87.1% (p = 0.46); 80% vs. 72.2% (p = 0.46) for the group treated ≥200 mg/m2 and <200 mg/m2 cumulative dose cisplatin. There was statistically significant difference between groups for overall survival and there was close to being statistically significant difference between groups for local relapse-free survival. Age, gender, T category, N category, chemotherapy schedules were not associated with prognosis in the uni-variety analysis. Radiotherapy technique and cumulative dose of cisplatin was associated with prognosis in uni-variate analysis (HR = 0.21; 95% CI: 0.071-0.628; p = 0.005 and HR = 0.29; 95% CI: 0.125-0.686; p = 0.003, respectively). Only cumulative dose of cisplatin was found as an independent prognostic factor in multivariate analysis (HR = 0.36; 95% CI: 0.146-0.912; p = 0.03). When toxicities were evaluated, such as hematological toxicity, dermatitis, mucositis, nausea and vomiting, there were no statistically significant differences between cumulative dose of cisplatin groups (<200 mg/m2 and ≥200 mg/m2) and chemotherapy schedules (3-weekly and weekly). But malnutrition was statistically significant higher in patients treated with 3-weekly cisplatin compared with patients treated with weekly cisplatin (p = 0.001). Conclusion: A cisplatin dose with ≥200 mg/m2 is an independent prognostic factor for overall survival. Chemotherapy schedules weekly and 3-weekly have similar outcomes and adverse effects. If patients achieve ≥200 mg/m2 dose of cumulative cisplatin, weekly chemotherapy schedules may be used safely and effectively in nasopharyngeal carcinoma patients.

Resumo Introdução: Três doses semanais de cisplatina com quimiorradioterapia concomitante são aceitas como o tratamento-padrão para carcinoma nasofaríngeo. No entanto, diferentes esquemas quimioterápicos são recomendados na literatura científica. Objetivo: Comparar a toxicidade e os resultados de 3 doses altas semanais de cisplatina versus dose baixa semanal de cisplatina em pacientes com carcinoma nasofaríngeo e verificar a dose cumulativa de cisplatina. Método: Foram incluídos 98 pacientes, entre 2010 e 2018. As doses cumulativas de cisplatina (≥ 200 mg/m2 e < 200 mg/m2) e diferentes esquemas de quimioterapia (semanal e a cada 3 semanas) foram comparadas em termos de toxicidade e sobrevida. Além disso, fatores prognósticos, inclusive idade, sexo, categoria T, categoria N e técnica de radioterapia, foram avaliados na análise uni-multivariada. Resultados: O tempo médio de seguimento foi de 41,5 meses (intervalo: 2-93 meses). Sobrevida global de cinco anos, sobrevida livre de recidiva local, sobrevida livre de recidiva regional e sobrevida livre de metástases a distância foram: 68,9% vs. 90,3% (p = 0,11); 66,2% vs. 81,6% (p = 0,15); 87,3% vs. 95,7% (p = 0,18); e 80,1% vs. 76,1% (p = 0,74) para os grupos tratados semanalmente e 3 x/semana, respectivamente. Não houve diferença estatisticamente significante entre os grupos. Taxas de sobrevida global, sobrevida livre de recidiva local, sobrevida livre de recidiva regional e sobrevida livre de metástases a distância em cinco anos foram; 78,2% vs. 49,2% (p = 0,003); 75,8% vs. 47,9% (p = 0,055); 91% vs. 87,1% (p = 0,46); 80% vs. 72,2% (p = 0,46) para o grupo tratado com ≥ 200 mg/m2 e < 200 mg/m2 de dose cumulativa de cisplatina. Houve diferença estatisticamente significante entre os grupos para sobrevida global e houve uma diferença quase estatisticamente significante entre os grupos para sobrevida livre de recidiva local. Idade, sexo, categoria T, categoria N e esquemas de quimioterapia não foram associados ao prognóstico na análise univariada. A técnica de radioterapia e dose cumulativa de cisplatina foram associadas ao prognóstico na análise univariada (HR = 0,21; IC 95%: 0,071 ± 0,628; p = 0,005 e HR = 0,29; IC 95%: 0,125 ± 0,686; p = 0,003, respectivamente). Apenas a dose cumulativa de cisplatina foi considerada um fator prognóstico independente na análise multivariada (HR = 0,36; IC 95%: 0,146 ± 0,912; p = 0,03). Quando as toxicidades foram avaliadas, como toxicidade hematológica, dermatite, mucosite, náusea e vômito, não houve diferença estatisticamente significante entre a dose cumulativa dos grupos cisplatina (< 200 mg/m2 e ≥ 200 mg/m2) e esquemas de quimioterapia (semanal e a cada 3 semanas). Entretanto, a desnutrição foi estatisticamente maior em pacientes tratados com cisplatina a cada 3 semanas em comparação com pacientes tratados com cisplatina semanalmente (p = 0,001). Conclusão: Uma dose de cisplatina ≥ 200 mg/m2 é fator prognóstico independente para sobrevida global. Os esquemas de quimioterapia semanais e a cada 3 semanas têm resultados e efeitos adversos semelhantes. Se os pacientes atingirem uma dose cumulativa ≥ 200 mg/m2 de cisplatina, os esquemas semanais de quimioterapia podem ser usados com segurança e eficácia em pacientes com carcinoma nasofaríngeo.

Contribution of involved-field radiotherapy to survival in patients with relapsed or refractory Hodgkin lymphoma undergoing autologous stem cell transplantation.

OBJECTIVES: To assess the outcomes of overall survival and posttransplantation survival in patients with Hodgkin lymphoma (HL) undergoing autologous stem cell transplantation (ASCT) because of the development of relapse or resistance after chemotherapy (CT) or CT plus radiotherapy (combined modality treatment, CMT). METHODS: Forty-five patients undergoing ASCT because of the development of relapse or resistance after CT or CMT for HL were enrolled in the study. Radiotherapy was given as involved-field radiotherapy. Patients were treated with CT alone (n=25) or CMT (n=20). These 2 groups were further divided into 2 subgroups: the patients with early-stage (I to II) and advanced-stage (III to IV) HL. RESULTS: Median patients age was 29 years (range, 16 to 60 y) and the median follow-up was 60 months (range, 12 to 172 mo). In the patients with advanced-stage HL, there was no statistically significant difference in overall survival between irradiated and nonirradiated patients (n=18, irradiated n=4 and nonirradiated n=14). However, in the patients with early-stage disease, there was a significant difference in 5- and 10-year overall survival between the irradiated and nonirradiated groups (81% vs. 48% and 66% vs. 24%, respectively, P=0.045; n=26, irradiated n=16 and nonirradiated n=10). In the univariate analysis, irradiated group and involvement of 1 to 2 nodal regions were found to be significant for overall survival, whereas irradiated group, early stage, and involvement of 1 to 2 nodal regions were found to be significant for posttransplantation survival. However, only irradiated group was found to be significant for posttransplantation survival in multivariate analysis (P<0.05). CONCLUSIONS: Addition of involved-field radiotherapy to CT in patients undergoing ASCT after relapse or recurrence failed to provide survival benefit in patients with advanced HL, while a survival benefit was observed in patients with early-stage HL. Radiotherapy should be considered as part of CMT in the patients with early-stage HL, which should not be neglected.

Lack of any association between season of diagnosis and survival of gastric cancer cases in Kayseri, Turkey.

BACKGROUND: The influence of season of diagnosis on cancer survival has been an interesting issue for many years. Most studies have shown a possible association between seasonality and survival in some cancers. We aimed to investigate whether there is an association between season of diagnosis and survival in patients with gastric cancer. MATERIALS AND METHODS: We reviewed retrospectively the files of 279 histologically proven gastric cancer patients. According to diagnosis date, the patients were grouped into 4 seasons of diagnosis groups, spring, summer, autumn, and winter. RESULTS: There was no significant differences when the overall survival rates of the patients were compared according to the patients' season of diagnosis (p: 0.871). Median overall survival rates were 22.0 (14.5-29.5) months for the patients who were diagnosed in spring, 24.0 (12.4-35.6) for summer, 18.0 (9.96-26.0) for autumn and 21.0 (16.3-25.7) for winter. Median disease-free survival rates were 66.0 (44.1-68.1) months for the patients who were diagnosed in spring, 28.0 (17.0-39.0) for summer, 22.0 (0-46.4) for autumn and 23.0 (17.5-28.5) for winter. While the rate was best for the patients diagnosed in spring the differences were not statistically significant (p= 0.382). CONCLUSIONS: On the basis of the above results the season was not suggested as contributing to prognosis in gastric cancer cases in Kayseri, Turkey.

Prognostic value of SPARC expression in unresectable NSCLC treated with concurrent chemoradiotherapy.

BACKGROUND: The aim of the present study was to determine the predictive/prognostic value of the secreted protein, acidic and rich in cysteine (SPARC) in cases of unresectable, locally advanced, non-small cell lung cancer. MATERIALS AND METHODS: The study included 84 patients with Stage IIIA-B non-small cell lung cancer, undergoing simultaneous chemoradiotherapy including radiotherapy at a dose of 66 Gy and weekly docataxel (20 mg/m2) and cisplatin (20 mg/m2). SPARC expression was studied in biopsy material by immunohistochemical methods and correlations with treatment responses or survival were evaluated. RESULTS: Median overall survival was 16±2.73 (11.55-20.46) months for low expression vs 7±1.79 months (7.92-16.08) months for high expression (p=0.039), while median local control was 13±2.31 (8.48-17.5) months for low expression vs 6±0.85 (4.34-7.66) months for high expression (p=0.045) and median progression-free survival was 10±2.31 (5.48-14.5) months for low expression vs 6±1.10 (3.85-8.15) months for high expression (p=0.022). In both univariate and multivariate analyses, high SPARC expression was associated with significantly shorter overall survival (p=0.003, p=0.007, respectively), local control (p=0.008, p=0.036) and progression-free survival (p=0.004, p=0.029) when compared to low SPARC expression. No significant difference was detected between high and low SPARC expression groups regarding age, sex, T stage, N stage, histopathology and stage-related patient characteristics. CONCLUSIONS: High SPARC expression was identified as a poor prognostic factor in cases with locally advanced NSCLC treated with concurrent chemoradiotherapy.

Albumin-globulin ratio for prediction of long-term mortality in lung adenocarcinoma patients.

BACKGROUND: Prior studies showed a relationship between serum albumin and the albumin to globulin ratio with different types of cancer. We aimed to evaluate the predictive value of the albumin-globulin ratio (AGR) for survival of patients with lung adenocarcinoma. MATERIALS AND METHODS: This retrospective study included 240 lung adenocarcinoma patients. Biochemical parameters before chemotherapy were collected and survival status was obtained from the hospital registry. The AGR was calculated using the equation AGR=albumin/ (total protein-albumin) and ranked from lowest to highest, the total number of patients being divided into three equal tertiles according to the AGR values. Furthermore, AGR was divided into two groups (low and high tertiles) for ROC curve analysis. Cox model analysis was used to evaluate the prognostic value of AGR and AGR tertiles. RESULTS: The mean survival time for each tertile was: for the 1st 9.8 months (95%CI:7.765-11.848), 2nd 15.4 months (95%CI:12.685-18.186), and 3rd 19.9 months (95%CI:16.495-23.455) (p<0.001). Kaplan-Meier curves showed significantly higher survival rates with the third and high tertiles of AGR in comparison with the first and low tertiles, respectively. At multivariate analysis low levels of albumin and AGR, low tertile of AGR and high performance status remained an independent predictors of mortality. CONCLUSIONS: Low AGR was a significant predictor of long-term mortality in patients with lung adenocarcinoma. Serum albumin measurement and calculation of AGR are easily accessible and cheap to use for predicting mortality in patients with lung adenocarcinoma.

Are neutrophil/lymphocyte and platelet/lymphocyte rates in patients with non-small cell lung cancer associated with treatment response and prognosis?

BACKGROUND: Inflammation is a critical component of tumor progression. Many cancers arise from sites of infection, chronic irritation, and inflammation. It is now becoming clear that the tumour microenvironment, which is largely orchestrated by inflammatory cells, is an essential participant in the neoplastic process, promoting proliferation, survival and migration. Platelets can release some growth factors such as platelet-derived growth factor, platelet factor 4, and thrombospondin. Such factors have been shown to promote hematogenous tumour spread, tumor cell adhesion and invasion, and angiogenesis and to play an important role in tumor progression. In this study, we aimed to investigate effects of the pretreatment neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) on survival and response to chemoradiotherapy in patients with non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS: Ninety-four patients with non-metastatic NSCLC were included and separated into two groups according to median value of NLR and PLR (low: <3.44 or high: ≥ 3.44 and low: <194 or high ≥ 194, respectively). RESULTS: Pretreatment high NLR and PLR were associated with significantly shorter disease-free and overall survival rates. Multivariate analysis revealed that the overall survival rates were significantly linked with PLR (OR: 1.87, CI: 1.20-2.91, p: 0.006) and response to chemoradiotherapy (OR: 1.80, CI: 1.14-2.81, p: 0.012) and the disease-free survival rates were significantly associated with NLR (OR: 1.81, CI: 1.16-2.82, p: 0.009) and response to chemoradiotherapy (OR: 2.30, CI: 1.45-3.66, p: 0.001). There was no significant difference between patients with high and low NLR in terms of response to chemoradiotherapy. Similarly, there was no significant influence of the PLR. CONCLUSIONS: Pretreatment NLR and PLR measurements can provide important prognostic results in patients with NSCLC and assessment of the two parameters together appears to better predict the prognosis in patients with NSCLC. The effect of inflammation, indicators of NLR and PLR, on survival seems independent of the response to chemoradiotherapy.

ABO blood groups are not associated with treatment response and prognosis in patients with local advanced non- small cell lung cancer.

BACKGROUND: Lung cancer is the leading cause of cancer death, late diagnosis being the main obstacle to improving the outcomes with stage at diagnosis as an important prognostic factor. Relationships between ABO blood groups and risk of benign or malignant diseases have been observed and in this study, we aimed to investigate whether they might affect prognosis and response to chemoradiotherapy in patients with local advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Eighty-one patients with non-metastatic local advanced NSCLC were included in the study. ABO blood groups were A in 45 (55.6%), B in 7 (8.6%), AB in 8 (9.9%), and O in 21 (25.9%) patients. The patients were also divided two groups according to blood group A (45 patients) and non-A (B, AB and O; 36 patients). Response to chemoradiotherapy was complete remission in 10 (12.3%), disease regression in 42 (51.9%), stable disease in 12 (14.8%), and disease progression in 17 (21.0%) patients. RESULTS: There was no significant difference among ABO blood group categories or between patients with A blood group and those with non-A blood group in terms of responses to chemoradiotherapy (p>0.05). There were also no significant differences regarding overall and disease-free survival rates. CONCLUSION: The ABO blood group system has no significant effect on prognosis and response to chemoradiotherapy in patients with non-metastatic NSCLC.