A study on basic demographic and disease characteristics of cancer-diagnosed Syrian refugees treated in the border city of Turkey, Sanliurfa; a hospital-based retrospective case series study.

PURPOSE: Turkey hosts around 3 million Syrian refugees which is more than any other country in the world. Along with some other adaptation issues like cultural, language, and economic difficulties, significant problems in managing medical problems, chronic diseases like cancer in particular, have to be fixed. However, there are few studies which explore main patient and clinicopathological characteristics in Syrian refugees with cancer. The purpose of this study was to highlight the aforementioned characteristics along with management issues after cancer diagnosis of these patients. METHODS: This study was designed as a hospital-based retrospective observational case-series study of 134 Syrian refugees cancer patients between 2015 and 2017. RESULTS: The patient median age was 47.5 years (range 18- 80). Out of the 134, 102 (76.1%) were female. The most common cancer types were breast (n=57, 42.5%) and gynecological cancers (n=14, 10.4%). The majority of patients were diagnosed at advanced stage (n=60, 44.8%). There were 91 (67.9%) and 43 (32.1%) patients admitted to our center from refugee camps and staying in a house, respectively. The median follow-up was 14 months (range 1-111) and 11 (8.2%) patients died. One and two-year survival rate of the whole group were 93% and 86%, respectively. There were 12 (9%) patients with grade 3-4 hematological and non-hematological toxicities. Neutropenia was the most common grade 3-4 toxicity (n=8, 6%). The patients staying in refugee camp (n-91) or in a house (n=43) finished all planned cycles of chemotherapy with a rate of 71% (n=65) and 79% (n=34), respectively. Statistical analysis failed to show significant relationship between the staying site (either camp or house), chemotherapy compliance rate, grade 3-4 toxicities with p=0.347 and p=0.09, respectively. CONCLUSION: Our results revealed that breast cancer and gynecological cancers were the most common cancer types which are good candidates for cancer screening. Unfortunately, the majority of patients had cancer diagnosed at advanced stage. However, after diagnosis they could reach all health facilities including surgical operation, radiotherapy, and systemic chemotherapy similar to Turkish cancer patients. Therefore, our results suggested that major problem for the Syrian refugees adapting them into national screening program which may resulted that cancer diagnosis at earlier stage with high cure rate.

The prognostic factors in patients with advanced hepatocellular carcinoma: impact of treatment sequencing.

The prognosis of patients with advanced HCC can vary widely depending on factors such as the stage of the cancer, the patient's overall health, and treatment regimens. This study aimed to investigate survival outcomes and associated factors in patients with hepatocellular carcinoma (HCC). In this retrospective study, data from 23 medical oncology clinics were analyzed. Progression-free survival (PFS) and overall survival (OS) values were estimated using the Kaplan-Meier method. Prognostic factors associated with survival which were identified in univariate analysis were subsequently evaluated in a multivariate Cox-regression survival analysis was conducted using the backward stepwise (Conditional LR) method to determine the independent predictors of PFS and OS. Of 280 patients, 131 received chemotherapy and 142 received sorafenib, 6 received atezolizumab plus bevacizumab and 1 received nivolumab for first-line setting. The median follow-up time was 30.4 (95%CI 27.1-33.6) months. For-first line, median PFS was 3.1 (95%CI2.7-3.5) months, and it was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab (PFS 5.8 (95%CI 4.2-7.5) than in those received chemotherapy (PFS 2.1 (95%CI 1.9-2.3) in the first-line setting (p < 0.001). Multivariate analysis revealed that male gender (HR: 2.75, 95% CI: 1.53-4.94, p = 0.01), poor ECOG performance score (HR: 1.88, 95% CI: 1.10-3.21, p = 0.02), higher baseline AFP level (HR: 2.38, 95% CI: 1.54-3.67, p < 0.001) and upfront sorafenib treatment (HR,0.38; 95% CI: 0.23-0.62, p < 0.001) were significantly associated with shorter PFS. The median OS was 13.2 (95%CI 11.1-15.2) months. It was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab in the first-line setting followed by TKIs (sorafenib or regorafenib, OS 18.6 (95%CI 13.8-23.5)) compared to those who received chemotherapy (OS 10.3 (95%CI 6.6-14.1)) in the first-line setting. The multivariate analysis revealed that upfront chemotherapy treatment approach, male gender (HR: 1.77, 95% CI: 1.07-2.94, p = 0.02), poor ECOG performance score (HR: 1.96, 95% CI: 1.24-3.09, p = 0.004) and Child-Pugh score, presence of extrahepatic disease (HR: 1.54, 95% CI: 1.09-2.18, p = 0.01), and higher baseline AFP value (HR: 1.50, 95% CI: 1.03-2.19, p = 0.03) were significantly associated with poor prognosis. Additionally, regarding of treatment sequence, upfront sorafenib followed by regorafenib showed a significantly lower risk of mortality (HR: 0.40, 95% CI: 0.25-0.66, p < 0.001). Sorafenib followed by regorafenib treatment was associated with a significantly lower risk of mortality rather than upfront sorafenib followed by BSC group or upfront chemotherapy followed by TKIs. These findings underscore the importance of the optimal treatment sequences to improve survival in patients with advanced HCC.

[Cerebral venous thrombosis]. / Thrombose veineuse cérébrale.

Cerebral venous thrombosis represents less than 1 % of all strokes, usually affecting young women, probably because of hormonal factors. The most common symptom is headache, with or without focal neurological findings such as deficits or seizures. Brain MRI is the gold standard for diagnosis. Anticoagulation should be initiated as soon as possible, followed by vitamin K antagonists, for at least 3 months. Predisposing causes and risk factors for cerebral venous thrombosis are multiple. Prognosis is good and recurrence rate is low.

Assessment of Apparent Diffusion Coefficient Parameters and Coefficient of Variance in Discrimination of Receptor Status and Molecular Subtypes of Breast Cancer.

OBJECTIVE: The objective of this study was to investigate the diagnostic power of apparent diffusion coefficient/coefficient of variance (ADCcV) as well as ADC parameters formed based on magnetic resonance images (MRI) in the distinction of molecular breast cancer subtypes. METHODS: The study involved 205 patients who had breast cancer at stages 1-3. Estrogen receptor (EsR), progesterone receptor (PrR), human epidermal growth factor receptor 2 (Her2), and proliferation index (Ki-67) were histologically analyzed in the tumor. The correlations between the immunohistochemistry and intrinsic subtypes were analyzed using ADC and ADCcV. RESULTS: The maximum whole tumor (WTu) ADC (p=0.004), minimum WTu ADC (p<0.001), and mean WTu ADC (p<0.001) values were significantly smaller in the EsR-positive tumors than those in the EsR-negative tumors. Compared to the PrR-negative tumors, the PrR-positive tumors showed significantly smaller maximum, minimum, and mean WTu ADC values (p=0.005, p=0.001, and p<0.001, respectively). In the comparisons of the molecular subtypes in terms of ADCcV, the p-values indicated statistically significant differences between the luminal A (lumA) group and the triple negative (TN) group, between the luminal B (lumB) group and the TN group, and between the Her2-enriched and TN groups (p<0.001, p=0.011, and p=0.004, respectively). Considering the luminal and non-luminal groups, while a significant difference was observed between the groups considering their minimum, maximum, and mean WTu ADC values, their ADCcV values were similar (p<0.001, p=0.004, and p<0.001, respectively). CONCLUSION: Using ADCcV in addition to ADC parameters increased the diagnostic power of diffusion weighted-MRI (DW-MRI) in the distinction of molecular subtypes of breast cancer.

Real-world outcomes of pazopanib in metastatic soft tissue sarcoma: a retrospective Turkish oncology group (TOG) study.

AIM: Description of patient characteristics, effectiveness and safety in Turkish patients treated with pazopanib for metastatic soft tissue sarcoma (STS). PATIENTS AND METHODS: This multicenter study is based on retrospective review of hospital medical records of patients (≥ 18 years) treated with pazopanib for non-adipocytic metastatic STS at 37 Oncology clinics across Turkey. Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) were evaluated with further analysis of data on the three most common histological subtypes (leiomyosarcoma [LMS], undifferentiated pleomorphic sarcoma [UPS], synovial sarcoma [SS]) in the cohort. RESULTS: Data of 552 adults (57.6% women, median age: 52 years) were analyzed. DCR and ORR were 43.1% and 30.8%, respectively. Median PFS was 6.7 months and OS was 13.8 months. For LMS, UPS and SS, median PFSs were 6.1, 5.9 and 7.53 months and median OSs were 15.03, 12.87 and 12.27 months, respectively. ECOG ≥ 2 was associated with poor PFS and OS. Liver metastasis was only a factor for progression. Second-line use of pazopanib (vs. front-line) was associated with better PFS, its use beyond third line predicted worse OS. Adverse events (AE) occurred in 82.7% of patients. Most common AEs were fatigue (58.3%) and anorexia (52.3%) which were graded as ≥ 3 in 8.2% and 7.4% of patients, respectively. CONCLUSION: Pazopanib is effective and well-tolerated in treatment of non-adipocytic metastatic STS. Its earlier use (at second-line), good performance status may result in better outcomes. Worldwide scientific collaborations are important to gain knowledge on rarer STS subtypes by conducting studies in larger patient populations.

The Value of 18F-FDG PET/CT Imaging in the Evaluation of Interim Neoadjuvant Chemotherapy Response in Locally Advanced Breast Cancer.

Objectives: Neoadjuvant chemotherapy (NAC) is the frequently used treatment option for locally advanced breast cancer (LABC). This study investigated the potential value of 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to estimate the pathological complete response (pCR) using maximum standardized uptake value (SUVmax) and change (ΔSUVmax) after 3-4 cycles of NAC. Additionally, it was established the relationship between PET/CT imaging findings and histopathological features in LABC patients whose treatment response was evaluated with interim PET/CT. Methods: Patients were evaluated with pretreatment and interim PET/CT scans and operated after on NAC. Data on the age of patients, menopausal status, tumor placement, histopathological and molecular subgroups were noted. SUVmax and ΔSUVmax of the primary tumor and axillary lymph node (ALN) were calculated from PET/CT review. Results: Pretherapy mean SUVmax of the primary tumor and ALNs were 8.13±4.25 and 7.22±3.58, respectively. The highest mean primary tumor ΔSUVmax and ALN ΔSUVmax values were observed to be human epidermal growth factor receptor 2 positivity (p<0.001). SUVmax-T, SUVmax-N, ΔSUVmax-T, and ΔSUVmax-N values were significantly correlated with the ki-67 index (p<0.001). ΔSUVmax-T and ΔSUVmax-N values of pCR (+) patients were statistically higher than the ΔSUVmax-T and ΔSUVmax-N values of pCR (-) patients (p<0.001). Conclusion: An earlier and more accurate response to NAC can be performed using interim 18F-FDG PET/CT imaging. ΔSUVmax levels of the breast tumor and ALNs may act as predictive for pCR in LABC patients receiving NAC.

Predicting the Overall Survival in Patients with Advanced Pancreatic Cancer by Calculating L3 Skeletal Muscle Index Derived from CT.

BACKGROUND: Pancreatic cancer is mostly diagnosed in advanced stages, and treatment results are not satisfactory. L3 skeletal muscle index (SMI) has emerged as a prognostic factor in pancreatic cancer patients. We aimed to assess the association between sarcopenia and overall survival in patients with pancreatic cancer in this study. METHODS: Patients who were admitted to the Department of Oncology between March 2012 and December 2019 and diagnosed with pancreatic cancer were evaluated. The computerized tomography images and laboratory parameters of a total of 115 patients were included in this retrospective singlecenter study. We defined sarcopenia as an SMI <43,56 cm²/m² for females and <56,44 cm²/m² for males using the receiver operating characteristics (ROC) curve in the study population. Univariate and multivariate analyses were performed by using Cox-regression modelling, and survival curves were constructed by using Kaplan-Meier method. RESULTS: 70% of the patients were male, and the mean age was 64.9±9.9 years (mean ± SD). 70.6% of female patients and 67.9% of male patients were diagnosed with stage 4 cancer. The prevalence of sarcopenia in the whole patient group was 29.6%. By multivariate analysis, SMI (p=0.009) and advanced stage (p=0.003) were found as poor prognostic factors for overall survival (OS). The neutrophil to lymphocyte ratio (NLR) was statistically significantly higher in sarcopenic patients than in nonsarcopenic patients (p=0.031). CONCLUSION: Patients having sarcopenia at the time of diagnosis may demonstrate poorer overall survival of pancreatic cancer, and SMI may be considered as a potential prognostic factor.

Impact of COVID-19 lockdown on mood status: A comparison of hemodialysis and oncology patients.

INTRODUCTION: Coronavirus related lockdown measures had a severe psychological toll. We investigated the effects of population-wide infection control measures on hemodialysis (HD) and oncology patients' mood statuses. METHODS: An electronic survey was used to collect data. We used the Profile of Mood States (POMS) and the Hospital Anxiety and Depression Scale (HADS) to measure the mood statuses. RESULTS: The study groups composed of 400 HD, 234 oncology patients, and 276 controls. HADS anxiety and total POMS scores were significantly higher in the control group than that of both HD and oncology patients, a finding consistent with a worse mood status. In multivariate models, the male gender and the perception of having received appropriate medical support during the pandemic period were independent predictors of better POMS and HADS-anxiety and depression scores. CONCLUSION: HD and oncology patients appear to be less affected by the psychological stress induced by social distancing and lockdown periods.

Atezolizumab combined with chemotherapy in the first-line treatment of extensive-stage small cell lung cancer: a real-life data of the Turkish Oncology Group.

PURPOSE: Atezolizumab has been shown to be effective and safe in randomized trial in the first-line treatment of extensive-stage small cell lung cancer (SCLC). However, there are limited real-life data on atezolizumab. In this study, we aimed to determine the real-life efficacy and safety of atezolizumab combined with chemotherapy in the first-line treatment of extensive-stage SCLC. METHODS: This trial is a retrospective multicenter study of the Turkish Oncology Group, which included extensive-stage SCLC patients who received atezolizumab combined with chemotherapy in a first-line treatment. The characteristics of the patients, treatment and response rates, and PFS and OS are presented. Factors associated with PFS and OS were analyzed by univariate and multivariate analysis. RESULTS: A total of 213 patients at the 30 oncology centers were included. The median number of chemotherapy cycle was 5 (1-8) and atezolizumab cycle was 7 (1-32). After median 11.9 months of follow-up, median PFS and OS was 6.8 months (95%CI 5.7-7.8), and 11.9 months (95%CI 11-12.7), respectively. The ORR was 61.9%. ECOG-PS (p = 0.002) and number of metastatic sites (p = 0.001) were associated with PFS and pack-year of smoking (p = 0.05), while ECOG-PS (p = 0.03) and number of metastatic sites (p = 0.001) were associated with OS. Hematological side effects were common and toxicities were manageable. CONCLUSION: This real-life data confirm the efficacy and safety of atezolizumab in combination with chemotherapy in first-line treatment of extensive-stage SCLC.

Comparative assessment of three different second-line regimens in chemotherapy resistant / refractory small-cell lung cancer.

PURPOSE: Small cell lung cancer (SCLC) patients unresponsive or relapsing within 90 days following frontline chemotherapy have poor prognosis and they should be treated with different chemotherapy regimens other than those used in the first-line regimen. Currently there is no globally accepted standard chemotherapeutic regimen for the treatment of these patients. This retrospective study was designed to compare CAV (Cyclophosphamide, Doxorubicin, Vincristine), weekly topotecan and weekly irinotecan regimens and to evaluate the efficacy of the three regimens in patients with chemotherapy resistant/refractory (CRR) SCLC. METHODS: A total of 67 CRR-SCLC patients, who were treated with CAV, weekly topotecan and weekly irinotecan were reviewed for weekly irinotecan (27 for 60 mg/m2 intravenously on days 1, 8 and 15 of a 28-day cycle,24 for CAV (Cyclophosphamide 750 mg/m² on day 1, Doxorubicin 50 mg/m² on day 1 and Vincristine 1.4mg/m2 on day 1 every 3 weeks), 16 for weekly topotecan (4 mg/m2 intravenously on days 1, 8 and 15 of a 28-day cycle). RESULTS: The median follow-up time was 12.45 months, there was no difference about disease control rates (DCR) between three chemotherapy regimens (DCR; 25.9% with irinotecan, 29.2% with CAV and 31.3% with topotecan, p=0.92). Objective response rates (ORR) for irinotecan, CAV and topotecan groups were 3,7%, 8,8%, and 0%, respectively (p=0.63). Median progression free survival (PFS) and overall survival (OS) were similar according to irinotecan, CAV, and topotecan (PFS: 1.93 months, 2.30 months and 3.45 months; OS: 2.89 months, 4.79 months and 5.81 months, respectively). The adverse events were generally mild and manageable for both hematological and nonhematological toxicities in all three arms. CONCLUSIONS: Weekly irinotecan, CAV and weekly topotecan are similarly effective and safe chemotherapy protocols for the treatment of CRR-SCLC patients.

Efficacy of regorafenib in the second-and third-line setting for patients with advanced hepatocellular carcinoma: A real life data of multicenter study from Turkey.

PURPOSE: After failure of the first-line sorafenib treatment in advanced or metastatic stage hepatocellular carcinoma (HCC), regorafenib is one of the newly-approved targeted agents. We aimed to evaluate the efficacy of regorafenib in patients with advanced HCC treated in the second- or third-line setting. METHODS: In this retrospective and multicenter study, advanced HCC patients not eligible for local therapies, who received a second- or third-line regorafenib therapy after progression on the first-line sorafenib or sequential therapy with chemotherapy (CT) followed by sorafenib, were included. RESULTS: In the first-line setting, 28 (28.9%) patients received CT and 69 (71.1%) patients received sorafenib. There were 24 (24.7%) patients who were intolerant to sorafenib. Disease control rate (DCR) was 53.6% for all patients treated with regorafenib, 62.3% in patients who received regorafenib in the second-line, and 32.1% for those receiving regorafenib in the third-line (p=0.007). Median progression-free survival (PFS) and overall survival (OS) were 5.6 (range; 4.3-6.9) and 8.8 (range, 6.3-11.3) months for all patients treated with regorafenib vs. 7.1 months and 10.3 months for patients who received regorafenib in the second-line vs. 5.1 and 8.7 months for patients who received regorafenib in the third-line, respectively; however, there was no statistically significant difference (pPFS=0.22 and pOS=0.85). CONCLUSION: Although receiving CT as a first-line therapy in advanced HCC patients did not affect the survival rates of subsequent regorafenib therapy, it might diminish the DCR of regorafenib.

Are there any differences among psoriasis, psoriatic arthritis and rheumatoid arthritis in terms of metabolic syndrome and cardiovascular risk factors?

OBJECTIVE: Although the frequency of metabolic syndrome has been studied separately in psoriasis, psoriatic arthritis (PsA), and rheumatoid arthritis (RA) patients, there is no study that compares the prevalence of metabolic syndrome in all three diseases. The purpose of this study is to evaluate the relationship between metabolic syndrome (MetS) and chronic low-grade inflammatory diseases, and to determine the frequency of MetS and insulin resistance in psoriasis and PsA as compared to RA. METHODS: A total of 155 patients were included in this cross-sectional study. Fifty patients who were diagnosed with psoriasis, 55 PsA patients who were diagnosed according to the CASPAR criteria, and 50 seropositive RA patients who were diagnosed according to the ACR/EULAR 2010 classification criteria were included in this study. MetS was diagnosed by the 2005 criteria of International Diabetes Federation. The cardiovascular risk factors and parameters associated with MetS were evaluated. RESULTS: The patients' mean age was significantly higher in the RA. MetS was determined in 33.5% of all patients and MetS and insulin resistance showed no significant difference among the three groups (psoriasis: 36%, PsA: 29%, RA: 36%; p: 0.684 and psoriasis: 70%, PsA: 64%, RA: 66%, respectively; p: 0.785). Triglyceride levels were higher in psoriasis and PsA as compared to the RA (psoriasis: 34%, PsA: 32.7%, RA: 16%, respectively; p: 0.045). The frequency of hypertension was 38% in the RA, which was higher than PsA and psoriasis (p: 0.011). CONCLUSION: In all three groups, the prevalence of MetS was shown to be higher than the general population. The lack of difference between these groups may be due to the small number of patients, the retrospective study design, and the inequality of the population with respect to age and gender.

Regorafenib or rechallenge chemotherapy: which is more effective in the third-line treatment of metastatic colorectal cancer?

PURPOSE: To assess the efficacy and safety of regorafenib versus rechallenge chemotherapy in previously treated mCRC patients in third-line setting. MATERIALS AND METHODS: The data of 104 patients diagnosed with mCRC enrolled from 2010 to 2017 in six oncology centers were analyzed. Tumor treatment options were obtained from follow-up and treatment files. Rechallenge chemotherapy was identified as the re-use of the regimen which was previously administered to patients in one of the therapy lines and obtained disease control, these were the patients whose disease did not progress within 3 months. RESULTS: A total of 104 patients had received previously two lines of chemotherapy regimens for mCRC. Of these, 73 patients with mCRC who received regorafenib and 31 those who received rechallenge chemotherapy in third-line therapy were analyzed. Overall survival was better with rechallenge than it was with regorafenib (HR 0.29 95% CI 0.16-0.54, p < 0.001). Median OS was 12.0 months (95% CI 8.1-15.9) in rechallenge versus 6.6 months (95% CI 6.0-7.3) in regorafenib group (p < 0.001). Progression-free survival in the rechallenge group showed a higher median value of 9.16 months (95% CI 7.15-11.18) versus with that recorded in the regorafenib group of 3.41 months (95% CI 3.01-3.82), in favor of rechallenge chemotherapy. The most common adverse events of regorafenib was liver function test abnormality and hand-foot syndrome. Although grade 3 or 4 adverse events were similar, non-hematologic toxicities were more common than those of rechallenge. CONCLUSIONS: Rechallenge is still a valuable option against regorafenib in patients who achieved disease control in one of the first two lines of therapy. Even though mCRC patients treated with regorafenib benefited clinically from this treatment, we revealed that chemotherapy rechallenge compared to regorafenib was more effective in the third-line treatment for mCRC patients.