The effect of radiologic imaging studies on the risk of secondary malignancy development in patients with Hodgkin lymphoma.

PURPOSE: Recently, reports have been published, which suggest that diagnostic radiologic imaging studies could play a role in the risk of secondary malignancy development in patients with cancer. The aims of our study are to calculate the average amount of accumulated radiation dose gained by means of radiologic imaging studies performed intensively in diagnosis and follow-up of patients with Hodgkin lymphoma and to evaluate whether this amount of accumulation accounts for a real risk for secondary malignancies. PATIENTS AND METHODS: This study consists of 15 male patients, whose mean age was 23.67 years +/- 4.24 years. All radiologic imaging studies performed in patients with Hodgkin lymphoma were noted in detail, and average radiation dose accumulation was calculated. RESULTS: Median radiation doses to which patients were subjected during a median of 14.5 months of disease duration were 85.19 mSv and 161.08 mSv according to data of the National Radiological Protection Board and Biological Effects of Ionizing Radiation VII report, respectively. The cumulative radiation dose, because of radiologic imaging studies, is 8.5-16-times greater than that of the described dose having 1 in 1,000 chance of cancer development according to Biological Effects of Ionizing Radiation VII report. Approximately, this amount is equivalent to the dose of natural background radiation received during 35-70 years. CONCLUSION: Our study demonstrated that radiation dose accumulation because of radiologic imaging studies used in diagnosis, staging, and follow-up of patients with Hodgkin lymphoma was high enough to cause development of secondary malignancies. Finally, it is obvious that the radiologic imaging study policies used in follow-up of these patients should be overviewed.

Survival benefit with GM-CSF use after high-dose chemotherapy in high-risk breast cancer.

AIMS AND BACKGROUND: The role of high-dose chemotherapy in breast cancer has not been fully defined. It has been concluded that new trials should focus on defining potential subgroups that are more likely to benefit from high-dose chemotherapy. We compared survival differences in patients receiving human granulocyte-colony stimulating factor (G-CSF) or granulocyte-monocyte colony stimulating factor (GM-CSF) after high-dose chemotherapy with stem cell support. METHODS: High-risk non-metastatic breast cancer patients (axillary lymph node involvement more than 8) aged 16 to 65 years and with a performance status < or = 1 underwent high-dose chemotherapy with autograft. Written informed consent was obtained from every patient, and the study was approved by the local ethics committee. RESULTS: For 54 eligible women, the median follow-up was 41.4 months. The five-year disease-free survival was 45.7%. The five-year projected overall survival rate was 53.9%. Among them, patients who received GM-CSF (n = 12) posttransplant lived longer than the patients who received G-CSF (n = 15) (five year survival rates, 46.6% vs 75%, P < 0.050). The patients who received GM-CSF posttransplant had fewer relapses (5 vs 9). However, between the two groups there was no statistically significant difference regarding disease-free survival rates calculated with the Kaplan-Meier method (58.8% vs 40%; P = 0.121). CONCLUSIONS: Patients receiving GM-CSF posttransplant lived longer and they had fewer relapses than those who received G-CSF. This result merits consideration. The antitumor activity of GM-CSF should be investigated further in prospective randomized trials.

Malignant peripheral primitive neuroectodermal (pPNET) of tongue.

Primitive neuroectodermal tumors (PNETs) are relatively rare tumors. Tumors that once would have been diagnosed as Ewing's sarcoma are now often designated as peripheral neuroepithelioma or synonymously PNET. This paper reports a case of PNET located orally on the tongue, which is, to our knowledge, the first case reported in medical literature. The patient was treated with postoperative radiotherapy and chemotherapy. Multiple liver metastases occurred 5 months after the initial diagnosis and following extensive chemotherapy the patient was only able to survive for a further 10 months.

Impact of c-erb2 status on survival after high dose chemotherapy in high-risk breast cancer patients.

OBJECTIVE: To investigate the impact of c-erb2 status on survival after high-dose chemotherapy. METHODS: Between March 1997 and June 2004, a total of 54 women with breast cancer who has at least 8 metastatic lymph nodes underwent high-dose chemotherapy with hematopoietic stem cell transplantation in Gulhane Military Medical School, Ankara, Turkey. Archival specimens were analyzed by fluorescent in situ hybridization to determine the impact of c-erb2 status after peripheral blood stem cell transplantation on survival. The patients were divided into c-erb2 negative (n=20) and positive (n=11) groups. RESULTS: No statistically significant differences were detected between c-erb2 negative and positive groups regarding 5-year disease-free survival (41 and 27%, log rank p=0.11), and overall survival (60 and 45%, p=0.33). Transplant related mortality did not differ between groups. CONCLUSION: We found no differences between c-erb2 negative and positive groups regarding disease-free and overall survival. To clarify the value of the c-erb2 status in predicting outcome after high-dose chemotherapy, prospective randomized studies are needed.

Primary glioblastoma multiforme in younger patients: a single-institution experience.

AIMS AND BACKGROUND: To report our experience of patients with primary glioblastoma multiforme of young age by evaluating the characteristics, prognostic factors, and treatment outcomes. PATIENTS AND METHODS: Seventy patients with primary glioblastoma multiforme (GBM) treated at our department between 1996 and 2004 were studied. The male-female ratio was 2.6:1. The median age was 53 (16-74). Sixty-eight patients (97%) were operated on before radiotherapy and 2 patients (3%) underwent only stereotactic biopsy. All patients received radiotherapy. Postoperative chemotherapy as an adjuvant to radiotherapy was given to 9 patients (12%). The patients were divided into 2 groups according to their age (group A < or = 35 years, n = 21 vs group B > 35 years, n = 49). Survival was determined with the Kaplan-Meier method and differences were compared using the log-rank test. Cox regression analysis was performed to identify the independent prognostic factors. Karnofsky performance status (> or = 70 vs < 70), age (< or = 35 vs > 35 years), gender, tumor size (< or = 4 vs > 4 cm), number of involved brain lobes (1 vs more than 1), type of surgery (total vs subtotal), preoperative seizure history (present vs absent), radiotherapy field (total cranium vs partial), total radiotherapy dose (60 vs 66 Gy), and adjuvant chemotherapy (present vs absent) were evaluated in univariate analysis. RESULTS: The median survival was 10.3 months in the whole group, 19.5 months in the younger age group and 5.7 months in the older age group. During follow-up re-craniotomy was performed in 2 patients (3%), and 1 patient (1%) developed spinal seeding metastases and was given spinal radiotherapy. In univariate analysis younger age vs older age: median 19.5 months vs 5.27 months (P = 0.0012); Karnofsky performance status > or = 70 vs < 70: median 15.3 months vs 2.67 months (P < 0.0001), and external radiotherapy dose 60 Gy vs 66 Gy: median 11.6 months vs 3 months (P = 0.02) were found as significant prognostic factors for survival. In regression analysis a worse performance status (KPS <70) was found to be the only independent factor for survival (P = 0.014, 95% CI HR = 0.0043 [0.0001-0.15]). CONCLUSIONS: Younger patients with primary glioblastoma multiforme had a relatively long survival (median, 19.5 months, with a 2-year survival rate of 30%) compared to older patients. This was due particularly to their better performance status.

Determination of anxiety levels of turkish university students and affecting factors in COVID-19 pandemic: sample of a private university

INTRODUCTION: The Coronavirus disease 2019 (COVID-19) pandemic and its consequences have created anxiety in various segments of society. In particular, the transition to online education brought by this process has made the education process of university students difficult. Therefore, in the COVID-19 pandemic, it is important to examine the anxiety levels of university students and their relationship with somatic symptoms. OBJECTIVE: To examine the level of generalised anxiety disorder and to reveal the relationship between somatic symptoms and the generalised anxiety disorder level of Turkish university students. METHODS: Empirical research. Participants in the research constituted a total of 605 students studying at a private university in Istanbul. The Generalised Anxiety Disorder Scale (GAD-7) was used to collect data. Data were analysed using the chi-square test and Pearson correlation analysis. RESULTS: It was found that, among the participants, 193 (31.90%) of the students had mild anxiety, 149 (24.63%) had moderate anxiety and 121 (20.00%) had severe anxiety. The study revealed that there is a significant positive relationship between the number of somatic symptoms and generalised anxiety disorder scores of university students. CONCLUSION: Most of the university students are affected by anxiety during the COVID-19 pandemic and this effect is correlated with the frequency of somatic symptoms. In this context, it would be beneficial for universities to plan for acute and long-term psychological services and to cooperate with the government to provide timely crisis-oriented psychological services.

Assessment of quality of life of nasopharyngeal carcinoma patients with EORTC QLQ-C30 and H&N-35 modules.

PURPOSE: The current study reports on long-term quality of life (QoL) status after conventional radiotherapy in 187 nasopharyngeal carcinoma patients from 14 centers in Turkey. PATIENTS AND METHODS: Patients with the diagnosis of nasopharyngeal carcinoma, who were treated in 14 centers in Turkey with minimum 6 months of follow-up and were in complete remission, were asked to complete Turkish versions of EORTC QLQ-C30 questionnaire and the HN-35 module. Each center participated with the required clinical data that included age at diagnosis, gender, symptoms on admission, follow-up period, treatment modalities, radiotherapy dose, and AJCC 1997 tumor stage. Each patient's 33 QoL scores, which included function, global health status, and symptoms, were calculated as instructed in EORTC QLQ-C30 scoring manual. All of the scales and single-item measures range from 0 to 100. A high score represents a higher response level. Kruskal-Wallis and Mann-Whitney U nonparametric tests were used for comparisons. RESULTS: One hundred eighty-seven patients with median age of 46 years (range, 16-79 years) participated and completed the questionnaires. Median follow-up time was 3.4 years (range, 6 months-24 years). All patients have received external-beam radiotherapy. Beside external-beam radiotherapy, 59 patients underwent brachytherapy boost, 70 patients received concomitant chemotherapy, and 95 patients received adjuvant/neoadjuvant chemotherapy. Most of the patients in the analysis (75%) were in advanced stage (Stage III, n = 85 [45.4%]; Stage IV, n = 55 [29%]). Mean global health status was calculated as 73. Parameters that increased global health status were male gender, early-stage disease, and less than 4-year follow-up (p < 0.05). Functional parameters were better in males and in early-stage disease. Factors that yielded better symptom scores were short interval after treatment (10 scores), male gender (7 scores), and lower radiation dose (6 scores). Neoadjuvant or adjuvant chemotherapy did not have any effect on QoL, whereas concomitant chemotherapy adversely affected 5 symptom scores. CONCLUSION: Quality of life is adversely affected in our nasopharyngeal carcinoma patients treated with combined therapies. The factors that adversely affect quality of life are advanced tumor stage, female gender, and long-term follow-up. Further controlled studies to evaluate both preradiotherapy and postradiotherapy status are necessary to clarify the contribution of each treatment modality to QoL.

Central neurocytoma: proton MR spectroscopy and diffusion weighted MR imaging findings.

PURPOSE: To present proton magnetic resonance spectroscopy and diffusion-weighted imaging (DWI) findings of central neurocytoma (CN). METHODS AND MATERIALS: Imaging findings of seven patients with the histopathological diagnosis of CN (five male and two female; age range, 21-28 years of age) were evaluated retrospectively. In addition to conventional magnetic resonance imaging features, we also assessed the metabolite ratios and tumor normalized apparent diffusion coefficient (NADC), which was calculated by dividing the tumor apparent diffusion coefficient (ADC) values by normal ADC. Approval from our institutional review board was obtained for this review. RESULTS: The tumor choline/creatine ratios were 5.17+/-2.38, while N-acetyl aspartate/choline and N-acetyl aspartate/creatine ratios were 0.33+/-0.15 and 1.84+/-1.38, respectively. On DWI, tumors had heterogeneous hyperintense appearances when compared with the contralateral parietal lobe white matter and tumor NADC values were 0.63+/-0.05. CONCLUSION: Significantly increased choline/creatine and decreased N-acetyl aspartate/choline ratios with lower NADC values in CN resemble high-grade gliomas and complicate the diagnosis. Familiarity its physiologic features would help to presurgical diagnosis of ventricular and exraventricular CNs.

Cyclooxygenase-2 (Cox-2) expression and angiogenesis in glioblastoma.

Cyclooxygenase-2 (Cox-2), the key enzyme that catalyzes the first steps in the biosynthesis of the prostaglandins from arachidonic acid, appears to play a role in the regulation of progression, invasiveness and angiogenesis of various neoplasms. We analyzed the immunohistochemical expression of Cox-2 and angiogenic parameters (microvessel density (MVD) and vascular patterns) in 54 glioblastomas. We also examined their relation with prognosis. Cox-2 immunohistochemical expression was observed in 48 tumors (89%). There was no staining in six tumors (11%). On univariate analysis, MVD was correlated with a poor outcome (MVD > 70; hazard ratio, 0.441; 95% confidence interval, 0.200-0.975, P = 0.041). But MVD showed no prognostic impact on multivariate analysis. Neither Cox-2 expression nor vascular pattern showed prognostic value. The difference in Cox-2 expression between the classical and bizarre vascular pattern in glioblastomas was statistically significant (P = 0.047). However, no correlation was found between Cox-2 expression and MVD. These findings suggest that Cox-2 is heterogeneously expressed in glioblastomas without a significant association with MVD. However, Cox-2 expression may be related to vascular pattern in glioblastomas.

Six gray single dose radiotherapy in the treatment of metastatic bone pain.

Bone metastases are observed in approximately 50% of patients with cancer and these are essential to influence the quality of life. As one of the most effective means of therapy for patients with bone metastases, radiotherapy can be applied as fractional and single dose. In this prospective study, we analyzed the pain relief after 6 Gy single dose irradiation in 62 patients with painful bone metastases. This was assessed by an 11-point scale questionnaire. In 88.7% of the treatments response was obtained after the single-dose radiotherapy (37.1% complete response, 51.6% partial response, 11.3% no response). In approximately 53% of the treatments the response initiated within one week. We concluded that a single dose of 6 Gy was very effective in the palliation of painful bone metastases.

Retrospective analysis of 74 cases of seminoma treated with radiotherapy.

BACKGROUND: Standard post-orchiectomy radiotherapy (RT) is accepted as a standard management option for stage I seminoma. METHODS: Retrospective evaluation of 74 patients with stage I seminoma was performed according to the Royal Marsden staging system. All of the patients underwent RT in the Radiation Oncology Department of Gülhane Military Medical Academy between 1974 and 1995. The median age of patients was 27 years (range, 20-56). Radiotherapy was applied to all of the patients after orchiectomy for adjuvant purposes. Sixty-nine patients underwent RT while five patients who had recurrence received chemotherapy following radiotherapy. RESULTS: After a mean follow-up period of 54 months, the 5-year overall survival rate was 98.61%, which complied with the literature. The disease-free survival rate was 90.54%. According to the World Health Organization toxicity scale, acute enteritis was 9.4% for grade I and 5.4% for grade II, while nausea/vomiting was 36.4% for grade I and 5.4% for grade II. CONCLUSION: To avoid acute toxicity related to RT, prognostic risk factors should be well-known and patients with low risk factors should be monitored carefully after orchiectomy. RT should be directed to the para-aortic +/- ipsilateral pelvic lymph nodes in high risk patients. Although post-orchiectomy RT is a traditional management option for clinical stage I seminoma, the results of RT should be well-known to compare it with other treatment options (e.g. RPLND, adjuvant chemotherapy and surveillance).

An optimization method for reference dose point of rectum in brachytherapy of gynecological neoplasms.

Rectum reference dose points have a direct impact on the morbidity seen in gynecological intracavitaty radiotherapy. The aim of this study is to obtain less morbidity by marking rectum with radio opaque solution. Fourteen patients with gynecological cancer who underwent external radiotherapy received 15 Gray (Gy) intracavitary radiotherapy. During the internal radiotherapy planning, radio opaque solution has been administered into the rectum to observe it on lateral radiogram. Thus rectum reference dose point and five points were marked at sites nearest to the sources. Nucletron Planning system was used for obtaining three-dimensional planning. After therapy patients were followed at every three months. Median follow-up was 18 months. Most frequently observed morbidities were grade 1-2 rectitis and cystitis in six patients. As a result, more accurate rectum dose values and less factors causing dose changing can provide better results for gynecological intracavitary brachytherapy.

The effect of leptin on engraftment in patients undergoing peripheral blood stem cell transplantation.

AIM AND BACKGROUND: To evaluate the alterations of serum leptin levels during stem cell transplantation and its possible role in engraftment. Thirty-two patients (19 male, 13 female) with various hematological and solid tumors and 28 healthy subjects (15 male, 13 female) as a control group were enrolled in the study. METHODS: Serum leptin levels were measured on the day before administering G-CSF, at the time of leukapheresis harvest, on day +1st and +7th after transplantation and on the day of leukocyte engraftment. RESULTS: There was no significant difference in serum leptin levels between patients (mean +/- SEM, 11.62 +/- 2.75 ng/ml) before transplantation and control groups (9.79 +/- 1.73 ng/ml). Pre-G-CSF (baseline) level of serum leptin (11.62 +/- 2.75 ng/ml) was significantly decreased to 7.73 +/- 2.02 ng/ml at the time of apheresis harvest (P = 0.0029). Later, serum leptin levels increased to 16.75 +/- 3.26 ng/ml on day +1 after transplantation (P < 0.0001). Subsequently serum leptin levels both on day +7th posttransplant (12.11 +/- 2.17 ng/ml) and leukocyte engraftment day (9.26 +/- 1.50 ng/ml) were gradually decreased. There was no correlation between the serum leptin levels and the leukocyte or platelet engraftment. CONCLUSION: The present study concludes that serum leptin level does not change remarkably during peripheral blood stem cell transplantation and no association exists between circulating leptin levels and the onset of engraftment suggesting that circulating serum leptin does not have a significant direct influence on engraftment.