Changes in lung perfusion scintigraphy and pulmonary function tests in irradiated breast cancer patients.

OBJECTIVE: To investigate the utility of quantitative lung perfusion scintigraphy and pulmonary function tests in the assessment of radiation-induced lung injury. METHODS: The prospective study was conducted at Zonguldak Bulent Ecevit University Hospital, Turkey, from May 2012 to October 2016, and comprised female breast cancer patients having undergone lung perfusion scintigraphy with Tc-99m macroaggregated albumin before and after radiotherapy. Pulmonary function tests and carbon monoxide diffusing capacity tests were also carried out on all the patients, and the relationship between treatment-related changes and its association with radiotherapy doses was analysed. Data was analysed using SPSS 19. RESULTS: There were 43 patients with a median age of 49 (interquartile range: 32-71 years). Carbon monoxide diffusing capacity values at baseline showed a significant decrease at 6 and 12 months post- radiotherapy (p<0.05), while none of the parameters of the pulmonary function tests showed a significant difference (p>0.05). Also, the median percentage of perfusion studies in the irradiated lung decreased significantly (p<0.001) at 12 months post-treatment. There was significant reduction in perfusion studies of irradiated lungs (p<0.05). CONCLUSIONS: Carbon monoxide diffusing capacity and quantitative lung perfusion scintigraphy were found to be useful tools for the early diagnosis and monitoring of radiation-induced lung injury.

Dosimetric comparison of organs at risk in 5 different radiotherapy plans in patients with preoperatively irradiated rectal cancer.

BACKGROUND: Intensity-modulated radiotherapy (IMRT) is a widely used irradiation technique in rectal cancer patients. We aimed to compare 4 different IMRT plans with 3-dimensional conformal radiotherapy (3D-CRT) considering organs at risk (OARs) in patients with rectal carcinoma. METHODS: This retrospective study included 27 rectal cancer patients who were irradiated preoperatively between January 2016 and December 2018. Five different plans (4-field 3D-CRT in 2 phases, 7-field IMRT in 2 phases, 9-field IMRT in 2 phases, 7-field simultaneous integrated boost [SIB] IMRT, and 9-field SIB IMRT) were generated for each patient. Comparison of 5 different plans according to bladder and bilateral femoral head mean doses, bladder V40, bilateral femoral head V40, and small bowel V35 values were evaluated. RESULTS: Most of the OAR parameters significantly favored IMRT plans compared to the 3D-CRT plan. The largest difference was observed in bladder V40 values (reduction of V40 value up to 51.2% reduction) in favor of IMRT. In addition, SIB plans showed significantly better reduction in OARs than phase plans except for small bowel V35 values. CONCLUSIONS: IMRT plans reduced almost all the OARs doses compared with the 3D-CRT plan in rectal cancer patients. Furthermore, SIB plans demonstrated lower OAR doses than the phase plans. IMRT techniques, especially SIB plans, reduce OAR doses and provide safer doses for the treatment of rectal carcinoma.

Effects of ozone preconditioning on recovery of rat colon anastomosis after preoperative radiotherapy.

BACKGROUND: Anastomotic leakage is a devastating complication of colorectal surgery. Neoadjuvant radiotherapy for colorectal cancer can affect the mechanical and biochemical parameters of anastomotic healing. It has been reported that ozone increases antioxidant enzyme activity and stimulates adaptive processes to oppose the pathophysiologic conditions mediated by reactive oxygen species (ROS). OBJECTIVES: The objective of this study was to investigate the effect of controlled administration of ozone on the healing of anastomosis and the activation of antioxidant enzymes in the colon after radiotherapy. MATERIAL AND METHODS: Rats (n = 48) were randomly assigned to the following groups: control groups (1 and 2), saline-treated and irradiated (IR) groups (3 and 4) and ozone oxidative preconditioning (OOP) and IR groups (5 and 6). Rats were exposed to whole-body IR (6 Gy) after pretreatment with either saline or ozone. Rats in groups 1, 3 and 5 were euthanized on postoperative day 3, whereas those in groups 2, 4 and 6 were euthanized on postoperative day 7. The anastomoses were performed on day 7 post-IR. The anastomotic segment was resected to measure hydroxyproline (HPO) content, myeloperoxidase (MPO) activity and malondialdehyde (MDA) concentration and for histopathological evaluation. RESULTS: The mean bursting pressure of the groups that underwent radiotherapy was lower than that of the control groups (p < 0.001). In groups 5 and 6, the tissue HPO concentrations were higher than those in groups 3 and 4. Although mean values for MPO activity in groups 5 and 6 were higher than those in groups 3 and 4, the differences were not significant. Regarding oxidative damage markers, MDA concentrations were significantly lower in group 5 than those in group 3. CONCLUSIONS: In this experimental model, OOP exerted favorable effects on colon anastomotic healing after radiation exposure.

Radiation therapy for biliary tract tumors: the joint experience of three centers.

BACKGROUND/AIM: This study presents the joint experience of three centers in the treatment of patients with biliary tract tumors with radiation therapy (RT). MATERIALS AND METHODS: The records of 27 patients were retrospectively reviewed. All of the patients who had undergone surgical resection received postoperative adjuvant RT, whereas all of the patients who had not undergone a surgical resection received RT with palliative intent. Twenty patients with adequate performance status were treated with RT and chemotherapy, while the remaining seven patients were treated with RT alone. RESULTS: Follow-up ranged from 1 to 44 months. Local control was not achieved in 10 out of 11 patients who had received RT with palliative intent. Systemic failure was observed in eight patients at 5 to 16 months. Fifteen patients died due to disease-related causes at 1 to 22 months. At 2 years, overall survival was 33% and disease-free survival was 19%. A surgical resection with curative intent predicted improved local failure-free survival and improved disease-free survival. CONCLUSION: Since local recurrence is still the leading cause of failure following postoperative RT and the outcome following palliative RT is far from satisfactory, the indications, the target volume, and the doses for RT should be reconsidered.

Effect of treatment position and radiotherapy planning on testicular dose in patients with rectal carcinoma.

AIMS: The aim of this study was to evaluate and compare the effect of radiotherapy on testicles with different treatment positions and plans for rectal cancer patients. SETTINGS AND DESIGN: Mono-institutional prospective study. PATIENTS AND METHODS: Three different plans; supine 4-fields (s4f), prone 4-fields (p4f), and prone 3-fields (p3f) of 15 male patients with rectal carcinoma receiving 45 Gy pelvic radiotherapy were evaluated. Testicular doses in each plan were calculated. Since the localizations of the primary tumor may affect testicular dose, boost doses were not taken into account. STATISTICAL ANALYSIS USED: Kruskal Wallis test, Pearson and Spearman correlation analysis. RESULTS: Median cumulative testicular doses of s4f, p4f, and p3f plans were 19.8, 69.3, and 100.8 cGy, respectively (P = 0.013). Median V0.5 (Volume receiving more than 0.5 Gy) and V1 (Volume receiving more than 1 Gy) for testicles were also significantly lower in s4f plans (3%, 60.7%, and 78.1% for V0.5 and 0.3%, 35.8%, and 52.3% for V1 in s4f, p4f, and p3f, respectively) (P = 0.001). The median distances between lower edge of fields and testicles in s4f, p4f, and p3f plans were 65 mm, 29 mm, and 29 mm, respectively (P < 0.01). Median bladder doses were significantly lower in p3f plans (P = 0.002). CONCLUSIONS: S4f external beam radiotherapy for rectal carcinoma allows better testicular dose than p3f and p4f. The probably reason was the increase of distance between lower edge of the field and testicles.

Bilateral synchronous squamous cell tonsil carcinoma treated with chemoradiotherapy.

The incidence of numerous head and neck tumours is a known issue though bilateral synchronous tonsillar carcinoma reports are so uncommon that only 20 cases were found in a literature review. Most of these patients were treated with bilateral tonsillectomy followed by adjuvant radiotherapy. We report, to our knowledge, the first case of bilateral synchronous tonsillar squamous cell carcinoma treated only with chemoradiotherapy without tonsillectomy.

Chronic pelvic abscedation after completion proctectomy in a rectal stump insufficiency; treatment with gracilis muscle flap following vacuum assisted closure therapy.

Presacral abscess formation due to rectal stump insufficiency following Hartmann procedure is very rare complication. If the abscess cavity is large, it might delay the reversal of the stoma and will probably result in a devastating future functioning of the neorectum. Moreover, very invasive treatments will be required in order to prevent severe septic complications. We present the case of a 58-year-old man with a past history of Hartmann procedure for a low rectal carcinoma who presented with rectal stump insufficiency and a large presacral abscess. Following extensive debridement and rectal stump resection, a vacuum-assisted closure (VAC) system was applied to the large abscess cavity to facilitate gracilis muscle flap reconstruction and to optimize wound healing. The satisfactory results showed in the present report led us to favor a combination of VAC therapy and a gracilis muscle flap in intrapelvic and perineal reconstruction in the case of large defects associated with high risks of septic complications.

Chemotherapy in elderly patients with metastatic gastric cancer; a single Turkish cancer center experience.

AIM: To analyze the results of chemotherapy applied at the Bülent Ecevit University School of Medicine, Department of Medical Oncology, to elderly patients with metastatic gastric cancer (GC). METHODS: The study retrospectively investigated hospital records including pathological reports, imaging records, chemotherapy regimens, response and toxicity profile. All patients received systemic chemotherapy for pathologically proven metastatic GC at the Bülent Ecevit University School of Medicine, Department of Medical Oncology. RESULTS: From 2005 to 2012, 23 metastatic GC patients older than 70 years were treated with systemic chemotherapy as a first-line therapy. As the first-line chemotherapy, 17 (74%) patients received polychemotherapy and the remaining six (26%) patients received monotherapy. Overall, 113 cycles were administered. The median progression free survival (PFS) for the first-line chemotherapy was 6 months (95% CI, 0-16) and the median overall survival (OS) was 14 months (95% CI, 3-30). Multivariate analysis revealed that decreased OS was significantly associated with poor Eastern Cooperative Oncology Group (ECOG) performance status (p=0.045), elevated carcinoembryonic antigen (CEA) levels at the diagnosis time (p = 0.040) and decreased number of chemotherapy cycles (p=0.019) with R-Sq (adj) = 41, 6%. One patient had a complete response with docetaxel, cisplatin and fluorouracil combined (DCF) regimen and had 12 months of disease free survival (DFS). CONCLUSION: This is the first study investigating the outcomes of chemotherapy in Turkish elderly metastatic GC patients. Docetaxel, cisplatin and fluorouracil combination were the most common regimen, which is a tolerable and effective choice in elderly patients who had good performance status.

Protection by L-carnitine against radiation-induced ileal mucosal injury in the rat: pattern of oxidative stress, apoptosis and cytokines.

PURPOSE: In this study, we tested the effects of L-carnitine (LC) on radiation-induced ileal mucosal damage. MATERIALS AND METHODS: Thirty Wistar albino rats were divided into five groups. The control group received physiological saline intraperitoneally (i.p.). Radiation-1 and radiation-2 groups received whole-body X-irradiation of 8.3 Gy as a single dose. These groups were sacrificed at the 6th hour and 4th day after irradiation, respectively. The Radiation-1 + LC and the radiation-2 + LC groups received the same dose irradiation plus a daily dose of 200 mg/kg LC. LC was applied one day before and for four days after irradiation. RESULTS: The levels of serum monocyte chemotactic protein-1 (MCP-1) and interferon gamma (IFN-γ) were significantly higher in the radiation groups when compared with the control. Treatment with LC decreased the serum MCP-1 and IFN-γ levels considerably. In the radiations groups, the Chiu score was significantly elevated compared with that of the control group. However, LC administered prior to the irradiation reduced the severity of mucosal damage. The number of apoptotic cells of the ileal crypt in the irradiated rats increased from the 6th hour after irradiation and then decreased at 4th day. CONCLUSIONS: Our data demonstrated that LC may be beneficial to radiation enteritis.

Effects of ozone oxidative preconditioning on radiation-induced organ damage in rats.

Because radiation-induced cellular damage is attributed primarily to harmful effects of free radicals, molecules with direct free radical scavenging properties are particularly promising as radioprotectors. It has been demonstrated that controlled ozone administration may promote an adaptation to oxidative stress, preventing the damage induced by reactive oxygen species. Thus, we hypothesized that ozone would ameliorate oxidative damage caused by total body irradiation (TBI) with a single dose of 6 Gy in rat liver and ileum tissues. Rats were randomly divided into groups as follows: control group; saline-treated and irradiated (IR) groups; and ozone oxidative preconditioning (OOP) and IR groups. Animals were exposed to TBI after a 5-day intraperitoneal pretreatment with either saline or ozone (1 mg/kg/day). They were decapitated at either 6 h or 72 h after TBI. Plasma, liver and ileum samples were obtained. Serum AST, ALT and TNF-α levels were elevated in the IR groups compared with the control group and were decreased after treatment with OOP. TBI resulted in a significant increase in the levels of MDA in the liver and ileal tissues and a decrease of SOD activities. The results demonstrated that the levels of MDA liver and ileal tissues in irradiated rats that were pretreated with ozone were significantly decreased, while SOD activities were significantly increased. OOP reversed all histopathological alterations induced by irradiation. In conclusion, data obtained from this study indicated that ozone could increase the endogenous antioxidant defense mechanism in rats and there by protect the animals from radiation-induced organ toxicity.

Effects of ozonated olive oil on acute radiation proctitis in rats.

BACKGROUND: Acute radiation proctitis is a common complication of pelvic radiation and management of acute radiation proctitis is under evaluation. The beneficial effects of ozonated olive oil (OzOO) have already been shown in the treatment of chronic wounds. Thus, this study was designed to evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. AIMS: To evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. STUDY DESIGN: Animal experimentation. METHODS: RATS WERE DIVIDED INTO THREE GROUPS: control; irradiation+saline (1 mL); and irradiation +OzOO (1 mL). A single fraction of 17.5 Gy was delivered to each rat. The OzOO was administered rectally each day after irradiation. Each rat was observed daily for signs of proctitis. Irradiated rats were euthanised on days 5 and 10. The mucosal changes were evaluated macroscopically and pathologically. RESULTS: According to the clinical findings, five rats in the irradiation+saline group showed Grade 4 symptoms on the 10(th) day. Macroscopic finding scores on the 10(th) day in the irradiation+saline and irradiation+OzOO groups were statistically significantly different. On pathological examination, radiation-induced mucosal damage was the most prominent 10 days after irradiation in saline-treated rats. On the 10(th) day, the irradiation+OzOO group showed mild inflammation and slight crypt change, which corresponded to Grade 1 pathological findings. CONCLUSION: OzOO attenuates macroscopic and pathological findings of acute radiation proctitis in rats.