Protective effects of rectal ozone administration on colon anastomoses following radiotherapy.

BACKGROUND: Anastomotic leakage (AL) following rectal surgery is associated with increased mortality and morbidity. Neoadjuvant radiotherapy disrupts the wound healing process in rectal surgery. OBJECTIVES: To evaluate the effects of intra-rectal ozone application on rectal anastomoses after radiotherapy. MATERIAL AND METHODS: This study was performed on animals. Thirty-two male Wistar rats were randomly divided into 4 groups: control group, ozone group, radiotherapy group, and radiotherapy/ozone group. Ozone was administered intrarectally in the ozone group and water was administered intrarectally in rthe control group for 5 days. The radiotherapy group received 20 Gy of pelvic radiotherapy. The radiotherapy/ozone group received 20 Gy of pelvic radiotherapy after the administration of ozone. Afterward, colon resection followed by an anastomosis were performed under general anesthesia in all groups. Anastomotic segments were resected to evaluate tissue hydroxyproline (HYP) and myeloperoxidase (MPO) levels, perform a histological evaluation, and measure bursting pressure. RESULTS: There were no statistically significant differences between groups regarding tissue MPO levels (p = 0.55). Tissue HYP levels were significantly decreased in the radiotherapy group (p = 0.04). Bursting pressure was found to be significantly lower in the radiotherapy group (p < 0.05). No significant differences were found between adhesion scores in the control and ozone groups. Exudate formation was significantly lower in the radiotherapy group (p < 0.05). The lowest macrophage scores were found in the radiotherapy group (p < 0.05). Fibroblast scores were the highest in the control group and the lowest in the radiotherapy group (p < 0.05). CONCLUSIONS: Intra-rectal ozone application significantly improved the anastomotic healing process after radiation exposure.

Ibtisam Lale Atahan (1946-2007): The first female Turkish physician in the discipline of radiation oncology.

Female physicians started to earn up their deserved places as late 1970's in the historically male predominant Radiation Oncology community. The first female physician emerging as a leading scientist in the Discipline of Radiation Oncology was Professor Ibtisam Lale Atahan, who untimely passed away in 2007. This eulogy attempts to shine the light on her life, achivements and legacy.

Adjuvant radiotherapy for Stage I seminoma: A Single-institutional experience.

OBJECTIVES: There is no consensus regarding the management of Stage 1 seminomas following inguinal orchiectomy. In this study, we evaluated the treatment results and treatment-related toxicity for patients with Stage 1 seminomas treated with adjuvant radiotherapy (RT) at a single institution. METHODS: Sixty-five patients who underwent adjuvant RT following orchiectomy for Stage 1 seminomas between January 1996 and December 2007 were retrospectively reviewed. The age, tumor location, histopathological type, stage, tumor size, RT field, and radiation dose were recorded for all patients. RESULTS: The patients' ages ranged from 17 to 61 years (median, 37 years). Sixty-three patients (97%) were diagnosed with classical seminoma and the remaining two patients (3%) had spermatocytic seminoma. After orchiectomy, 37 patients (57%) received para-aortic RT and 28 patients (43%) received dog-leg field RT. RT was applied with 1.8-2 Gy/day fractionation and the median RT dose was 26 Gy (range, 20-38). Follow-up ranged from 0.3 to 18 years (median, 9.5 years). Local control had been achieved in all patients and all of them were alive with no evidence of disease. Fifty-one patients (77%) had at least 5 years of follow-up and 27 patients (41%) had at least 10 years of follow-up. Overall survival at 10 years was 100%. CONCLUSION: Although retrospective in nature, this single-institutional study provides useful information about the outcomes and toxicities associated with adjuvant RT in patients with Stage 1 seminomas reporting excellent disease control and survival rates at the expense of acceptable toxicity.

Role of vascular endothelial growth factor in clinically localized prostate cancer treated with radiation therapy.

BACKGROUND: Anti-vascular endothelial growth factor (Anti-VEGF) agents are a promising approach to increase the efficacy of treatment for treatment-resistant prostate cancer. AIMS: To correlate vascular endothelial growth factor (VEGF) expression and outcome following radiation therapy in the treatment of clinically localized prostate cancer. STUDY DESIGN: Retrospective observational study. METHODS: Forty-one patients and clinically localized disease that were treated with radiation therapy were analyzed. For VEGF expression, immunoreactivity scores (IRS) were calculated using percent scores and intensity scores. Twenty-four patients were classified as having low (0 to 4 IRS) and 17 patients were classified as having high (5 to 8 IRS) VEGF expression. RESULTS: The median age was 71 years, median follow-up was 5.4 years and median radiation therapy dose was 70 Gy. VEGF expression was calculated as low in 24 patients and high in 17 patients. Higher VEGF expression was observed in 6/26 patients with a low Gleason score versus 11/15 patients with a high Gleason score (p=0.02). Biochemical failure (BF) was observed in 2/24 patients with low VEGF expression versus 7/17 patients with high VEGF expression (p=0.01). In univariate analysis, having a higher Gleason score (p<0.01), being in the high risk group (p=0.03) and having higher VEGF expression (p=0.01) predicted BF after definitive radiation therapy. The biochemical failure-free survival rate at 5 years tended to be different (91% vs. 53%) when patients were grouped according to VEGF expression (p=0.06). CONCLUSION: In attempt to define patients with clinically localized disease that are not sensitive to standard treatment modalities, cellular and/or molecular biological markers may be required.

Assessment of early and late dysphagia using videofluoroscopy and quality of life questionnaires in patients with head and neck cancer treated with radiation therapy.

BACKGORUND: The aim of this study was to evaluate dysphagia in patients with head and neck cancer (HNC) undergoing three-dimensional conformal radiation therapy using objective and subjective tools simultaneously and to associate the clinical correlates of dysphagia with dosimetric parameters. METHODS: Twenty patients were included in the study. The primary tumor and the involved lymph nodes (LN) were treated with 66-70 Gy, the uninvolved LN were treated with 46-50 Gy. Six swallowing structures were identified: the superior pharyngeal constrictor muscle (SPCM), the middle pharyngeal constrictor muscle (MPCM), the inferior pharyngeal constrictor muscle (IPCM), the base of tongue (BOT), the larynx and the proximal esophageal sphincter (PES). Dysphagia was evaluated using videofluoroscopy and European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaire (QLQ-C30) and supplemental EORTC QoL module for HNC (QLQ-H&N35). The evaluations were performed before treatment, at 3 months and at 6 months following treatment. RESULTS: On objective evaluation, the Dmax for the larynx and the sub-structures of the PCM were correlated with impaired lingual movement, BOT weakness and proximal esophageal stricture at 3 months, whereas the V65, the V70and the Dmax for the larynx was correlated with BOT weakness and the V65, the V70, the Dmax or the Dmean for the sub-structures of the PCM were correlated with impaired lingual movement, BOT weakness, reduced laryngeal elevation, reduced epiglottic inversion and aspiration at 6 months following treatment. On subjective evaluation, the V60, the Dmax and the Dmean for SPCM were correlated with QoL scores for HNSO at 3 months, whereas the V70 for SPCM were correlated with QoL scores for HNPA and the V60, the V65, the V70, the Dmax and the Dmean for SPCM were correlated with QoL scores for HNSO at 6 months following treatment. CONCLUSIONS: The use of multiple dysphagia-related endpoints to complement eachother rather than to overlap with one another, as well as the use of multiple evaluations over time to represent a scale of early to late findings might provide a better insight in terms of the association of the clinical correlates of dysphagia with the dose-volume data for the dysphagia-related anatomical structures.

Solitary angiokeratoma of the tongue in an adult patient treated with intensity modulated radiation therapy.

A solitary mucosal angiokeratoma is an extremely rare presentation. In this report, we present a 67-year-old woman with a 3 cm solitary angiokeratoma involving the tongue, who was treated with intensity modulated radiation therapy after declining surgery. The patient is alive and free of disease at 1.5 years following radiation therapy.