The Effect of Music on Anxiety, Pain Levels, and Physiological Parameters in Women Undergoing Brachytherapy: A Randomized Controlled Trial.

OBJECTIVES: This study was conducted to investigate the effect of music on anxiety, pain, and physiologic parameters in women undergoing brachytherapy. DATA SOURCES: The study was conducted with a randomized controlled design between June and December 2022. Music intervention was practiced to the patients in the experimental group (n = 30), while no practice was given to the control group (n = 25). In the study, the data were collected using the Descriptive Information Form, Hospital Anxiety and Depression Scale, visual analog scale, and vital signs (temperature, pulse rate, blood pressure, respiratory rate, SpO2) recording form. Intergroup and intragroup averages were evaluated by the mixed-design analysis of variance. Variables with pre-post intervention designs were evaluated with the one-way analysis of covariance. There was no significant difference in physiological parameters between the groups (P > . 05). Although the mean anxiety scores decreased in the music group and increased in the control group, there was no statistically significant difference (P > .05). A significant difference was found in the pain levels of the patients in repeated measurements made in intragroup evaluations (P < .001). The depression mean of the music intervention group was significantly lower than the control group (P ≤ .05). CONCLUSION: It was concluded that the music played during the brachytherapy process had positive effects on feeling less pain and management of depressive symptoms but did not affect anxiety and physiological parameters. Since each patient is different, the effects of music therapy can vary individually. IMPLICATIONS FOR NURSING PRACTICE: Nurses should apply different strategies to investigate session frequencies and durations for different patient groups and treatment stages in cancer care.

Prognostic value of primary tumor and lymph node volumetric metabolic parameters at pre-treatment F-18 FDG PET/CT in nasopharyngeal carcinoma.

BACKGROUND: The aim of this study was to evaluate the prognostic significance of volumetric metabolic parameters of pre-treatment PET/CT along with clinical characteristics in patients with non-metastatic nasopharyngeal carcinoma. MATERIAL AND METHODS: Seventy-nine patients with nasopharyngeal carcinoma underwent F18- FDG PET/CT for pretreatment evaluation and included in this study. The patient features (patient age, tumor histopathology, T and N stage, size of primary tumor and the largest cervical lymph node) and PET parameters were analyzed: maximum, mean and peak standardized uptake values (SUVmax, SUVmean, SUVpeak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumor and largest cervical lymph node. After treatment, patients were evaluated for disease progression and mortality. Survival analysis for progression-free survival (PFS) and over-all survival (OS) was performed with Kaplan-Meier method using PET findings and clinical characteristics. RESULTS: The median follow-up duration was 29.7 months (range 3-125 months). Among clinical characteristics, no parameters had significance association for PFS. Primary tumor-MTV and cervical lymph node-MTV were independent prognostic factors for PFS (p = 0.025 and p = 0.004, respectively).Patients with primary tumor-MTV >19.4 and patients with lymph node-MTV>3.4 had shorter PFS. For OS, age and the size of the lymph node were independent prognostic factor (p = 0.031 and p = 0.029).Patients with age over 54 years and patients with lymph node size >1 cm were associated with decreased OS. CONCLUSION: Primary tumor-MTV and lymph node-MTV on pre-treatment PET/CT are significant prognostic factors for long-term PFS in non-metastatic nasopharyngeal carcinoma. We consider that measuring MTV as volume-based metabolic parameter on pretreatment PET/CT may contribute decision of treatment intensity and individualized risk stratification and may improve long-term PFS. Additionally, age and the size of lymph node are independent prognostic factors for mortality.

Determination of the factors contributing to depression and anxiety in advanced stage lung cancer patients.

Background: The diagnosis of cancer and initiation of treatment disrupt physical, emotional, and socio-economical stability of the patients by reducing the quality of lives and ultimately leading to depression and anxiety. We aimed to observe the indicators for anxiety and depression among lung cancer (LC) patients by comparing with other cancer (OC) patients. Methods: This study has been conducted between 2017 and 2019. Questionnaires were provided for both LC and OC patients. Results: Two hundred and thirty patients with the ages varied between 18 and 86 (median: 64.0) were included in the study. A total of 115 patients (case group) were diagnosed as LC, and the remaining were with OC diagnosis (control). No difference was determined between the groups in means of median anxiety and depression scores. Patients who required assistance in hospital procedures, daily life activities, and self-care had higher depression and anxiety scores (p < 0.05) compared to those did not require assistance. Anxiety and depression scores in OC groups showed a remarkable difference according to performance status (p < 0.001). The depression score of the patients who stated that they did not know their social rights was remarkably higher than those of the patients who stated that they know their social rights. We found no relationship between depression and anxiety scores because of disease caused income loss and expense increase. Conclusion: For LC patients, declaration of requirement for assistance and supportive care in daily life can be an important indication for anxiety and depression. Lung cancer patients, especially those informed by health care professionals and provided psychosocial support following the information, require a patient-specific professional management approach.

The effect of lower urinary tract substructure doses on side effects of cervical cancer image-guided adaptive brachytherapy.

OBJECTIVE: Image-Guided Adaptive Brachytherapy (IGABT) provides a survival advantage in locally advanced cervical cancer (LACC). Although side effects are seen less with this technique, dose parameters that cause urinary side effects are still questionable. We aim to investigate whether the radiotherapy doses of the lower urinary tract substructures (LUSS) affect the urinary system side effects (USSE) of cervical cancer external beam radiotherapy (EBRT) and the IGABT. METHODS: LUSS (bladder, trigone, bladder neck, and urethra) doses were calculated in 40 patients diagnosed with LACC and receiving primary EBRT, IGABT, and concomitant chemotherapy. D0.1cc, D2cc, and D50% values were examined by contouring the bladder, trigone, bladder neck, and urethra from the intracavitary BT planning computed tomography (CT) images taken every 4 BT fractions, retrospectively. Besides, late USSE (urgency, dysuria (recurrent), frequency, obstruction, incontinence, hematuria, fistula, cystitis) were queried and categorized according to Common Toxicity Criteria for Adverse Events version 5.0. STATISTICAL ANALYSIS USED: The Chi-square and Fisher's exact tests, Mann-Whitney U-test. RESULTS: For the whole study population, for both incontinence and dysuria, trigone (D50%), urethra (D50%, D0.1cc,), and bladder neck (D50%, D0.1cc, D2cc) volume and hot spot doses remained significant. For cystitis, urethra (D50%, D0.1cc,) and bladder neck doses (D0.1cc, D50%, D2cc) are worth investigating. CONCLUSIONS: Although USSE is less common in the intensity-modulated radiation therapy and IGABT era, it may be meaningful to take the doses of LUSS into account when planning IGABT. In addition, delineation of LUSS using only CT seems feasible. More proof is needed to determine delineation technique and dose constraints for LUSS for IGABT.

Evaluation of the voluntary deep inspiration breath-hold reproducibility in left-sided breast radiotherapy.

PURPOSE: Voluntary deep inspiration breath hold (v-DIBH) reduces cardiac dose during left-sided breast irradiation. The purpose of this study is to evaluate the reproducibility and variability of breath-hold level (BHL) using breath-hold curves and lateral kV setup images together. MATERIAL/METHOD: A retrospective analysis of 30 left breast cancer patients treated using the v-DIBH technique in our department is performed. The BHL difference is measured from breath hold curves and lateral (LAT) kilo-Voltage (kV) setup images. The planning CT image and the selected treatment fraction data are collected. If the changes in BHL relate to the displacement of various bones in the kV setup, images are assessed. Furthermore, the maximum heart distance inside the treatment field is compared from LAT MV portal images. RESULTS: The median and mean values of the BHL are nearly identical in different fractions (good reproducibility). However, the mean BHL values between planning and all measured fractions are statistically different; 16.3 vs. 20.8 mm for the planning and measured fractions (p < 0.001), which indicates that the variability of BHL is significantly different. CONCLUSION: While reproducibility testing shows good agreement for inter-fractional breath-hold level, the variability between planning and fractions is relatively poor.

Awareness and attitudes of oncology physicians recommending exercise to patients with cancer.

Objectives: The aim of our study was to evaluate oncology physicians' attitudes and awareness toward recommending exercise to their patients with cancer. Patients and methods: A total of 86 oncology physicians (52 males, 34 females; mean age: 46.7±10.9 years; range, 26 to 60 years) were included in the study between June 2019 and September 2019. A questionnaire was prepared to evaluate the physicians' perspectives about exercise and it consisted of five main sections including the physician's exercise habits, physicians' attitudes toward recommending exercise, the effects of exercise on cancer-related symptoms and cancer treatments, whether there was an exercise unit in the hospital, and whether the physician was referring the patients and on which subjects the physicians were willing to receive training. Results: A total of 87.2% of the physicians recommended exercise to their patients. There were three reasons for physicians who did not recommend exercise: "I don't have enough training to recommend exercise; I don't know which type of exercise to recommend; and I don't know what I should pay attention while recommending exercise." A total of 83.7% physicians considered that exercise reduced the symptoms associated with cancer. A total of 73.3%, 64%, and 80.2% physicians believed that exercise increased the effectiveness of chemotherapy, radiotherapy, and immunotherapy, respectively. About 94.2% of the physicians were willing to be trained on the effects of exercise in cancer. Conclusion: Oncology physicians believe that exercise has positive effects on cancer; however, they still need training on this subject.

Effects of palliative radiotherapy and bisphosphonate usage on bone turnover marker levels in cancer patients with osteolytic bone metastases.

OBJECTIVES: In this study, we aimed to investigate the bone turnover marker levels according to bisphosphonate usage and radiotherapy (RT) in cancer patients with metastases in osteolytic pattern. PATIENTS AND METHODS: A total of 52 patients (13 males, 39 females; median age: 52 years; range, 37 to 78 years) treated with RT for osteolytic bone metastases between April 2005 and April 2006 were retrospectively analyzed. Bone-specific alkaline phosphatase (BAP), amino-terminal cross-linked telopeptide of type I collagen (NTX-I), amino-terminal propeptide of type I procollagen (PINP), osteocalcin (OC), deoxypyridinoline (DPD), pyridinoline (PYD), alkaline phosphatase (ALP), creatinine, calcium (Ca), phosphate (P), magnesium (Mg), and 24-h urine Ca levels were measured in blood and urine before the initiation of RT, six weeks and six months after RT. RESULTS: A decrease in BAP, PINP, and creatinine levels was observed after RT (Week 6 p=0.006, Month 6 p=0.008). Sixteen patients who already used bisphosphonate before RT were excluded from statistical calculation. The remaining 36 patients who were treated with bisphosphonate after the first blood test were evaluated separately. In this group of patients, BAP, PINP, NTX, creatinine, and Ca levels significantly increased at six weeks after RT. The PINP and creatinine values significantly decreased at six months after RT. The variation between two different RT arms was assessed with repeated measures variance analysis. There was a statistically significant difference for NTX, OC, and creatinine levels between the first and second measurements. CONCLUSION: Radiotherapy is an effective method in the treatment of osteolytic bone metastases. Bone turnover markers can provide an objective evaluation on RT response and parallel to imaging modalities criteria for evaluation. Bisphosphonates may alter the levels of these indicators. However, in this study, there were no statistically significant differences between the levels of markers for two different RT schedules.

Investigation of the Spiritual Care Effects on Anxiety, Depression, Psychological Distress and Spiritual Levels of Turkish Muslim Radiotherapy Patients.

The aim of this study is to examine the spiritual care support given to Muslim cancer patients undergoing radiotherapy with an experimental study on the spirituality, anxiety, depression and distress levels of these patients. In this study, experimental research design with experimental control group was used. Personal information form designed by researchers, HAD scale, DT scale and Spirituality Scale was used for personal information. In conclusion, it was determined that the support for Islamic spiritual care had positive effects on hospitalized radiotherapy patients. According to the results obtained, it is recommended to examine in larger sample groups in different treatment programs in order to reveal the effect of spiritual care support.

Development of palliative care services in Turkey.

INTRODUCTION: Palliative care (PC) is a holistic philosophy of care that can only be obtained through the awareness of public and healthcare professionals, PC training and good integration into the health system. Depending on health system structures, there are differences in PC models and organisations in various countries. This study is designed to evaluate the current status of PC services in Turkey, which is strongly supported by national health policies. METHODS: The data were collected through official correspondence with the Ministry of Health, Provincial Directorate of Health and hospital authorities. Numbers of patients who received inpatient PC, the number of hospital beds, diagnosis of disease, duration of hospitalisation, the first three symptoms as the cause of hospitalisation, opioid use, place of discharge and mortality rates were evaluated. RESULTS: A total of 48,953 patients received inpatient PC support in 199 PC centres with 2,429 beds over a 26-month period. The most frequent diagnosis for hospitalisation was cancer (35%), and the most common symptom was pain (25%). Opioids were used in 26.7% of patients. CONCLUSION: Steps should be taken for PC training and providing continuity through organisations outside the hospital and home care.

The contribution of hospital-based home health services in pulmonary diseases: Current Practice in Turkey.

BACKGROUND: The medical management of chronic respiratory diseases becomes more difficult with the increase in the rate of the elderly population. Monitoring and treating chronic respiratory diseases at home are more comfortable for both the patient and their relatives. Therefore, countries need to develop policies regarding home health services (HHS) according to the state of their social, cultural, and financial infrastructure. OBJECTIVE: The objective of this study is to show the role and contribution of hospital-based HHS regarding respiratory disorders, and to evaluate the model and its efficiency. STUDY DESIGN: The design of this study was cross-sectional. Data were obtained from the Ministry of Health of Turkey with official permission. Data were collected for HHS concerning respiratory diseases between 2011 and 2017. Age and sex distribution, the number of recorded patients, the number of visits for pulmonary diseases, the distribution of institutional visits, and the quantitative alterations within the years were investigated. STUDY POPULATION: The study population was based on patients with respiratory disorders who were given HHS as directed by the Ministry of Health of Turkey. RESULTS: Between 2011 and 2017, the majority of patients with pulmonary diseases, mostly those with chronic obstructive pulmonary disease, asthma, and lung cancer, visited government hospitals (78%). The number of house visits concerning pulmonary disorders increased nearly ten times, but hospitalization due to respiratory diseases decreased (13.5% in 2011 to 12.9% in 2017). CONCLUSION: Hospital-based HHS in pulmonary diseases can be considered as an appropriate model for implementation for countries like Turkey, those that have inadequate hospice-type health service infrastructure.

Turkish Ministry of Health, 2nd Turkish Medical General Assembly Clinical Oncology Study Group Report.

OBJECTIVE: There is an increase in the incidence of cancer, and consequently in mortality rates, both in the world and in Turkey. The increase in the incidence and mortality rate of cancer are more prominent in our country as well as in other developing countries. The aim of this workshop was to determine the current status on prevention, screening, early diagnosis and treatment of cancer in our country, to identify related shortcomings, specify solutions and to share these with health system operators, and to aid in implementation of these systems. Developments on palliative care were also evaluated. MATERIALS AND METHODS: The current situation in the practice of clinical oncology, related drawbacks, problems encountered during multidisciplinary approach and their solutions were discussed under several sub-headings during a 3-day meeting organized by the Turkish Ministry of Health (Türkiye Cumhuriyeti Saglik Bakanligi-TCSB) with participation of 16 scientists from Turkey and 6 from abroad, and the conclusions were reported. RESULTS: It is expected that the newly established Turkish Health Institutes Association (Türkiye Saglik Enstitüleri Baskanligi-TÜSEB) and the National Cancer Institute (Ulusal Kanser Enstitüsü) will provide a new framework in the field of oncology. The current positive findings include the increase in the number of scientists who carry out successful trials in oncology both in Turkey and abroad, the implementation of the national cancer registry program by the Cancer Control Department and the breast cancer registry program by the Turkish Federation of Breast Diseases Societies (Türkiye Meme Hastaliklari Dernekleri Federasyonu-TMHDF), and introduction of Cancer Early Diagnosis, Screening, and Training Centers (Kanser Erken Tani, Tarama ve Egitim Merkezi-KETEM) for the application of community-based cancer screening programs. In addition to these, obvious shortcomings related to education, implementation, management and research issues were also determined, and policy and project proposals to address these issues were presented. Collaboration with relevant organizations in the implementation of these studies was supported. CONCLUSION: Both the incidence and mortality rates of cancer are increasing in Turkey. The widespread deficiencies in population-based screening and in effective treatment lead to an increase in delay in diagnosis and mortality. Despite improvements in data recording, screening and treatment over the last 10 years, extensive, organized, population-based screening programs and fully equipped early diagnosis and treatment centers are required. Enhancement of basic cancer epidemiologic, translational, genetic and molecular research studies is essential in our country. Improvements on pain treatment and palliative care of patients with chronic and terminal cancer are also required.

Planning of nuclear medicine in Turkey: current status and future perspectives.

BACKGROUND AND PURPOSE: An analysis of the current nuclear medicine (NM) status and future demand in Turkey in line with the international benchmarks was conducted to establish a comprehensive baseline reference. METHODS: Data from all NM centers on major equipment and manpower in Turkey were collected through a survey and cross-checked with the primary research and governmental data. Data regarding manpower currently working were obtained from the relevant academic centers and occupational societies. RESULTS: The current numbers of NM laboratories, NM specialists, gamma cameras, PET/CT scanners, radioiodine treatment units for thyroid cancer are 217, 474, 287, 75 and 39, respectively. There was personnel and equipment need underestimated in the field compared to developed countries. Equipment insufficiency was more significant in the Ministry of Health (MoH) hospitals. These gaps should be eliminated with strategic planning of equipment and NM laboratories. Currently, the number of the PET/CT devices is at the level of the developed countries. The number of specialists in the field should reach the expected goal in 2023. By 2023, Turkey will need around 820 NM specialists, 498 gamma cameras and 99 PET/CT devices. In addition, further studies should be made regarding other related staff, particularly for health physicians, radiopharmacists and NM technicians. CONCLUSION: There is an insufficiency of personnel and equipment in Turkey's NM field. Comprehensive strategic planning is required to allocate limited resources and the purchase of the equipment and employment policies should be structured as part of " National Special Feature Requiring Health Service Plan".

Radiotherapy applications of patients with malignant mesothelioma: A single center experience.

BACKGROUND: In the management of malignant pleural mesothelioma, radiotherapy has been used for the purpose of prophylaxis to reduce the incidence of recurrence at surgical insertion sites or palliate the symptoms. AIM: The purpose of the study was to evaluate the techniques and effectiveness of radiotherapy in malignant pleural mesothelioma. MATERIALS AND METHODS: Forty-four (18 female, 26 male) patients diagnosed with malignant pleural mesothelioma were retrospectively evaluated. All patients had surgery or thoracoscopic biopsy for diagnosis, staging or treatment and all received palliative or prophylactic radiotherapy. Fifty-seven percent of the patients received chemotherapy. RESULTS: Prophylactic radiation was applied to 27 patients with 4-15 MeV electron energies. The median radiotherapy dose was 30 Gy with 3 Gy daily fraction dose. During treatment, 12 patients had grade 1 erythema according to the RTOG scale. In 3 (12%) patients, a local failure at treatment field was observed. Palliative radiotherapy was applied to 17 patients for pain palliation. The median radiation dose was 40 Gy with 2 Gy daily fraction dose by using 6-18 MV photon and/or 4-12 MeV electron energies. Two patients had grade 1 erythema and one patient had grade 2 odynophagy according to the RTOG scale. For 10 (59%) patients, palliation of chest pain was delivered. No late toxicity was observed for all cases. CONCLUSION: Our experience showed that prophylactic and palliative radiotherapy are effective and safe therapy modalities in malignant pleural mesothelioma in preventing seeding metastasis at intervention sites or relieving pain. Prospective randomized studies are still needed to determine the benefits of radiotherapy application and to indicate optimum dose schemes.

Opioids for cancer pain: availability, accessibility, and regulatory barriers in Turkey and Pallia-Turk Project.

Palliative care is an emerging topic in Turkey within recent years. Currently, there are only few number of palliative care services across the country and majority of the centers are pain control units. Morphine consumption rate per capita is low, accessibility and availability of morphine products are also limited. One of the main headings of Turkish Cancer Control Programme 2009-2015 is palliative care and a serial palliative care unit implementation with continuous training programmes is planned to be finalized until 2015. This article reviews the current palliative care situation in Turkey, opioid availability in Turkey and also briefly summarizes Pallia-Turk Project which is unique with respect to many different aspects for implementation, and can be a good model for many other countries that still did not have such an implemented palliative care program.

Determination of parameters affecting the use of complementary and alternative medicine in cancer patients and detection of prevalence of use.

This study was conducted to find out the frequency of complementary and alternative medicine (CAM) use that could lead to troubles in patient health and in applied standard therapy protocols when used improperly, which method is used, the reasons for use and from which resources the information about this topic were obtained. A questionnaire consisting of 28 questions was applied to 195 patients with cancer diagnosis by a face-to-face interview. The obtained data were assessed with SPSS 11.5 program. Out of 195 cancer patients, 100 (51.3%) were using CAM and 48.7% (n=95) were not. The most commonly used agent was nettle (72%). This was followed by herbal teas (21%), grape molasses (20%) and black seed (20%). The frequency of CAM use was found higher in those under age 50, in literate people, in those working during the diagnosis stage and having disease at the later stage. While CAM was commonly recommended by friends and relatives of the patients (73%), this ratio was only 5% for health professionals. While 51.3% of all patients were gathering information about CAM, 75% of those actually using CAM gathered information about it. Whilst information was gathered mostly from the relatives of patients and tamperers (47%), it can be gathered from physicians only with a ratio of 10%. Cancer patients use CAM and they gather information mainly from unreliable sources rather than physicians. Although the primary information source should be physicians, the ratio for this was very low (10%). We suggest that physicians should spend more time in gathering correct information and sharing them with their patients for a better guidance.

Radiation oncology facilities in Turkey: current status and future perspectives.

BACKGROUND AND PURPOSE: An analysis of the current radiotherapy status in Turkey was conducted to establish a comprehensive baseline. Turkey's future demand analysis in view of international benchmarks was conducted. Moreover, the ministerial plans are shared to present an example for making a comprehensive planning in developing countries. METHODS: The data from all radiotherapy centers in Turkey was collected through a survey and cross-checked with primary research and government data. Survey covered the status of radiotherapy centers in terms of major equipment and personnel. Data regarding manpower currently working is obtained from relevant academic centers and occupational associations. RESULTS: The latest ministerial registry data demonstrated 150,000 new cancer cases each year with 400,000 patients living with cancer in Turkey. Around 100,000 patients are estimated to need radiotherapy each year--a figure expected to reach around 170,000 by 2023. The current numbers for radiotherapy centers, megavoltage equipment, radiation oncologists, medical physicists and radiotherapy technicians are 90, 186, 446, 130 and 600 respectively. By 2023, Turkey will need around 680 radiation oncologists, 624 medical physicists, 2,650 radiotherapy technicians and 379 megavoltage machines. CONCLUSION: Turkey faces a slight oversupply of radiation oncologists in contrast to undersupply in megavoltage machines and other personnel. Careful planning is required to allocate limited resources. The purchase of the equipment and employment policies should be structured as part of national cancer control program.

Outcome of newly diagnosed glioblastoma patients treated by radiotherapy plus concomitant and adjuvant temozolomide: a long-term analysis.

AIMS AND BACKGROUND: Glioblastoma is the most common primary brain tumor in adults. The standard treatment is surgery and radiotherapy. In this study, the results of radiotherapy plus concomitant and adjuvant temozolomide are reported. In addition, the efficiency of adjuvant temozolomide is evaluated. METHODS AND STUDY DESIGN: Forty-one patients were analyzed. All patients received radiotherapy (2 Gy daily fractionation dose, median 60 Gy total doses) and concomitant temozolomide (at a daily dose of 75 mg/m2/day, 7 days per week) after surgery. Thirty-one patients received an average of 6 cycles (range, 1-8 cycles) of adjuvant temozolomide after radiotherapy, every 28 days for 5 days at a dose of 200 mg/m2/day. The primary end point was overall survival. RESULTS: The median overall survival was 16.7 months. The overall survival significantly increased in the adjuvant temozolomide group compared to the group with no adjuvant therapy (18.9 vs 9.8 months). The difference in overall survival between adjuvant temozolomide cycles of < or = and > 3 was significant (8.7 vs 20 months). On multivariate analyses, the important prognostic factors were type of surgery and application of adjuvant temozolomide for at least 4 cycles. Grade III/IV toxicity was seen in 4% and 6.5% of patients during concomitant and adjuvant therapy, respectively. CONCLUSIONS: The study confirmed the effectiveness of radiotherapy plus temozolomide in newly diagnosed glioblastoma. It was established that the application of adjuvant temozolomide for at least 4 cycles is required to obtain a benefit from adjuvant therapy. However, further studies are needed to confirm these data.

Effects of soluble fiber on matrix metalloproteinase-2 activity and healing of colon anastomosis in rats given radiotherapy.

BACKGROUND AND AIMS: Soluble fiber is fermented by colonic microflora yielding short-chain fatty acids (SCFAs) in the colon. We aimed to investigate the effect of oral administration of soluble fiber on healing of anastomosis and matrix metalloproteinase-2 activity in radiotherapy received colonic anastomosis. METHOD: Eighty-four Wistar rats were divided into six groups. All rats were performed a left colonic resection with end-to-end anastomosis. Group I received rat cow. Group II received soluble fiber orally for five consecutive days preoperatively as well as 3rd and 6th days postoperatively. Group III received SCFAs via rectum for five consecutive days preoperatively. Group IV received irradiation to the pelvis at a total dose of 24 Gy on the 10th and 5th days before the operation. Group V was exposed to irradiation like the rats in Group IV and oral treatment like the rats in Group II. Group VI received irradiation like the rats in Group IV and transrectal treatment like the rats in Group III. On the 3rd and 7th postoperative days, all the rats were anesthetized to evaluate the anastomosis healing clinically, histologically and biochemically. RESULTS: Third and 7th day bursting pressures of the rats that were fed with a normal diet and exposed to radiotherapy were significantly decreased (P<0.001). Bursting pressures of Groups V and VI on the 7th day were significantly higher than the control group's bursting pressures (P<0.05). Hydroxyproline levels of Group IV were significantly decreased (P<0.001). Following oral soluble fiber and transrectal administration of SCFAs, these low levels reached to the levels of control radiotherapy group. Matrix metalloproteinase-2 activity of all the rats that were exposed to radiotherapy was higher than the control group (P<0.001). Matrix metalloproteinase-2 enzyme levels in the Groups V and VI were lower than the ones in the Group IV (P<0.001). The histologic parameters of anastomotic healing such as epithelial regeneration, exudate, necrosis, and fibroblast levels were significantly improved by the use of oral soluble fiber and transrectal SCFAs treatment. CONCLUSION: Undesirable effects of preoperative radiotherapy on mechanical, histological and biochemical parameters can be overcome by oral soluble fiber. Oral soluble fiber administration has similar positive effects like the transrectal administration of the SCFA's.

[Retrospective analysis of patients with small cell lung cancer treated at Gazi University Department of Radiation Oncology]. / Gazi Universitesi Radyasyon Onkolojisi Anabilim Dali'nda tedavi gören küçük hücreli akciger kanseri tanili hastalarin retrospektif analizi.

The combination of radiotherapy (RT) and chemotherapy (CT) is the main treatment modality of limited-stage small cell lung cancer (SCLC). The application of radiation timing, doses, fraction schedules in this modality and the indication of prophylactic cranial irradiation is recently controversial. In this retrospective study, these subjects were evaluated by considering our patients results. Seventy patients having adequate data for examination with limited-stage SCLC were referred to our clinic in the period between December 1995 and December 2002. The patients were classified according to their response to CT, the dose and timing of RT applications. The effects of obtained variables on overall survival were analyzed. Male/ female ratio was 5/1; and the mean age was 55 years (range 31-80 years). The mean follow-up of all patients was 10 months and the mean survival time was 16 months. An objective (complete and partial) response to CT administered before RT was seen in 47 (67%) patients. The survival time was better in the CT responding patients (median 11 months versus 6 months, p= 0.002). The application of more than 50 Gy radiation dose was found to be ineffective on survival. An improvement in survival was observed in RT application beginning before fourth cycle CT (median 14 months versus 8 months p= 0.01). In despite of the ineffectiveness of prophylactic cranial irradiation on survival is observed in survival analysis, it was found to be a parameter affecting survival in Cox-regression analysis. However the most frequently complication during RT was oesophagitis. Grade III was seen in 1 (3%) patient. The response to CT can be accepted as an indicator for survival. We concluded that the administering of RT in the beginning of CT, not administering radiation doses of more than 50 Gy and the necessity of applying prophylactic cranial irradiation to all patients showing complete response are points to be considered according to our retrospective analysis.