The effectiveness of gamma knife radiosurgery for the management of residual high-grade gliomas: A single institutional study.

High-grade gliomas (HGGs) are presently managed via surgical resection, external beam radiation therapy (EBRT), and chemotherapy. Although Gamma Knife radiosurgery (GKRS) is currently used to manage HGGs, it has not been considered standard care. This paper aims to compare the contribution of GKRS to clinical outcomes in patients in which gross total resection (GTR) cannot be achieved. We retrospectively reviewed the data of 99 patients with HGG (World Health Organization (WHO) grade III and IV) from two groups: group 1 consisted of 68 patients for which only EBRT was administered, and group 2 consisted of 31 patients for which EBRT and GKRS were administered. Patient demographic data, the extent of resection, IDH mutation, radiation dosage, progression-free survival (PFS), overall survival (OS), and follow-up time were recorded and compared across groups. The grade III/IV tumor ratio was 10/58 and 10/21 in groups 1 and 2, respectively. In group 2, PFS and OS were higher than in group 1 (P = 0.030 and 0.021). The mean follow-up time was 15.02 ± 11.8 (3-52) and 18.9 ± 98.6 (7-43) months in groups 1 and 2, respectively. In addition to the standard management of HGGs in patients without GTR, boost GKRS during the early postoperative period is beneficial for increasing PFS and OS.

The importance of IDH1, ATRX and WT-1 mutations in glioblastoma.

Numerous genetic pathways associated with glioblastoma development have been identified. In this study, we investigated the prognostic significance of IDH1 and ATRX mutations and WT-1 and p53 expression in glioblastomas and that of surgical methods, radiotherapy and chemotherapy. 83 patients with glioblastomas were retrospectively evaluated. Immunohistochemical analysis was performed for IDH1, ATRX and WT-1 expression. Tumour cells were positive for IDH1 in 9.6% of the patients. In 4.8% of the patients, loss of ATRX expression was observed in tumour cells; 86.7% of the patients were WT-1 positive, and 12.05% of the patients were p53 positive. No statistically significant difference was found in the progression-free and overall survival according to IDH1, ATRX, WT-1 and p53 expression. There was a statistically significant difference in the progression-free and overall survival according to the radiotherapy status. There was a statistically significant difference in the overall survival according to the chemotherapy status. There was no statistically significant difference in the progression-free and overall survival according to the surgical method. IDH1 and ATRX mutations, p53 overexpression and WT-1 expression alone did not have a significant effect on the prognosis of patients with glioblastoma; however, radiotherapy and chemotherapy had a positive effect on survival.

Psychosocial stressors, social support and socio-demographic variables as determinants of quality of life of Turkish breast cancer patients.

PURPOSE: The aim of the present study was to investigate the effects of psychosocial stressors, social support and socio-demographic variables on quality of life of breast cancer patients. TOOLS AND METHODS: The study was conducted between December 2004 and May 2005 and included 101 patients, treated in the Oncology Departments of Ege and Pamukkale University Hospitals and Denizli State Hospital. Patients' demographic data were collected by questionnaire. The methods used in the interviews were the Rotterdam Symptom Checklist (RSCL), and the Multidimensional Scale of Perceived Social Support (MSPSS), the Karnofsky Performance Status (KPS). Psychosocial stressors were classified according to life events using the DSM-IV multi-axial diagnostic system. RESULTS: It was found that increase of cancer stage triggers a decrease in psychological quality of life (p<0,05); overall global life quality (p<0,001), perceived social support and performance status (p<0,05), all of these being negatively affected by family stressors. The patients with increased social support, better psychological and overall quality of life (p<0,01) and younger age had more physical wellness besides overall quality of life (p<0,05); lower incomes negatively affected overall global life quality (p<0,01) and working at a job decreased the psychological stressors (p<0,05). CONCLUSION: From these results, it can be postulated that psychosocial stressors, social support and some socio-demographic variables mostly affected quality of life of the breast cancer patients.

The preventive effect of vitamin D3 on radiation-induced hair toxicity in a rat model.

Our aim is to investigate the protective effect of vitamin D3 especially from radiation-induced hair toxicity. A model of skin radiation injury was developed and a single fraction of 20 Gy Gamma irradiation was applied to the right dorsal skin of fourteen rats. All animals were randomly divided into 2 groups: Group I: irradiation alone (n = 7) and Group II: irradiation and 0.2 microg vitamin D3 given IM (n = 7). Fifty days after post-irradiation rats were sacrificed. The outcomes were evaluated on the basis of histopathological findings and immunohistochemical staining for Vitamin D receptor (VDR) in skin and hair follicles. The number of hair follicles in the radiation field for the group of animals irradiated without pretreatment was significantly lower than outside of the irradiated area (p = 0.016) as it is expected. Contrarily the number of hair follicles did not show significant difference in the pretreated group between the irradiated field and outside of the fields (p = 0,14). Skin of the vitamin D3 pretreated group demonstrated stronger immunoreactivity for VDR compared to irradiation alone group. These results indicate that administration of vitamin D3 may protect hair follicles from radiation toxicity. Further clinical trials should be conducted to prove the preventive effect of vitamin D3 as well as dosing and timing of the agent on radiation-induced alopecia.

Psychiatric morbidity among cancer patients and awareness of illness.

A significant proportion of cancer patients experience psychiatric morbidity. Potential predictors of psychiatric morbidity include patient disease-related factors and factors relating to the patient's environment. The aim of this study was to investigate the prevalence of psychiatric morbidity and the relationship between the clinical or personal factors, especially psychiatric morbidity, and awareness of cancer diagnosis among a group of Turkish cancer patients. A total of 117 cancer patients were assessed using the Structured Clinical Interview for DSM-IV (SCID), the Hospital and Anxiety Depression Scale (HADS) and the General Health Questionnaire (GHQ). Of these patients, 30% had a psychiatric diagnosis. Adjustment disorders comprised most of the psychiatric diagnoses. Awareness of the diagnosis of cancer, history of previous psychiatric disorders, pain and stress factors were correlated with psychiatric morbidity. Of the 117 patients, 64 (54.7%) were unaware of the diagnosis of cancer. Most of the patients (67.9%) who were considered to be aware of the cancer diagnosis stated that they had guessed their illness from the treatment process or drug adverse effects. Psychiatric morbidity was significantly higher in the patients who knew that they had a cancer diagnosis (P=0.03). These findings suggest that the awareness of cancer diagnosis is related to the presence of psychiatric morbidity. In particular, the understanding of the diagnosis indirectly may be stressful to the patient because it arouses suspicion about the cancer and treatment, and consequently can lead to psychiatric disturbance. In Turkey honest disclosure of the true diagnosis is still not common for cancer patients and it seems to be essential to improve this situation.

[Psychiatric disorders in cancer patients and associated factors]. / Kanser hastalarinda psikiyatrik bozukluklar ve iliskili etmenler.

OBJECTIVE: There is a high prevalence of psychiatric disorders, especially depression and anxiety, among cancer patients. If they are left untreated, especially depressive disorders, they may result in poor treatment compliance, increased hospital stays and reduced quality of life. The aim of this prospective study is to investigate the prevalence of psychiatric morbidity among cancer patients and the factors that predict psychiatric morbidity. METHOD: One hundred and fifty patients with the diagnosis of cancer who were treated in different departments of the Pamukkale University Hospital were included in this study. Psychiatric diagnoses were made according to the criteria of DSM-IV with the SCID-I interview. In addition, all patients were evaluated using the General Health Questionnaire (GHQ) and the Hospital and Anxiety Depression Scale (HADS). RESULTS: 28.7% of cancer patients were found to have a DSM-IV Axis I diagnosis. The most common diagnoses were adjustment disorder with depressed mood (14%) and major depressive disorder (11.3%). Female gender, awareness of the diagnosis of cancer, history of previous premorbid psychiatric disorders and stress factors were correlated with psychiatric morbidity. CONCLUSION: In this study, the most common diagnoses were adjustment disorder with depressed mood and major depressive disorder, suicidal ideations were also frequently found. Awareness of the nature of the illness, female gender and the duration of the illness were the parameters which predicted psychiatric morbidity. Careful attention should be paid to cancer patients in order to diagnose and treat their psychiatric disorders. Furthermore, two screening instruments (GHQ and HADS) performed satisfactorily for screening of psychiatric disorders in cancer patients.

Radiotherapy in maxillary sinus carcinomas: evaluation of 79 cases.

PURPOSE: The aim of this study is to evaluate the outcome of patients with maxillary sinus carcinoma after radiotherapy regarding local control, prognostic factors and morbidity of treatment. MATERIALS AND METHODS: Between January 1983 and December 1996, 79 cases of maxillary sinus carcinoma without any evidence of distant metastases, were treated with radiotherapy. RESULTS: Fifty-two patients (65.8%) were male and 27 (34.2%) were female. The median age was 57. Histologically 62% were epidermoid carcinoma, 32.9% were non-epidermoid carcinoma and 5.1% were unclassified. Sixteen patients (20.5%) had T2, 25 (29.8%) had T3 and 38 (49.7%) had T4 tumour while 13 patients (16.5%) had lymph node metastases. Fifty-nine patients (74.4%) underwent surgical resection followed by postoperative radiotherapy and 20 patients (25.3%) received radiotherapy alone. The median follow-up was 71 months; 5-year overall survival and local control rates were 53% and 54% respectively. Prognostic factors influencing the overall survival were histologic type (epidermoid carcinoma, p = 0.02), advanced T stage (p = 0.04), postoperative residual tumour (p = 0.002) and lymph node involvement (p = 0.01) whereas the factors influencing local control were histologic type (p = 0.05) and postoperative residual tumour (p = 0.005). Late radiation morbidity were cataract (11.4%), loss of vision (8.9%), trismus (5.1%) and hearing loss (2.5%). CONCLUSION: In maxillary sinus carcinomas high rates of local control can be achieved with surgery and radiotherapy. Postoperative radiotherapy can have a positive impact on local control and overall survival especially in patients with early stage tumour of non-epidermoid histology and without residual disease after surgery.