Hormone receptor and HER2 status in patients with breast cancer by races in southeastern Turkey.

PURPOSE: Hormone receptor (HR) status is a prognostic factor in women with breast cancer and differs among different ethnic groups. HR status among Turkish, Kurdish and Arabic women with breast cancer living in Turkey is unknown and in this study we investigated the relationship between HR and HER2 status and race. METHODS: FA total of 648 women with breast cancer (Turkish 438, Kurdish 174, Arabic 35 and Armenian 1) living in southeastern Turkey and referred to the Department of Radiation Oncology between July 2006-July 2012 were included in the study. Patients were categorized into 4 groups according to their HR status. Estrogen receptor (ER) and progesterone receptor (PR) positive (ER+/PR+), ER positive and PR negative (ER+/PR-), ER negative and PR positive (ER-/PR+) and ER and PR negative (ER-/PR-). Human epidermal growth factor receptor 2 (HER2) status was recorded immunohistochemically (IHC) as negative (0 and 1+), and positive (3+). Statistical analysis included ER, PR, HER2, triple subtypes (combination of ER, PR and HER2), and race. RESULTS: The median age at diagnosis was 48 years (range 20-83). ER+, PR+ and HER2+ patients were 453 (70%), 470 (72.6%) and 206 (32.1%), respectively. ER+/PR+ rates among Turkish and Arabic patients were similar, but were higher than Kurdish patients (p<0.002). Triple-negative (ER-/PR-/HER2-) rates among Kurdish and Arabic patients were similar, but were higher than Turkish patients (p=0.04). CONCLUSION: Turkish, Kurdish and Arabic women with breast cancer in southeastern Turkey differed by HR status. Compared to Turkish and Arabic patients, Kurdish patients had more unfavorable prognostic factors.

Reduction of irradiated small bowel volume with Trendelenburg position in gynecologic pelvic radiotherapy.

The aim of this study was to assess the effect of Trendelenburg position in comparison to prone position on small bowel volume and treatment dose in gynecologic pelvic external beam radiotherapy using three-dimensional conformal treatment plans. Eight patients with gynecologic cancers, treated with definitive or postoperative pelvic radiotherapy were investigated. Pelvic computerized tomography (CT) scans for treatment planning were performed in prone and 25 degree Trendelenburg positions for each patient. The dose-volume histograms of small bowel within the treatment fields were obtained and compared for both positions. The clinical target volume (CTV) and the planning target volume (PTV) were also defined and evaluated in the subjects. Treatment dose was 5040 cGy to PTV with 180 cGy daily fraction doses in both techniques for all patients. The average irradiated small bowel volume was 726 cc for prone position and 458 cc for the Trendelenburg position. The average irradiated small bowel volume reduction in the Trendelenburg position was 38.0% (95% CI 19.5 +/- 38%) compared with the prone position. The average small bowel percent dose was 25.4% (1280 cGy) for Trendelenburg position and 39.9% (2010 cGy) for prone position. PTV doses were similar in both techniques. The results of this dosimetric study suggest that gynecologic pelvic radiotherapy in the Trendelenburg position decreases the volume of irradiated small bowel compared to prone position and may decrease treatment related small bowel morbidity. Clinical benefit of this position should be evaluated in further clinical studies.

Dosimetric comparison of conventional helmet-field whole-brain irradiation with three-dimensional conformal radiotherapy: dose homogeneity and retro-orbital area coverage.

The aim of this study was to compare the dosimetric data from conventional two-dimensional (2D) helmet-field whole-brain irradiation (WBI) with those from three-dimensional conformal radiotherapy (3D-CRT), and to investigate the potential benefits of 3D-CRT as regards both dose coverage of the brain and retro-orbital (RO) area and ocular lens protection. Simulation CT scans of 30 patients were used. In 3D-CRT planning, the brain, optic nerves, ocular lenses and RO areas were contoured. Two opposed lateral fields were used and matched non-divergently behind the ocular lenses. The nominal prescribed photon beam dose was 1800 cGy in 10 fractions using 6 MV photons. Brain and RO areas were covered by at least 95% and 90% of the prescribed dose, respectively, and the maximum doses were limited to 110% of prescribed dose. In conventional 2D planning, the same field centre and angles were used as for the 3D-CRT plans. Fields were created using digital reconstructed radiographs and bony reference marks without information on the contour of structures. Brain, ocular lens and RO area doses were compared using cumulative dose-volume histograms. The mean value of minimum brain doses was significantly higher (p = 0.008) for 3D-CRT plans: all patients received a minimum of 95% of the prescribed dose. Mean doses of the left (p = 0.004) and right (p = 0.003) RO areas were also higher for 3D-CRT plans than for conventional 2D plans: all patients received a minimum of 90% of the prescribed dose. Furthermore, the mean values of minimum doses for both RO areas were statistically higher for 3D-CRT (p<0.001). 3D-CRT planning significantly improved the coverage of the RO areas and the dose homogeneity in WBI while protecting the ocular lenses.