Utilization of radiation therapy and predictors of noncompliance among Syrian refugees in Turkey.

BACKGROUND: Access to cancer care is a problem that continues to plague refugees displaced from their home countries. The turbulent political crisis in Syria, which has led to millions of refugees seeking asylum in Turkey, merits further attention. We aimed to study the rate of utilization of radiation therapy among Syrian refugees with cancer living in Turkey in an attempt to identify the contributing factors predictive of non-compliance with prescribed RT. METHODS: In this retrospective review of 14 institutional databases, Syrian refugee patients in Turkey with a cancer diagnosis from January 2015 to December 2019 who were treated with RT were identified. The demographic data, treatment compliance rates, and toxicity outcomes in these patients were surveyed. Variable predictors of noncompliance such as age, sex, diagnosis, treatment length, and toxicity were studied. The association between these variables and patient noncompliance was determined. RESULTS: We identified 10,537 patients who were diagnosed with cancer during the study period, of whom 1010 (9.6%) patients were treated with RT. Breast cancer (30%) and lung cancer (14%) were the most common diagnoses with up to 68% of patients diagnosed at an advanced stage (Stage III, IV). 20% of the patients were deemed noncompliant. Treatment with concurrent chemoradiotherapy (OR 1.61, 95% CI 1.06-2.46, p = 0.023) and living in a refugee camp (OR 3.62, 95% CI 2.43-5.19, p < 0.001) were associated with noncompliance. Age, sex and treatment length were not significantly associated with noncompliance. CONCLUSIONS: Noncompliance with radiotherapy among Syrian refugees in Turkey remains an area of concern with a multitude of factors contributing to these alarming numbers. Further studies to better ascertain the finer nuances of this intricately complex problem and a global combination of efforts can pave the way to providing a solution.

Does a patient-specific bladder-filling protocol affect bladder volume and dose in postprostatectomy radiotherapy?

PURPOSE: Our aim is to develop a patient-specific bladder-filling protocol (PSP) using an ultrasound-based bladder scanner (BS) and compare the volumetric and dosimetric parameters with those of the standard filling protocol (SP) in postprostatectomy patients. METHODS: Twenty postprostatectomy patients who received salvage radiotherapy (72 Gy/36 fx) were included. For PSP, the patient was asked to drink 500 mL of water after emptying his bladder. Bladder volume was measured using BS every 10 min. Each patient's unique time to reach a 150-200 cc volume was used for simulation and treatment. For the SP, the patient was asked about the feeling of having a full bladder. Organs at risk (OAR) were contoured on cone-beam computed tomography (CBCT) scans that were transferred to the treatment planning system (TPS). Treatment plans were applied to CBCTs. Changes in bladder volume and doses for planning computed tomography (PCT) and CBCT were determined. RESULTS: In the SP, there was no significant difference in mean bladder volume for PCT and CBCT (p = 0.139); however, there was a trend for significance in the mean bladder dose (p = 0.074). In PSP, there was no significant difference in the mean bladder volume or dose for PCT and CBCT (p = 0.139 and p = 0.799, respectively). There was a significant difference in terms of mean CBCT bladder volume between the two protocols (p = 0.007), whereas no significant difference was detected in terms of bladder dose (p = 0.130). CONCLUSION: With PSP, optimal bladder filling was obtained and maintained throughout the whole treatment course, and it was reproducible in every fraction.

Dosimetric evaluation of different radiotherapy techniques in mastectomized left-sided breast cancer.

CONTEXT: Inclusion of internal mammary lymph nodes in mastectomized left breast cancer radiotherapy may lead to high dose receiving risk of the heart, lung, and contralateral breast. AIM: The aim of this study is to compare the dosimetric differences of field-in-field (FIF), volumetric-modulated arc therapy (VMAT), seven-field intensity-modulated radiotherapy (7F-IMRT), and helical tomotherapy (HT) planning techniques for mastectomized left breast cancer. MATERIALS AND METHODS: Computed tomography images of ten patients treated with the FIF technique were used to compare four different treatment planning techniques. Planning target volume (PTV) included chest wall and regional lymph nodes. The heart, left anterior descending coronary artery (LAD), left and whole lung, thyroid, esophagus, and contralateral breast were identified as organs-at-risks (OARs). Except for HT, a single isocenter in PTV and bolus of thickness 0.3 cm on the chest wall was used. Complete and directional blocks were applied in HT, and the dosimetric parameters of PTV and OARs for four different techniques were analyzed using the Kruskal-Wallis test. RESULTS: 7F-IMRT, VMAT, and HT were superior to the FIF technique in providing homogeneous dose distribution covering the PTV (P < 0.0001). Mean doses (Dmean) of the contralateral breast and esophagus, lung, and body-PTV V5 (volume receiving 5 Gy) were reduced in FIF, whereas in the HT, Heart Dmean, LAD Dmean , Dmax, healthy tissue (body-PTV) Dmean , heart and left lung V20, and thyroid V30 were significantly reduced (P < 0.0001). CONCLUSIONS: FIF and HT techniques were found to be significantly advantageous over 7F-IMRT and VMAT for OARs. Using those three multiple-beam techniques reduced high-dose volumes of healthy tissues and organs in mastectomized left breast cancer radiotherapy but also increased low-dose volumes and contralateral lung and breast doses. Complete and directional blocks applied in HT reduce heart, lung, and contralateral breast doses.

Current treatment strategies in malignant pleural mesothelioma with a treatment algorithm.

Malignant pleural mesothelioma (MPM) is arare disease with apoor prognosis. The main therapeutic options for MPM include surgery, chemotherapy, and radiation therapy (RT). Although multimodality therapy has been reported to improve survival, not every medically operable patient is able to undergo all recommended therapy. With improvements in surgical techniques and systemic therapies, as well as advancements in RT, there has been apotential new paradigm in the management of this disease. In this review, we discuss the current literature on MPM management and propose afunctional treatment algorithm.

Treatment results and prognostic factors of patients with vulvar cancer treated with postoperative or definitive radiotherapy.

PURPOSE: Vulvar cancer is a relatively uncommon type of gynecologic cancer. The aim of this study is to analyze the treatment results and prognostic factors of vulvar cancer. METHODS: Forty-four vulvar cancer patients treated between 2000 and 2011 at the Department of Radiation Oncology, Ege University Faculty of Medicine, were retrospectively reviewed. External radiotherapy (RT) was applied with 6-18 MV linear accelerators with 1.8 Gy daily fractions with a median total dose of 50.4 Gy (45-59.4 Gy) for postoperative cases and 64.8 Gy (range 54-66 Gy) for definitive cases. Statistical analyses were performed with SPSS 13.0. RESULTS: Among 44 patients with a median age of 68 years (range 28-86), 14 (31.8%) were treated with curative and 30 (68.2%) were treated with postoperative RT or radiochemotherapy (RCT). According to International Federation of Gynecology and Obstetrics staging, 11 (25%) had stage IB, 10 (22.7%) had stage II, 6 (13.6%) had stage IIIA, 5 (11.4%) had stage IIIB, and 12 (27.3%) had stage IVA disease. Within a median of 24 months (range 6-135) of follow-up, 11 (27.3%) patients had local recurrence, 8 had regional recurrence, 2 had both local and regional recurrence, and 6 had distant metastases. Five-year locoregional, disease-free, and overall survival rates were 45%, 40%, and 54%, respectively. Older age, poor tumor differentiation, positive surgical margin, and lymphovascular space invasion were found to be important prognostic factors for disease-related outcomes. CONCLUSIONS: Prognosis of vulvar cancer remains poor even with a multidisciplinary approach. Molecular prognostic factors need to be defined for individualized treatment options to achieve better treatment results.