Gul Kanyilmaz

Background: There are very limited studies examining the sexual dysfunction in female rectal cancer treated with curative chemoradiotherapy (CRT). So, we aimed to evaluate the self-related sexual life quality and vaginal dose-volume relationship in female rectal cancer patients. Methods: The patients who had been treated with chemoradiotherpay between January 2012 and January 2019 were included. Vaginal contouring was performed according to the Radiation Therapy Oncology Group female pelvic normal tissue contouring atlas. Sexual functioning was evaluated by the European Organization for Research and Treatment Quality of life Questionnaire for Sexual Function Modules (EORTC QOL). Results: Fourty five disease-free female patients volunteered to participate in this study were evaluated. The mean total EORTC QOL score of patients was 19.44 points. The score was P = 0.01), and V50 ( P = 0.02) of vagina were the predictive factors for sexual functioning. Conclusions: Sexual dysfunctions in female rectal cancer were associated with tumor distance to anal verge, patients age, Dmean, Dmin, and V35-50 of vagina in female rectal cancer treated with curative radiochemotherapy.

Objective: Surgical resection is the cornerstone of rectal cancer treatment. Following neoadjuvant chemoradiotherapy (nCRT), many patients undergo surgery. Another group of patients may not undergo surgery for various reasons, regardless of nCRT response. This study investigates the differences in clinical characteristics and long‐term oncological outcomes of operated and non‐operated elderly rectal cancer patients.Methods: This multicentre observational retrospective cohort analysis included 296 elderly patients (169 surgery, 127 non‐surgical) treated at three tertiary cancer centres in Turkey between January 2010 and April 2024. Clinicopathologic features and survival outcomes were compared between groups.Results: Patients in the surgery group were younger (p < 0.000) and had better performance scores (p < 0.000). There were no differences in initial clinical (c) T stages or cM stages; however, cN2 patients were more prevalent in the surgical group and cN1 patients were more prevalent in the non‐surgical group (p = 0.010). No differences in radiotherapy treatment schedules were observed among the groups. The surgical group received more concurrent (p = 0.046) and adjuvant (p < 0.000) chemotherapy. Patient refusal (63.8%) was the most common reason among non‐surgical patients. The surgery group showed better overall survival (OS) (median, 99 vs. 33 months) (p < 0.000), local recurrence‐free survival (LRFS) (97.8% vs. 65.8% at 3 years, p < 0.000), and distant metastasis‐free survival (DMFS) (80.3% vs. 73.3% at 3 years, p = 0.022).Conclusion: This study shows that elderly rectal cancer patients without surgery had poor survival and tumour control. Surgical resection in rectal cancer is very important and should be strongly recommended for all medically suitable elderly patients.

The aim of this study to investigate the impact of contrast agent used for imaging purposes in the treatment of neoadjuvant rectal cancer patients. In rectal radiotherapy, contrast agent is used during the treatment simulation but the patient treated without contrast. In our study, we will examine whether CTs taken with contrast agent are sufficient for clinical application. A total of eighteen patients who had undergone neoadjuvant treatment with rectal cancer randomly selected. Two different CT scans were performed for each patient. The contours were delineated on a non-contrast CT images with the help of image fusion with contrast CT images. Then, the contours drawn on the non-contrast CT were copied to the contrast-enhanced CT with the help of fusion to be used in contrast CT plans for our retrospective study. Subsequently, all plans were generated in Eclipse TPS and Accuray Precision TPS. Finally the plans with contrast agent and non-constrat agent were compared. 3DCRT plans were compared for contrast and non-contrast images, no significant differences were observed in either the PTV or the maximum and mean values of critical organs. It was observed that the average post-contrast doses increased significantly for small bowel only in helical therapy (p = 0.019). As a result, no significant difference was observed in terms of PTV and critical organs in the comparison of 3DCRT plans. In the comparison of helical plans, there was only a significant difference in the bladder. Based on these results, we suggest that planning can be done with a single contrast CT for 3DCRT treatments, both to avoid further discomfort for the patient and to prevent additional tomography doses. On the other hand, for helical therapy, we believe that it can be clinically evaluated whether the treatment will be performed with contrast CT depending on the patient's condition.

Amaç Radyasyon onkoloji servisinde yatan kanser hastalarının beslenme durumları net değildir. Kanser hastaları üzerinde yapılan bu kesitsel çalışma, bu hasta grubundaki malnütrisyon riskinin yaygınlığını araştırmayı amaçladı. Yöntem Aralık 2018 ile Ocak 2022 tarihleri arasında radyasyon onkolojisi servisinde radyoterapi gören 373 hastayı retrospektif olarak araştırdık. Hastaların demografik bilgileri, NRS-2002 skoru, radyoterapiye ilişkin doz ve fraksiyon verileri toplandı. Sonuç Hastaların çoğunluğu (%66) erkekti. Küçük hücreli dışı akciğer kanseri (KHDAK) en sık görülen birincil tanıydı. Radyoterapinin birincil amacı 210 hastada (%56,3) palyatif radyoterapiydi. Hastaların çoğunluğunun (%46,4) normal BMI aralığında olduğu görüldü. Yatan hasta başvurusunda NRS-2002 skorlamasında hastaların %1,9'unun puanı ≥3 idi. Tartışma Araştırmanın sonucu radyasyon onkolojisi yataklı servisinde yetersiz beslenme oranının yüksek olmadığını gösteriyor. Ancak malnütrisyona yönelik sistematik bir taramanın yapılması ve hastaların multidisipliner beslenme ekibiyle desteklenmesi yataklı tedavi hizmetlerinde kanserli hasta bakımının anahtarıdır.

Different radiotherapy treatment techniques can be used in whole-brain radiotherapy (WBRT). This study aims to investigate the dosimetric advantages of the anterior isocenteric (AI) technique which is produced as an alternative to the central isocentric (CI) technique. 25 whole brain patients were included in this retrospective study. Plans were made with two treatment techniques for each patient. One central isocenter (CI) was made using a conventional helmet field (HF) to center the whole brain, which is the isocenter of the target volume. An automatic margin of 5 mm was given to the planning target volume (PTV) with multileaf collimators (MLC) for both plans. For CI and AI techniques, a total dose of 30 Gy was given in 10 fractions with 6 MV photon energy. The two planning techniques were compared dosimetrically. The dose homogeneity index (DHI) had lower values in the AI plan according to CI plans significantly (p=0.049). There was a 6,57% difference between CI and AI planning techniques for the maximum dose of the right lens. For the minimum dose and mean dose AI plans significantly had lower values according to the CI plan (p=0.001 and p=0.028 respectively). In this dosimetric study we found that the AI treatment technique for WBRT was superior to the CI technique for DHI and organs at risk. We recommended to use the AI technique, especially to better protect organs at risk in WBRT.

This study aimed to compare three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) planning techniques commonly used in gastric cancer radiotherapy with dose volume histograms. Computed tomography (CT) images of 20 gastric cancer patients were retrospectively analyzed. 3D-CRT, 5F- IMRT and 7F- IMRT treatment plans were created for each patient. The 3 plans were compared on dose volume histogram (DVH). 3D-CRT, 5F-IMRT and 7F-IMRT plans achieved a prescribed dose of 45 Gy for 95% of PTV volume. D95 values were 45.06±0.47 Gy for 3DCRT, 46.39±0.38 Gy for 5F-IMRT and 45.20±0.11 Gy for 7F-IMRT. In 3D-CRT, 5F-IMRT and 7F-IMRT techniques, the 13 Gy receiving volumes of the right kidney were found to be 35.08+9.59, 36.25+7.97 and 37.03+9.03 respectively. Moreover, the volume of the right kidney receiving a 20 Gy and 30 Gy dose received less dose with 5F-IMRT than with 7F-IMRT. Since each patient's critical organs are at different distances from the target and each technique has its own advantages in terms of critical organs, we suggest that the useful technique should be decided by clinical consensus.