Cagdas Yavas

Objectives: In this study, we aimed to determine the incidence and clinical features of uterine perforation during our 3-dimensional image-guided adaptive brachytherapy applications in patients with cervical cancer. Materials and Methods: Between 2010 and 2017, 155 patients with the diagnosis of stage IB1-IVA cervical cancer were retrospectively evaluated. All patients received 40 mg/m2 cisplatin concurrent with external-beam radiotherapy to 50.4 Gy in 28 fractions, followed by intracavitary brachytherapy (BRT) to 28 Gy in 4 fractions. BRT was performed using tandem-based intracavitary BRT with ovoids, with a computed tomography (CT) based image-guided adaptive BRT method. Seventy-four (47.7%) patients had magnetic resonance imaging (MRI) just after EBRT, before BRT application. Results: Of the 155 patients, nine (5.8%) had uterine perforation, and among 620 applications, 12 (1.9%) resulted in uterine perforation. The median age of patients with perforation was higher (63 years; range 44-84 years) than that of patients without perforation (52 years; range 29-85 years). The median pre-treatment tumor size, based on CT and/or positron emission tomography (PET)-CT imaging before EBRT, was 6.5 cm for patients with perforation and 5.0 cm for those without perforation. Five of the perforations were in retroverted uterine position (55.6%), and two were in anteverted uterine position (22.2%). The retroflexed case was included in the retroverted group. The Pearson chi-square test showed that older age (p=0.026), larger tumors (p=0.024), and a retroverted uterine position (p

We investigated dosimetrically lymphopenia concerning radiotherapy (RT) in patients receiving pelvic RT due to locally advanced prostate cancer (LAPCA). A total of 195 patients with lymph node-positive LAPCA were retrospectively evaluated and included in this single-center study. The relationship among absolute lymphocyte count (ALC), treatment modality, clinical stage, RT dose, and existence of pre-RT and post-RT lymphopenia (Grade≥2) was evaluated. Dependent McNemar analyses revealed significant relationship in pre-RT and post-RT (p<0.001). Of those with Grade<2, 108 (56.5%) developed Grade≥2 post-RT lymphopenia (p<0.001). V20-whole pelvic bone marrow (WPBM) (p=0.036), V30-WPBM (p=0.025), and V50-WPBM (p=0.008) values were significantly higher in Grade≥2 lymphopenia group. Also, V5-lumbo-sacral BM (LSBM) (p=0.013), V10-LSBM (p=0.041), V20-LSBM (p=0.015), and V30-LSBM (p=0.007) values were significant in Grade≥2 lymphopenia group. However, V30-lower-pelvis BM (LPBM) (p=0.024) and V50-LPBM (p<0.001) values were significant in Grade≥2 lymphopenia group. ROC analysis showed a significant effect on the development of Grade≥2 lymphopenia post-RT. Pre-RT baseline ALC values were associated with the development of Grade≥2 lymphopenia at a cut-off value of ≤1805 (p<0.001). Additionally, cut-off values of ≥76.1% for V20-WPBM (p=0.036), ≥47.3% for V30-WPBM (p=0.021), ≥7.3% for V50-WPBM (p=0.008), ≥68.5% for V30-WPBM (p=0.007), ≥41.2% for V30-LPBM (p=0.023), and ≥4.3% for V50-LPBM (p=0.001) were associated with development of Grade≥2 lymphopenia. Among all dosimetric parameters, V50-LPBM emerged as the strongest predictor of Grade ≥2 lymphopenia after RT. In clinical evaluations, no significant difference was seen in OS or PFS between Grades ≥2 and <2 groups (OS: p=0.194; PFS: p=0.489). This study demonstrated the clinical importance of pre-RT hematologic status and BM dosimetry, demonstrating that low pre-RT ALC and V50-LPBM values were the most significant predictors of Grade ≥2 lymphopenia after PNRT. These findings highlight importance of considering BM as an organ at risk and considering appropriate BM-sparing strategies in PNRT planning.

Purpose To determine recurrence patterns and prognostic factors in limited disease SCLC (LD-SCLC) and evaluate the effect of TNM classification on prognosis. Material and Methods We retrospectively evaluated 266 patients with LD-SCLC who underwent curative chemoradiotherapy ± prophylactic cranial irradiation (PCI) between 2003 and 2016. These patients were recruited from 10 centers and restaged using the 7th and 8th TNM staging systems. We assessed the impact of TNM stage, age, gender, and PCI on all survival outcomes through univariate and multivariate analyses. Survival rates were calculated using the Kaplan–Meier method. Results The median follow-up period was 42 months. In all cases, the 2- and 5-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates were 63.4–41.8%, 50.6–43.2%, and 50.9–27.7%, respectively. In the Cox regression analysis, N2-N3 disease and not receiving PCI were identified as poor prognostic factors for DMFS. In contrast, N2 disease, T4 stage according to the 8th TNM system, not receiving PCI, and thoracic RT doses < 60 Gy were recognized as prognostic factors negatively associated with OS. It was also observed that having N3 disease increases the risk of developing brain metastasis (BM) by a factor of 2.6. Conclusion In our cohorts, the N category emerged as the most significant prognostic factor for overall survival, distant metastasis-free survival, and the development of brain metastasis. Considering that the definition of limited disease encompasses a broad spectrum of patients, TNM staging may be more beneficial in predicting patient prognosis and guiding treatment decisions, as suggested.

This study aimed to evaluate the effects of acupressure on pain, anxiety, depression, and physiological parameters in women undergoing brachytherapy for gynecological cancer. The research was conducted between December 2023 and September 2024 using a randomized controlled design. All patients receiving brachytherapy were randomly assigned to the acupressure group (n = 40) or the control group (n = 40). In addition to standard clinical care, the acupressure group received manual acupressure for 30 min before each brachytherapy session at specific acupressure points (SP6, PC6, LI4, HT7, LV4). The data were collected using the Personal Information Form, Visual Analog Scale (VAS), State-Trait Anxiety Inventory (STAI-I), Hospital Anxiety and Depression Scale (HADS), and Vital Signs Form. The groups were comparable in terms of sociodemographic and clinical characteristics (p > 0.05). Significant reductions were observed in anxiety, depression, and pain levels in the acupressure group at post-test compared to baseline and the control group (p < 0.001). Additionally, diastolic blood pressure and body temperature significantly decreased in the intervention group (p < 0.001), whereas no significant differences were found for pulse and respiratory rate (p > 0.05). The results obtained from this study suggest that acupressure may be a beneficial complementary method for reducing anxiety, depression, and pain, as well as contributing to the regulation of certain physiological parameters in patients undergoing brachytherapy. These findings indicate that acupressure could be considered an intervention that may be integrated into clinical practice to support psychological and physiological well-being. NCT06531551. Date of Registration: 1 August 2024.

Bladder cancer (BC), the most common malignancy of the urinary tract, accounts for 90-95% of all urothelial carcinomas (UCs), while upper urinary tract UC (UUTUC) accounts for only 5-10%. Radical nephroureterectomy with excision of bladder cuff, and radical cystectomy with pelvic lymph node dissection and a urinary diversion (UD) are the gold standard treatments for UUTUC and muscle-invasive bladder cancer (MIBC), respectively. These two treatments can be performed simultaneously when a bilateral or unilateral UUTUC is present with a MIBC, and are called complete urinary tract extirpation (CUTE) and hemi-CUTE, respectively. This complex surgery can help the patient by avoiding multi-staged surgeries, repeated anesthesia, and delay in completion of treatment. Herein, we report the first cases of a hemi-CUTE and CUTE in our department and share our experience with this aggressive and complex surgical treatment. Cite this article as: Akand M, Kılıç Ö, Harmankaya İ, Karabağlı P, Yavaş Ç, Ata Ö. Aggressive treatment for urothelial cancer-complete urinary tract extirpation: Operative feasibility in two cases. Turk J Urol 2019; 45(5): 393-7.

We aimed to evaluate impact of spironolactone (S) on cardiovascular toxicity of concomitant use of radiotherapy (RT) and trastuzumab (T). S, an aldosterone receptor antagonist, is known to ameliorate the cardiac damage. S ameliorates anthracycline -induced cardiotoxicity, there is no data regarding to effect of S on both T and radiation-induced cardiotoxicity. Eighty rats were divided into eight groups: group (G) 1 was defined as control group. G2, G3 and G4 were RT, S and T groups respectively. G5, G6, G7 and G8 were RT + T, T + S, RT + S and RT + T + S groups respectively. Rats were sacrificed at 6th hour; 21st and 100th days after RT. Heart and thoracic aorta samples were taken for microscopical examination. Cardiac inflammation and fibrosis scores and; TGF-β expression were not significantly different within study groups at 6th hour and 21st days of RT. By 100th days of RT fibrosis scores and TGF-β expression in cardiac samples were significantly different between study groups (p values were 0.004 and 0.002 respectively). Pair-wise comparisons revealed that both cardiac fibrosis scores and TGF-β expression levels were higher in G5 when compared to G8 (p values were 0.046 and 0.028 respectively). Moreover the TGF-β expression was higher in G5 when compared to G2 (p = 0.046). We could not demonstrate any significant differences with respect to inflammation, fibrosis and TGF-β expression in thoracic aorta samples between study groups. Although S had a protective effect on cardiac tissue it had no protective effect on thoracic aorta when administered with RT + T.

To evaluate effects of halofuginone (H) on radiation-induced lung injury (RILI), 60 rats were divided into six groups: Group (G) 1 control, G2 radiotherapy (RT) only, G3 and G4 2. 5 and 5 μg H and G5 and G6 RT + 2.5 and 5 μg H groups, respectively. A single dose of 12 Gy RT was given to both lungs. H was applied intraperitoneally with daily doses, until animals were killed at 6 and 16 weeks after RT. At 6th and 16th weeks of RT, five rats from each group were killed. Lung tissues were dissected for light and electron microscopy. Chronic inflammation, fibrosis and transforming growth factor-beta (TGF)-β scores of all study groups were significantly different at 6th and 16th week (p < 0.001). Chronic inflammation, fibrosis and TGF-β scores of G2 were higher than G5 and G6 at 6th and 16th weeks of RT. At 16th week, fibrosis and TGF-β scores of G5 were higher than G6 (p = 0.040 and 0.028, respectively). Electron microscopical findings also supported these results. Therefore, H may ameliorate RILI. The effect of the H was more prominent at higher dose and after long-term follow-up. These findings should be clarified with further studies.