Harun Demir

Objective: To evaluate clinical outcomes of whole-brain radiotherapy (WBRT) and identify prognostic factors associated withoverall survival (OS) in non-small cell lung cancer (NSCLC) patients with brain metastases who were not candidates for stereotacticradiotherapy (SRT).Patients and Methods: In this retrospective study, 71 NSCLC patients with brain metastases who underwent WBRT were included.Clinical and treatment data were collected, and survival outcomes and prognostic factors were evaluated.Results: The median age was 65 years, and 78.9% of patients were male. Adenocarcinoma was the most common histological subtype(54.9%). A Karnofsky Performance Status (KPS) ≥80 was observed in 74.6% of patients. Brain metastases were synchronous in 64.8%of cases, and 32.4% of patients had isolated intracranial disease. The median OS and intracranial progression-free survival (iPFS)following WBRT were both 3 months (95% CI: 1.0–5.0 and 1.7–4.3, respectively). In multivariate analysis, independent predictors ofimproved OS included KPS ≥80 (HR=5.72), early radiologic response (HR=4.10), the use of immunotherapy or targeted agents as firstlinesystemic therapy (HR=5.26), and the presence of isolated brain metastasis (HR=4.53).Conclusion: These findings highlight key predictors of improved survival after WBRT and underscore its continued clinical relevancein carefully selected NSCLC patients ineligible for SRT.

Background/Objectives: The aim of this study was to identify which pre-radiotherapy (RT) immunonutritional indices best predict mortality and overall survival in geriatric patients with lung cancer (LC). Methods: This retrospective single-center study included LC patients aged ≥ 65 years who underwent RT between August 2020 and December 2024. Clinical records and laboratory data obtained within 14 days before RT were used to calculate immunonutritional indices. Survival and subgroup analyses evaluated prognostic significance. Results: Among the 174 patients included in the study, the median age was 69 years, and the median follow-up after RT was 8 months. Inflammatory indices were higher among non-survivors, whereas nutritional indices were lower (all p < 0.05). The ROC curve analyses identified the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), and CALLY (CRP–Albumin–Lymphocyte Index) as the strongest predictors of mortality (AUCs > 0.700). In adjusted Cox models, CALLY (HR = 0.652), PNI (HR = 0.939), and GNRI (HR = 0.950) were independently associated with reduced mortality risk. Conclusions: In older adults with LC undergoing RT, pre-treatment immunonutritional indices were independently associated with overall survival. Lower inflammatory burden and higher nutritional scores were linked to improved outcomes. These indices were associated with mortality before RT across LC types, independent of disease stage. Among them, CALLY, PNI, and GNRI showed the strongest associations with mortality, suggesting that these markers may be promising candidates for pre-RT risk assessment. However, further validation in prospective cohorts is required before routine clinical implementation.

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 study aims to evaluate the survival outcomes, survival-related prognostic factors, and treatment compliance in cancer patients aged ≥80 years treated with radiotherapy (RT). The records of 76 patients who received RT at a single center between August 2021 and May 2024 were retrospectively evaluated. Patient and tumor characteristics and treatment details were collected from medical records. The median age of the patients was 83 years (range: 80–92 years). According to the purpose of RT, palliative (53.8%), definitive (18.4%), and adjuvant (15.8%) RT were most frequently administered, respectively. The median overall survival (OS) in all patients was 10 months. The median OS in patients receiving curative (definitive and adjuvant RT) and palliative RT was 25.1 and 7.2 months, respectively. Poor performance status (PS), leukocyte count prior to RT, compliance, and hospitalization status in the curative group and poor PS, RT compliance, hospitalization status, and new distant recurrence in the palliative group were associated with decreased OS. The majority of patients showed full compliance with the RT process (69.7%). The rate of full compliance with the treatment process was significantly higher in patients with good PS and receiving outpatient treatment. RT-related high-grade toxicity (grade 3–4) was not observed. This study demonstrates that RT can be used effectively and safely for both palliative and curative purposes in cancer patients aged ≥80 years. The optimization of patient selection and ultimately improvement of treatment outcomes will be facilitated by the support of these results with multicenter studies.

Objective: To investigate the incidence, timing, and the factors predictors radionecrosis (RN) development in brain metastases (BMs) undergoing stereotactic radiotherapy (SRT). Methods: The study evaluated 245 BMs who exclusively received SRT between 2010 and 2020. RN was detected pathologically or radiologically. Results: The median of follow-up was 22.6 months. RN was detected in 18.4% of the metastatic lesions, and 3.3% symptomatic, 15.1% asymptomatic. The median time of RN was 22.8 months (2.5-39.5), and the rates at 6, 12, and 24 months were 16.8%, 41.4%, and 66%, respectively. Univariate analysis revealed that Graded Prognostic Assessment (P = .005), Score Index of Radiosurgery (P = .015), Recursive Partitioning Analysis (P = .011), the presence of primary cancer (P = .004), and localization (P = .048) significantly increased the incidence of RN. No significant relationship between RN and brain-gross tumour volume doses, planning target volume, fractionation, dose (P > .05). Multivariate analysis identified SIR > 6 (OR: 1.30, P = .021), primary of breast tumour (OR: 2.33, P = .031) and supratentorial localization (OR: 3.64, P = .025) as risk factors. Conclusions: SRT is used effectively in BMs. The incidence of RN following SRT is undeniably frequent. It was observed that the incidence rate increased as the follow-up period increased. We showed that brain-GTV doses are not predictive of RN development, unlike other publications. In study, a high SIR score and supratentorial localization were identified as factors that increased the risk of RN. Advances in knowledge: RN is still a common complication after SRT. Symptomatic RN is a significant cause of morbidity. The causes of RN are still not clearly identified. In many publications, brain dose and volumes have been found to be effective in RN. But, with this study, we found that brain dose volumes and fractionation did not increase the incidence of RN when brain doses were taken into account. The most important factor in the development of RN was found to be related to long survival after SRT.

Background: To evaluate the factors influencing brain metastases (BM) local control (LC) after stereotactic radiotherapy (SRT).Methods: Between 2010 and 2020, a cohort of 145 patients (246 BM) treated consecutively with robotic radiosurgery was analysed.Results: Median age was 61 years (range, 29–90 years). Median radiological follow‐up of the lesions was 21.7 months (range, 3–115 months). The mean overall survival and LC were 33.0 and 82.7 months, respectively. On univariate analysis, sex, primary cancer site, histological type, use of systemic steroids, maximum diameter, volume, early MRI response, isodose line, number of fractions, BED10 value, and BED10 value proportional to volume and maximum diameter were significant factors for LC. On multivariate analysis, female sex (hazard ratio [HR]: 2.10 P: 0.035), adenocarcinoma histology (HR: 6.54 P: 0.001), no steroid use (HR: 3.60 P: 0.001), maximum diameter (≤1 cm) (HR: 2.64 P: 0.018), complete response of lesion at first follow‐up MRI compared to stable or progressive disease (HR: 4.20, P = 0.024; HR: 19.15, P < 0.001), isodose line (≥90%) (HR: 2.00 P: 0.036), and tumour volume (PTV ≤2 cc) (HR: 5.19 P: 0.001) were independent factors improving LC.Conclusions: SRT is an effective treatment for patients with a limited number of BM with a high LC rate. There are many factors related to the patient, tumour, and radiotherapy plan that have an impact on LC after SRT in brain metastases. These results warrant further investigation in a prospective setting.