Aybala Nur Ucgul

Aim: This study aimed to evaluate survival outcomes and potential prognostic indicators in a real-world cohort of elderly patients diagnosed with early-stage muscle-invasive bladder cancer (MIBC) who underwent trimodal therapy (TMT). Material and Methods: This retrospective study included 23 patients with a mean age of 70 years diagnosed with stage T2N0–T2N1 MIBC and treated with TMT, which comprised maximal transurethral resection, chemotherapy, and radiotherapy. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, and the impact of clinical and laboratory variables on survival was assessed through multivariable Cox regression analysis. Inflammatory biomarkers such as the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) were also evaluated for their prognostic significance. Results: The median OS was 22 months (95% CI: 12.5–31.5), and the median PFS was 19 months (95% CI: 14.5–47.4). Patients receiving platinum-based chemotherapy had significantly improved OS (HR: 0.041; p = 0.015). Higher platelet-to-lymphocyte ratio (PLR) and advanced nodal stage (N stage) were negatively associated with OS. Although no factor was significantly associated with PFS, a trend toward decreased survival was observed with increasing T stage. Radiotherapy dose did not have a significant impact on survival outcomes. Conclusion: This study highlights the efficacy and tolerability of TMT in elderly, comorbid patients with early-stage MIBC who are candidates for bladder preservation. Platinum-based regimens appear to confer a survival advantage, while PLR and nodal stage may serve as practical prognostic markers. Given the acceptable survival outcomes and favorable toxicity profile, TMT should be considered a promising bladder-sparing option for appropriately selected elderly patients.

Neoadjuvant stereotactic radiosurgery (SRS) has emerged as a promising strategy for managing brain metastases, offering several advantages over traditional postoperative approaches. By delivering targeted radiation prior to surgical resection, neoadjuvant SRS aims to enhance local tumor control, reduce the risk of leptomeningeal dissemination, and optimize treatment efficiency. Recent findings suggest that neoadjuvant SRS provides comparable, if not superior, local control compared to postoperative SRS, while exhibiting lower rates of radiation necrosis and leptomeningeal disease. However, uncertainties persist regarding optimal dosing regimens, treatment timing, and patient selection criteria, as factors such as tumor size, volume, and histology may significantly influence clinical outcomes. Additionally, while neoadjuvant SRS addresses challenges related to target delineation and delays associated with postoperative treatment, its long-term efficacy and integration with systemic therapies require further investigation. This review consolidates evidence from recent retrospective and prospective studies, focusing on key outcomes such as local control rates, radiation toxicity profiles, and overall survival.

In study, we aimed to dosimetrically evaluate the usability of a new generation autocontouring algorithm (DirectORGANS) that automatically identifies organs and contours them directly in the computed tomography (CT) simulator before creating prostate radiotherapy plans. The CT images of 10 patients were used in this study. The prostates, bladder, rectum, and femoral heads of 10 patients were automatically contoured based on DirectORGANS algorithm at the CT simulator. On the same CT image sets, the same target volumes and contours of organs at risk were manually contoured by an experienced physician using MRI images and used as a reference structure. The doses of manually delineated contours of the target volume and organs at risk and the doses of auto contours of the target volume and organs at risk were obtained from the dose volume histogram of the same plan. Conformity index (CI) and homogeneity index (HI) were calculated to evaluate the target volumes. In critical organ structures, V60, V65, V70 for the rectum, V65, V70, V75, and V80 for the bladder, and maximum doses for femoral heads were evaluated. The Mann-Whitney U test was used for statistical comparison with statistical package SPSS (P < 0.05). Compared to the doses of the manual contours (MC) with auto contours (AC), there was no significant difference between the doses of the organs at risk. However, there were statistically significant differences between HI and CI values due to differences in prostate contouring (P < 0.05). The study showed that the need for clinicians to edit target volumes using MRI before treatment planning. However, it demonstrated that delineating organs at risk was used safely without the need for correction. DirectORGANS algorithm is suitable for use in RT planning to minimize differences between physicians and shorten the duration of this contouring step.

Introduction: Predicting prognosis before treatment in rectal cancer patients undergoing neoadjuvant therapy is essential for effective treatment strategy selection. This study evaluates the prognostic impact of the pretreatment pan-immune-inflammation value (PIV) on pathological response, local control, and overall survival. Methods: We included 126 patients who received neoadjuvant treatment for rectal cancer from November 2020 to May 2024. This study was conducted retrospectively. PIV was calculated as (neutrophil count × platelet count × monocyte count)/lymphocyte count, with an optimal threshold identified at 475. Patients were categorized into low (PIV < 475) and high (PIV ≥ 475) groups. Pathological responses were analyzed using the chi-square test, while survival rates were assessed with the Kaplan-Meier method and log-rank tests. Cox regression analysis examined the influence of variables on outcomes. Results: The high PIV group had a significantly higher prevalence of N2 disease (33.3% vs 13.7%, P = .02) and a greater incidence of abdominoperineal resection (35.9% vs 17.2%, P = .02). Pathological response was notably higher in the low PIV group (75% vs 33.3%, P < .001). Overall survival and local recurrence-free survival rates were significantly better in the low PIV group ( P = .006 and P = .004, respectively). In multivariate analysis, PIV was the only significant factor affecting overall and local recurrence-free survival. Conclusion: Higher pretreatment PIV values correlate with poorer pathological response and reduced overall and local recurrence-free survival in rectal cancer patients. These findings support the use of PIV for risk stratification and treatment personalization.

Determining prognosis is crucial for treatment selection, especially for prophylactic cranial irradiation (PCI), in patients with limited-stage small cell lung cancer (LS-SCLC). This study evaluates the prognostic value of the pan-immune inflammation value (PIV) in patients with LS-SCLC. We included patients who underwent thoracic chemoradiotherapy (TRT) and PCI at our clinic between July 2012 and April 2024. PIV was calculated as (neutrophil count × platelet count × monocyte count) / lymphocyte count. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal pre-treatment PIV cut-off to divide patients into two groups. Survival outcomes between these groups were compared using Kaplan-Meier analysis and log-rank tests. Multivariate analyses were conducted using Cox regression. Fifty-nine patients were included in the study. The optimal PIV cut-off was identified as 911 (AUC: 0.60, Sensitivity: 0.31, Specificity: 0.94, J-index: 0.26). Patients were grouped based on PIV levels: low (<911) and high (≥911). Lower PIV levels were significantly associated with improved overall survival (OS) (39 months vs. 10 months, p < 0.001) and intracranial progression-free survival (ICPFS) (not reached vs. 15 months, p < 0.001). The independent prognostic value of PIV was confirmed in multivariate analyses for both OS (p < 0.001) and ICPFS (p < 0.001). These findings suggest that pre-treatment PIV is an independent prognostic marker in LS-SCLC patients undergoing TRT and PCI.