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Öğe Dil kanserinde kombine tedavi (cerrahi ve radyoterapi) sonuçları ve prognostik faktörler(2007) Karadeniz, Ahmet; Saynak, Mert; Kadehçi, Züleyha; Fayda, Merdan; Aksu, Görkem; Kocaelli, Hümeyra; Hafız, GünterAmaç: Cerrahi ve cerrahi sonrası radyoterapi uygulanan primer dil kanserli hastalarda tedavi sonuçları değerlendirildi ve prognostik faktörler araştırıldı. Hastalar ve Yöntemler: Çalışmaya ameliyat sonrasında radyoterapi uygulanan dil kanserli 60 hasta (31 erkek, 29 kadın; medyan yaş 54; dağılım 22-82) alındı. Hastaların tümör evresine (AJCC-1997) göre dağılımı, evre I (n1), evre II (n21), evre III (n12), evre IVA (n26) şeklindeydi. Cerrahi tedavide 46 hastaya (%76) hemiglossektomi, 13 hastaya (%22) parsiyel, bir hastaya (%2) total glossektomi, 47 hastada (%78) boyun diseksiyonu uygulandı. Işın dozu genellikle 6000 cGy/30 fr idi. Medyan takip süresi 51 ay (dağılım 5-180 ay) idi. Bulgular: Tedavi sonrası beş yıllık genel ve hastalıksız sağkalım oranları sırasıyla %50 ve %47 idi. Beş yıllık genel sağkalım evre l-lll'de %70, evre IVA'da %20 bulundu. Yinelemeler çoğunlukla ilk iki yılda görüldü. Toplam 31 hastada (%52) yineleme görüldü. Yineleme sonrası medyan sağkalım sekiz ay (dağılım 1-53 ay) idi. Çokdeğişkenli analizde, tümör çapı, evre, N evresi, kapsüler invazyon varlığı ve toplam radyoterapi süresi yerel-bölgesel kontrol ve genel sağkalım için anlamlı prognostik faktörler olarak belirlendi. Tedaviye bağlı komplikasyonlar kabul edilebilir sınırlar içinde kaldı. Sonuç: Ameliyat sonrası radyoterapi evre III ve IVA dil kanseri olgularında standart olarak uygulanmalıdır.Öğe Is early postradiation dysplasia almost associated with poor prognosis? A case report and review of the literature(BLACKWELL PUBLISHING, 2006) Aksu, Maksut Görkem; Fayda, M; Saynak, Mert; Tore, G; Alatli, CFollowing radiotherapy for cervical carcinoma, abnormal cytologic changes have been reported in a number of publications. These reactions occur at varying periods of time following irradiation and do not necessarily reflect the presence of invasive cancer. On the basis of cytologic and histopathologic features, these reactions were determined as postradiation dysplasia (PRD). PRD has been reported to occur in 18.7-26% of patients treated by radiotherapy for cervical cancer. In the literature, it was reported that patients diagnosed with PRD less than 3 years after the initial diagnosis of cervical cancer had a mean survival rate of 33.8% as compared with a 100% 5-year survival rate in patients with a delayed (> 3 years) onset of period. We present a case of stage IIIB cervical squamous cell carcinoma with PRD detected 6 months after radiotherapy. The patient is still tumor free 8 years after radiotherapy. In the light of this patient, we review the literature and discuss the relationship of PRD with survival in the cervical carcinomas.Öğe The Results of Concomitant and Sequential Chemoradiotherapy With Cisplatin and Etoposide in Patients With Locally Advanced Non-Small Cell Lung Cancer(2005) Saynak, Mert; Aksu, G.; Fayda, Merdan; Kaytan, Esra; Oral, Ethem Nezih; Gürocak, S.; Kizir, Ahmet; Karadeniz, AralPurpose: To report on the treatment results and demographic characteristics of patients with locally advanced non small cell lung carcinoma (NSCLC) who were treated with concomitant or sequential chemoradiotherapy. Patients and methods: 132 patients with locally advanced NSCLC (stage IIIB) were evaluated Their median age was 60 years (range 33-80). Histopathological diagnosis was epidermoid carcinoma in 96 (73%) patients, adenocarcinoma in 33 (25%) patients and large cell carcinoma in 3 (2%) patients. Karnofsky performance status (KPS) score was ? 70 in 112 (85%) patients. Weight loss was greater than 5% in 34 (26%) patients at presentation. One hundred and six (80%)patients were treated with sequential chemoradiotherapy which consisted of 3 monthly cycles of cisplatin (100 mg/m2, day 1) and etoposide (100 mg/m2/day, days 1-3) before radiotherapy. Radiotherapy consisted of a total dose of 60 Gy in 30 fractions (2 Gy/fraction), given to a volume including primary tumor and mediastinum. Two to 4 cycles of chemotherapy were administered after completion of radiotherapy to patients whose disease had not progressed after initial chemotherapy. Twenty-six patients were treated with concomitant chemoradiotherapy. The same radiotherapy regimen was started with the 2nd cycle of chemotherapy which consisted of cisplatin (80 mg/m2, day 1) and etoposide (100 mg/m2/day, days 1-3). Chemotherapy was completed after 4 cycles in all patients. Results: Overall survival (OS) was 14.5 months in 106 patients treated with sequential chemoradiotherapy and 14.6 months in 26 patients treated with concomitant chemoradiotherapy (p=0.99). Median time to progression was 9.77 months in the concomitant group and 11.6 months in the sequential group (p=0.47). However progression-free survival was better in patients of both groups whose KPS was > 70 (12.4 months versus 11.5 months, p=0.02). While presence of anemia was found as an adverse prognostic factor only in univariate analysis, non-epidermoid histology, KPS less than 70 and presence of N2-N3 disease were found as adverse prognostic factors in both univariate and multivariate analysis. Conclusion: The addition of chemotherapy to radiation concomitantly or sequentially prolongs survival in locally advanced NSCLC patients with acceptable adverse event profiles in both arms compared with results of the trials in the literature in which radiotherapy is used as single treatment modality.Öğe Treatment results and prognostic factors in oral tongue cancer: analysis of 80 patients(CHURCHILL LIVINGSTONE, 2006) Aksu, Maksut Görkem; Karadeniz, A; Saynak, Mert; Fayda, M; Kadehci, Z; Kocaelli, HTreatment results and prognostic factors for 80 patients with oral tongue cancer admitted to Istanbul University Oncology Institute between 1987 and 2000 were retrospectively analysed. The patients were treated by surgery and postoperative or curative radiotherapy. Median age was 55 (22-93) out of which 41 patients (51%) were male and 39 (49%) were female. One patient (1%) had stage I disease, 28 patients (36%) stage II, 18 patients (23%) stage III and 32 patients (40%) stage IVA disease. Nineteen patients (24%) were medically inoperable or refused surgical treatment, so were treated with curative radiotherapy to a total dose of 70 Gy (group A). The remaining 61 patients (76%) were treated with surgery and postoperative external beam radiotherapy (group B). The median follow-up time was 44 months. The 5-year overall and loco-regional disease-free survival rates were 42% and 46%, respectively. The 5-year overall survival rates were 16% in group A and 49% in group B (P = 0.0002). The 5-year disease-specific survival rate was 23% in group A while in group B it was 49%; the difference was statistically significant (P = 0.02). Combined treatment improves overall and disease-free survival in patients with stage 11, 111 and IVA oral tongue cancer. In patients who are not candidates for surgery, the effect of radiotherapy may be increased with the use of brachytherapy.
