Survival and Prognostic Factors in Re-irradiation for Recurrent/Progressive Malignant Gliomas: Turkish Society of Radiation Oncology Neuro-Oncology Group, TROD 007-006 Study.

AIM: To evaluate survival and prognostic factors associated with survival among patients who underwent reirradiation for recurrent/ progressive primary brain tumors. MATERIAL AND METHODS: A multicenter, retrospective study (7 centers, N=236) was conducted by the Neuro-oncology Group of the Turkish Radiation Oncology Association. RESULTS: Median overall survival (OS) was 11 months and 1- and 2-year survival rates were 48% and 22%, respectively. Survival was negatively correlated with cumulative biologically effective dose (BED10) (r=-0.158, p=0.016) and cumulative equivalent dose in 2-Gy fractions (EQD2) (r=-0.158, p=0.016). In univariate analysis, survival was associated with performance status (p < 0.001), histopathology at diagnosis and recurrence (p < 0.001), radiotherapy (RT) method used for recurrence (p=0.025), tumor volume at recurrence (p=0.014), cumulative EQD2 ( < 110 vs. ≥110 Gy, p=0.038), and cumulative BED10 ( < 130 vs. ≥130 Gy, p=0.022). In multivariate analysis, tumor volume at recurrence (HR=1.68, 95% CI=1.06-2.64, p=0.025), Karnofsky Performance Status score (HR=5.7, 95% CI=3.26-9.98, p < 0.001), and histopathology at recurrence (glioblastoma vs. high-grade glioma: HR=0.48, 95% CI=0.26-0.88, p=0.019; glioblastoma vs. low-grade glial tumor: HR=0.16, 95% CI=0.08-0.34, p < 0.001) were found to be independent prognostic factors. Radionecrosis was detected in 25% (n=58) of the patients. Re-resection was associated with a higher rate of radionecrosis (37.7% vs. 18%, p=0.002). CONCLUSION: The prognostic factors most strongly associated with survival in glioma patients undergoing reirradiation were Karnofsky Performance Status score below 70, glioblastoma histopathology, and tumor volume greater than 4.5 cm3. In addition, survival time was negatively correlated with cumulative EQD2 and BED10. The rate of radionecrosis was higher in patients who underwent re-resection compared those who did not.

The relationship between quality of life and sex role of women with gynecological cancers undergoing brachytherapy.

PURPOSE: This study aims to analyze the relationship between the quality of life and sex roles of women diagnosed with cancer and undergoing brachytherapy. METHODS: The research is a cross-sectional descriptive study. The sample of the study included 116 women over 35 years old who were diagnosed with a gynecologic cancer and underwent intracavitary brachytherapy at the Radiation Oncology Department of a university hospital. Personal information form, SF-36 the Quality of Life Scale, and BEM Sex Role Inventory were used in the study. The researcher collected the data through face-to-face interview. The data were collected in the nurses' room after 3 different brachytherapy treatments that patients received weekly. RESULTS: It was found that the average score of the physical functioning subscale was 32.80 ± 24.33, the average score of role physical was 15.43 ± 28.78, the average score of role emotional was 17.81 ± 28.96, the average score of vitality was 39.13 ± 16.12, the average score of social functioning was 43.53 ± 20.55, the score average of pain was 50.0 ± 20.09, the average score of general health was 42.67 ± 14.61, and the general health of mental health was 55.86 ± 16.12. In the BEM sex roles scale, the average score of BEM femininity was 105.56 ± 13.95, and the average score of BEM masculinity was 80.61 ± 12.77. In our study, a very low, negative, and significant relationship was determined between the role of femininity and emotional role limitation, physical functionality, social functionality, and general health perception in the women undergoing brachytherapy (p < 0.05). CONCLUSIONS: Based on the findings of the present study, we can state that an increase in the "role of femininity" in women undergoing brachytherapy was effective in the decrease in the quality of lives of women. It can be claimed that the results will be a guidance for the nurses who will play an important role in increasing the quality of lives of the women undergoing brachytherapy.

The effect of the hand massage using baby oil with lavender application on the procedural pain and state anxiety of women undergoing brachytherapy: A parallel-group randomized controlled study.

OBJECTIVE: This parallel-group randomized controlled study evaluated the effect of the hand massage practiced using baby oil with lavender on reducing pain and situational anxiety in women with brachytherapy. METHODS: The study was completed with 36 patients. The treatment group included 18 patients, and the control group had 18. The data were collected through patient information form, visual analog scale, and state anxiety scale. Before the brachytherapy, three sessions of hand massages, each lasting 10 min (5 min for each hand), were performed using baby oil with lavender. Data collection forms were repeated after each session. The control group received routine treatment. Study groups were similar and homogeneous in terms of socio-demographic characteristics. The data obtained were assessed using Shapiro Wilk, Repeated Measures ANOVA, chi-square, and paired samples t-test. RESULTS: At the end of the brachytherapy, the pain and state anxiety scores of the group that applied hand massage   were determined to be lower than the control group's at each three-time point (1st, 2nd, and 3rd-time points) (p<0.001). CONCLUSION: It was determined that hand massage using baby oil with lavender effectively reduced pain and anxiety. It can be practiced by certified nurses in clinics that perform brachytherapy as a noninvasive, safe, and affordable practice.

Prediction of nonsentinel lymph node metastasis in breast cancer patients with one or two positive sentinel lymph nodes.

OBJECTIVE: The aim of the present study was to investigate the association between non sentinel lymph node metastasis (NSLNM) and clinicopathological factors, particularly in the case of sentinel lymph node (SLN) metastasis in one or two, in clinically node negative patients with breast cancer. METHODS: Between 10/2010 and 10/2014, 350 sentinel lymph node biopsy (SLNB) were performed in patients with histologically proven primary breast cancer in our clinic. The data collection includes the following characteristics: age, pathological tumor size, histological type, histological grade, lymphovascular invasion (LVI), number of positive SLN, size of the SLN metastasis (macrometastasis, micrometastasis, isolated tumor cells), multifocality (MF), extracapsuler invasion (ECI) of the SLN, the estrogen receptor (ER) status, the progesterone receptor (PR) status and the Her 2 receptor status, Ki 67 reseptor status. Data were collected retrospectively and then analyzed. RESULTS: A successful SLN biopsy were performed in 345 (98.5%) cases. SLN metastases were detected in 110 (31.8%) cases. These patients then underwent axillary dissection; among these patients, 101 (91.8%) had only one to two positive SLNs. Of the 101 patients with positive SLN biopsies, 32 (31.6%) had metastases in the NSLNs. Univariate and multivariate analysis showed that lymphovascular invasion, extracapsular invasion (ECI), Her-2 receptor positive, and Ki-67 > 14% were related to NSLNM (p<.0.05). CONCLUSION: The predicting factors of NSLNM were LVI, ECI, Ki-67 level, Her-2 reseptor positive and but should be further validated in our institutions, different institutions and different patient groups prospectively.

Prognostic Significance of Two Dimensional AgNOR Evaluation in Local Advanced Rectal Cancer Treated with Chemoradiotherapy.

The prognostic significance of AgNOR proteins in stage II-III rectal cancers treated with chemoradiotherapy was evaluated. Silver staining was applied to the 3µm sections of parafin blocked tissues from 30 rectal cancer patients who received 5-FU based chemoradiotherapy from May 2003 to June 2006. The microscopic displays of the cells were transferred into the computer via a video camera. AgNOR area (nucleolus organizer region area) and nucleus area values were determined as a nucleolus organizer regions area/total nucleus area (NORa/ TNa). The mean NORa/TNa value was found to be 9.02±3.68. The overall survival and disease free survival in the high NORa/TNa (>9.02) patients were 52.2 months and 39.4 months respectively, as compared to 100.7 months and 98.4 months in the low NORa/TNa (<9.02) cases. (p<0.001 and p<0.001 respectively). In addition, the prognosis in the high NORa/TNa patients was worse than low NORa/TNa patients (p<0.05). In terms of overall survival and disease-free survival, a statistically significant negative correlation was found with the value of NORa/TNa in the correlations tests. Cox regression analyses demostrated that overall survival and disease-free survival were associated with lymph node status (negative or positive) and the NORa/TNa value. We suggest that two-dimensional AgNOR evaluation may be a safe and usable parameter for prognosis and an indicator of cell proliferation instead of AgNOR dots.

Contribution of involved-field radiotherapy to survival in patients with relapsed or refractory Hodgkin lymphoma undergoing autologous stem cell transplantation.

OBJECTIVES: To assess the outcomes of overall survival and posttransplantation survival in patients with Hodgkin lymphoma (HL) undergoing autologous stem cell transplantation (ASCT) because of the development of relapse or resistance after chemotherapy (CT) or CT plus radiotherapy (combined modality treatment, CMT). METHODS: Forty-five patients undergoing ASCT because of the development of relapse or resistance after CT or CMT for HL were enrolled in the study. Radiotherapy was given as involved-field radiotherapy. Patients were treated with CT alone (n=25) or CMT (n=20). These 2 groups were further divided into 2 subgroups: the patients with early-stage (I to II) and advanced-stage (III to IV) HL. RESULTS: Median patients age was 29 years (range, 16 to 60 y) and the median follow-up was 60 months (range, 12 to 172 mo). In the patients with advanced-stage HL, there was no statistically significant difference in overall survival between irradiated and nonirradiated patients (n=18, irradiated n=4 and nonirradiated n=14). However, in the patients with early-stage disease, there was a significant difference in 5- and 10-year overall survival between the irradiated and nonirradiated groups (81% vs. 48% and 66% vs. 24%, respectively, P=0.045; n=26, irradiated n=16 and nonirradiated n=10). In the univariate analysis, irradiated group and involvement of 1 to 2 nodal regions were found to be significant for overall survival, whereas irradiated group, early stage, and involvement of 1 to 2 nodal regions were found to be significant for posttransplantation survival. However, only irradiated group was found to be significant for posttransplantation survival in multivariate analysis (P<0.05). CONCLUSIONS: Addition of involved-field radiotherapy to CT in patients undergoing ASCT after relapse or recurrence failed to provide survival benefit in patients with advanced HL, while a survival benefit was observed in patients with early-stage HL. Radiotherapy should be considered as part of CMT in the patients with early-stage HL, which should not be neglected.