Robotic stereotactic body radiotherapy for recurrent nasopharyngeal carcinoma.

Background: We aimed to evaluate the outcomes of patients reirradiated with stereotactic body radiotherapy for recurrent nasopharyngeal carcinoma (r-NPC) in our hospital. Methods: We retrospectively analyzed 10 patients with r-NPC previously irradiated with definitive radiotherapy. Local recurrences were irradiated with a dose of 25 to 50 Gy (median: 26.25 Gy) in 3 to 5 fractions (fr) (median: 5 fr). The survival outcomes calculated from the time of recurrence diagnosis were obtained using Kaplan-Meier analysis and compared with the log-rank test. Toxicities were assessed by using Common Terminology Criteria for Adverse Events Version 5.0. Results: The median age was 55 years (37-79 years), and nine patients were men. The median follow-up was 26 months (3-65 months) after reirradiation. The median overall survival (OS) was 40 months, OS in 1 and 3 years were 80% and 57%, respectively. OS rate of rT4 (n = 5, 50%) was worse compared with rT1, rT2, and rT3 (P = 0.040). In addition, those with less than 24 months of interval between first treatment and recurrence had worse OS (P = 0.017). One patient exhibited Grade 3 toxicity. There is no other Grade ≥3 acute or late toxicities. Conclusion: In r-NPC, reirradiation is inevitable for patients who are not suitable for radical surgical resection. However, serious complications and side effects prevent dose escalation due to the critical structures previously irradiated. Prospective studies with a large number of patients are required to find the optimal acceptable dose.

Radiosurgery effects and adverse effects in symptomatic eloquent brain-located Cavernomas.

In this study, the dose schedule efficacy, safety and late adverse effects of stereotactic radiosurgery (SRS) were evaluated for patients with symptomatic cavernomas who were not eligible for surgery and treated with SRS. Between January 2013 and December 2018, 53 patients with cavernomas were treated using SRS with the CyberKnife® system. Patients' diseases were deeply located or were in subcortical functional brain regions. In addition to bleeding, 23 (43.4%) patients had epilepsy, 12 (22.6%) had neurologic symptoms and 16 patients (30.2%) had severe headaches. The median volume was 741 (range, 421-1351) mm3, and the median dose was 15 (range, 14-16) Gy in one fraction. After treatment, six (50%) of 12 patients with neurologic deficits still had deficits. Rebleeding after treatment developed in only two (3.8%) patients. The drug was completely stopped in 14 (60.9%) out of 23 patients who received epilepsy treatment, and the dose of levetiracetam decreased from 2000 mg to 1000 mg in four (17.3%) of nine patients. Radiologically, complete response (CR) was observed in 13 (24.5%) patients, and partial responses (PR) were observed in 32 (60.2%) patients. Clinical response of CR was observed in 30 (56.6%) patients, PR was observed in 16 (30.2%), stable disease (SD) was observed in three (5.7%) and four (7.5%) patients progressed. In conclusion, SRS applied in the appropriate dose schedule may be an effective and reliable method in terms of symptom control and prevention of rebleeding, especially in patients with inoperable cavernomas.

Survival and Prognostic Factors in Limited-stage Small-cell Lung Cancer.

OBJECTIVE: To evaluate the factors affecting overall survival (OS) and progression-free survival (PFS) in patients with limited stage-small cell lung cancer (LS-SCLC). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey from January 2002 to October 2019. METHODOLOGY: Data of 89 patients was analysed, who were treated with chemoradiotherapy (CRT) for LS-SCLC, of whom some had also received prophylactic cranial irradiation (PCI). The clinical course and survival rates of LS-SCLS patients treated with different treatment modalities, were evaluated and the prognostic factors were analysed by Cox-regression analysis. RESULTS: The median age of the patients was 59.6 (39 - 83) years-old; 82% were men. The median follow-up duration was 20 (1 - 189) months. The median PFS and OS were 16 (95% CI, 13-18) months and 33 (95% CI, 25-41) months. Patients, who underwent PCI had better OS compared to patients who did not [54 (95% CI, 27-87) months vs. 19 (95% Cl,, 13-25) months, log-rank, p = 0.004]. Grade 3-4 hematologic toxicities were observed in 12 (13.5%) patients and grade 3-4 esophagitis was observed in 25 (28.1%) patients. Younger age, ECOG 0-1, stage I-II disease, complete response to CRT were good prognostic factors on OS and PFS. A complete response to  CRT was also a good independent factor in terms of PFS and OS. CONCLUSION: In this study, younger age, better ECOG status, stage I-II disease, and complete response to CRT had a favourable impact on OS and PFS in LS-SCLC. In addition, PCI has been shown to increase survival in these patients. Key Words: Limited-stage, Small-cell lung cancer, Thoracic radiotherapy, Chemoradiotherapy.

Effect of Pretreatment Platelet Parameters on Survival in Limited Disease Small Cell Lung Cancer.

Background: The aim of this study was to investigate the effect of platelet parameters before concurrent chemoradiotherapy (CCRT) on survival of patients with limited disease small cell lung cancer (LD-SCLC). Methods: This study consisted of patients who received CCRT due to LD-SCLC in the oncology clinic between 1997-2017. Examined platelet parameters included total platelet count (TPC), mean platelet volume, platelet distribution width, and platelet-lymphocyte ratio. The cut-off value for TPC was determined as 306x109/U (sensitivity: 62%, specificity: 75.5%), where patients below or equal to this level was classified as Group I, and those above as Group II. Results:The study included 90 patients whose mean age was 59 years (range: 42-83) and male ratio was 80.0% (n=72). Near three-fourths of patients (74.4%) were at clinical stage III. Among stage I-II patients, mOS was found as 126 months for Group I whereas it had not been reached in Group II (p=0.158). Stage III patients showed significantly lower mOS for Group 1 (16 [range: 14.1-17.8] months) compared to that in Group 2 (19.0 [range: 15.6-62.8] months; p=0.002). In multivariate analysis, Eastern Cooperative Oncology Group performance score (p=0.003), clinical stage (p<0.001), prophylactic cranial irradiation (p=0.004), and TPC (p=0.031) was determined as the most significant factors affecting survival. Conclusion: Our study suggests association of high baseline levels of TPC to improved survival in patients scheduled to undergo CCRT for LD-SCLC. Considering easiness and universal availability of TPC measurement, potential utilization of this biomarker may be promising to predict survival, albeit requiring validation by further well-designated prospective studies.

Prognostic Significance of Mean Platelet Volume on Local Advanced Non-Small Cell Lung Cancer Managed with Chemoradiotherapy.

Mean platelet volume (MPV), the most commonly used measure of platelet size, and is altered in patients with malignancies. The aim of this study was to investigate the effect of MPV on overall survival (OS) of patients with locally advanced (Stage IIIA/B) inoperable non-small cell lung cancer (NSCLC). This retrospective study included patients who received concomitant chemoradiotherapy (CCRT) with cisplatin + etoposide regimen due to locally advanced stage IIIA/B NSCLC. The study included a total of 115 cases, consisting of 110 (95.7%) male and 5 (4.2%) female patients. The mean age of the patients was 61.3 ± 10.4 (22-82) years. ROC curve generated by MPV for OS yielded an AUC of 0.746 (95% CI 0.659-0.833), (p < 0.001). MPV was detected as >9 fL with a sensitivity of 74.4% and a specificity of 72.0%. In patients with stage IIIA, median OS was 45.0 months (95% CI 17.3-74.1) and 21 months (95% CI 10.6-31.3) in groups with MPV > 9.0 fL and ≤9.0 fL, respectively (p = 0.013). In patients with stage IIIB, median OS was 44.0 months (95% CI 13.8-60.6) and 16 months (95% CI 9.5-22.4) in groups with MPV > 9.0 fL and ≤9.0 fL, respectively (p = 0.036). ECOG performance score, total platelet count, and MPV were found as the most significant independent factors affecting survival (p < 0.001, p = 0.008, and, p = 0.034, respectively). In this study, we showed that decreased pre-treatment MPV was an independent risk factor for survival in NSCLC patients who were administered CCRT. As part of routine complete blood count panel, MPV may represent one of the easiest measuring tools as an independent prognostic marker for survival in locally advanced NSCLC.

[Prognostic factors and survival rates in oral cavity cancers]. / Oral kavite kanserlerinde prognostik faktörler ve sagkalim oranlari.

OBJECTIVES: We evaluated the treatment results and prognostic factors that might affect local control and survival in patients receiving radiotherapy for oral cavity cancers. PATIENTS AND METHODS: The study included 32 patients (16 men, 16 women; mean age 62 years; range 26 to 90 years) who received radiotherapy for oral cavity cancers. All the patients had squamous cell carcinoma, which involved the tongue in 15 patients (46.9%) and the lower lip in 13 patients (40.6%). Most of the patients (n=21, 65.7%) had T1 or T2 tumors. Neck lymph nodes were positive in 11 patients (34.4%). Fifteen patients had early stage (stage I, II), 17 patients had advanced stage (stage III, IV) tumors. Sixteen patients received primary radiotherapy and 16 patients received postoperative adjuvant radiotherapy, with doses ranging from 5000 cGy to 7000 cGy. The mean follow-up period was 68 months (range 5 to 147 months). RESULTS: Two-year and five-year survival rates were 53% and 39%, respectively. Age, sex, tumor differentiation, and the total radiotherapy dose were not found to affect survival (p>0.05), whereas tumor size, positive lymph nodes, stage, and treatment modality were found as significant prognostic factors (p=0.01). CONCLUSION: Our data show that tumor size, lymph node involvement, stage, and postoperative adjuvant radiotherapy are significant parameters that affect survival in oral cavity cancers.

Prophylactic effect of pentoxifylline on radiotherapy complications: a clinical study.

OBJECTIVE: The purpose of this study was to assess the prophylactic effect of pentoxifylline (Ptx) on complications related to radiation. STUDY DESIGN AND SETTING: Seventy-eight patients who had postoperative radiotherapy for squamous cell carcinoma of the head and neck were enrolled into a prospective study. Patients were randomly assigned to the Ptx group (40 patients) and the control group (38 patients). Ptx was given to the patients at a dose of 400 mg 3 times a day orally to a total of 1200 mg. We noted radiotherapy complications in each group. RESULTS: Four patients were not able to tolerate this drug due to the development of gastrointestinal symptoms and dizziness. Late skin changes, fibrosis, and soft tissue necrosis were more severely in the control group than in the Ptx group (P < 0.05). We could find no positive effects on acute skin reactions and pain (P > 0.05). CONCLUSION: Our study suggests that Ptx has a prophylactic effect on the radiation complications. This can be explained by protective effect of Ptx against vascular pathology.