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    Investigation of the risk factors in the development of radionecrosis in patients with brain metastases undergoing stereotactic radiotherapy
    (Oxford Univ Press, 2024) Dogan, Bedriye; Demir, Harun; Isik, Naciye; Gunalp, Gun; Gunbey, Hediye Pinar; Yaprak, Gokhan
    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.
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    Predictors of local control after robotic stereotactic radiotherapy for brain metastases: 10-years-experience after Cyberknife installation
    (Wiley, 2024) Demir, Harun; Dogan, Bedriye; Gunbey, Hediye Pinar; Isik, Naciye; Yaprak, Gokhan
    ackground: 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.
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    Real-World Long-Term Outcomes of Operated and Non-Operated Rectal Cancer in the Elderly: A 14-Year Retrospective Multicentre Study
    (Wiley, 2025) Demir, Harun; Kanyilmaz, Guel; Babalioglu, Ibrahim; Dogan, Bedriye; Aktan, Meryem; Yavuz, Berrin Benli; Safi, Ayse Sumeyye
    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.