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Öğe Effects of cyanocobalamin on immunity in patients with pernicious anemia(Karger, 2008) Erkurt, Mehmet Ali; Aydogdu, Ismet; Dikilitas, Mustafa; Kuku, Irfan; Kaya, Emin; Bayraktar, Nihayet; Ozhan, OnurObjective: The aim of the study was to evaluate the role of vitamin B-12 in patients with pernicious anemia. Materials and Methods: This study was conducted prospectively at the Turgut Ozal Medical Center, Department of Hematology, between April and November 2002. Absolute numbers and ratio of the surface antigens of T and B lymphocyte subgroups, CD4/CD8 ratio were calculated in order to evaluate changes in leukocyte and lymphocyte numbers; natural killer (NK) cell count, serum C3, C4, and levels of immunoglobulins G, A, and M were also measured to evaluate vitamin B-12 effect on immunity. Values obtained before treatment with cyanocobalamin were compared with those found during peak reticulocyte count. Results: In vitamin B-12-deficient patients, absolute numbers of CD4+ and especially CD8+ lymphocytes were found to be decreased; CD4/CD8 ratio increased, and NK cell activity was depressed. After cyanocobalamin treatment, absolute numbers and percentage of lymphocyte subgroups were elevated. Increased CD4/CD8 ratio and depressed NK cell activity were restored and levels of C3, C4, and immunoglobulins were elevated. Conclusion: These findings suggest that vitamin B-12 has important immunomodulatory effects on cellular immunity, and abnormalities in the immune system in pernicious anemia are restored by vitamin B-12 replacement therapy. Copyright (C) 2008 S. Karger AG, Basel.Öğe Factors Affecting Survival in Non-Small Cell Lung Cancer Patients with Brain Metastasis(Akad Doktorlar Yayinevi, 2016) Harputluoglu, Hakan; Kaplan, Nihal; Dikilitas, Mustafa; Yagar, YavuzIn this study, prognostic factors in non small cell lung cancer (NSCLC) patients with brain metastasis, and relation between brain metastasis location and survival were investigated. 103 NSCLC patients with brain metastasis were enrolled in this study. Demographic, clinical characteristics and treatment modalities of the patients who were followed up in medical oncology department between May 2009 and February 2015 were assessed retrospectively using the hospital database. Brain metastasis location, treatment of brain metastasis, systemic treatment after brain metastasis and survival of the patients were recorded. The relation between these factors and survival was assessed. Follow-up period of the patients was between one and 42 months. Mean survival of the patients after brain metastasis diagnosis was 7.2 months. In the single variant analyses; patient age below 65, good performance status, detection of brain metastasis during initial diagnosis and receiving systemic treatment after brain metastasis were found to be positive prognostic factors. In the multivariant analyses; while combined treatment of brain metastasis with surgery and radiotherapy and systemic therapy after brain metastasis were found to be independent prognostic factors, no relation between location of brain metastasis and survival was found. In this study, systemic therapy including surgery, radiotherapy and chemotherapy was found as independent prognostic factors in selected patients who had NSCLC with brain metastasis. We think that defining prognostic factors in lung cancer patients with brain metastasis is important for both estimating prognosis and selecting optimal therapy for the patient.Öğe POSTERIOR REVERSIBLE LEUKOENCEPHALOPATHY SYNDROME DEVELOPING SECONDARY TO SUNITINIB THERAPY IN A PATIENT WITH METASTATIC RENAL CELL CARCINOMA(Carbone Editore, 2018) Kaplan, Nihal Bozdag; Harputluoglu, Hakan; Dikilitas, Mustafa; Elkiran, Emin Tamer; Temelli, OztunPosterior reversible encephalopathy syndrome (PRES) is characterized by vasogenic edema occurring generally in parietal and occipital areas of the brain as a result of different etiologic causes and it is diagnosed by means of clinical and radiologic assessment. Sunitinib is an orally administered tyrosine kinase inhibitor used in the treatment of renal cell carcinoma with its antiangiogenic and antitumor effects. Fatigue, nausea-vomiting, diarrhea, hypertension, cardiotoxicity, hypothyroidism, neutropenia, and skin toxicity are among common side effects associated with sunitinib therapy. The current report presents a female patient with metastatic papillary renal cell cancer who developed posterior reversible encephalopathy syndrome as determined by means of clinical and radiologic assessment at 8 months of sunitinib therapy and who completely recovered with antihypertensive, antiepileptic, and antiedema therapy.Öğe Posterıor reversıble leukoencephalopathy syndrome developıng secondary tosunıtınıb therapy ın a patıent wıth metastatıc renal cell carcınoma(Carbone edıtore, vıa quıntıno sella, 68, palermo, 90139, ıtaly, 2018) Kaplan, Nihal Bozdag; Harputluoglu, Hakan; Dikilitas, Mustafa; Elkiran, Emin Tamer; Temelli, OztunPosterior reversible encephalopathy syndrome (PRES) is characterized by vasogenic edema occurring generally in parietal and occipital areas of the brain as a result of different etiologic causes and it is diagnosed by means of clinical and radiologic assessment. Sunitinib is an orally administered tyrosine kinase inhibitor used in the treatment of renal cell carcinoma with its antiangiogenic and antitumor effects. Fatigue, nausea-vomiting, diarrhea, hypertension, cardiotoxicity, hypothyroidism, neutropenia, and skin toxicity are among common side effects associated with sunitinib therapy. The current report presents a female patient with metastatic papillary renal cell cancer who developed posterior reversible encephalopathy syndrome as determined by means of clinical and radiologic assessment at 8 months of sunitinib therapy and who completely recovered with antihypertensive, antiepileptic, and antiedema therapy.Öğe Prevention of oral mucositis due to 5-fluorouracil treatment with oral cryotherapy(Natl Med Assoc, 2005) Baydar, Mustafa; Dikilitas, Mustafa; Sevinc, Alper; Aydogdu, IsmetIntroduction: One of the most common and important side effects of 5-fluorouracil (5-FU) is mucositis with ulcerations in the oral cavity. We investigated the effects of local cryotherapy on mucositis incidence administrated during 5-FU treatment. Methods: In a total of 99 courses, 5-FU and folinic acid combination chemotherapy was given to 40 patients. In our study, we considered every course as a single case, and cryotherapy was given to the some patient in one course but not given in the next. Results: While mucositis developed in 6.7% of the courses given with cryotherapy, this ratio was 38.9% in courses given without cryotherapy, In the logistic regression analysis, development of mucositis had been found to correlate only with cryotherapy. Odds ratio (OR)=11.5; in the 95% confidence interval (CI)=3.2-41.9; (p=0.001). Discussion: Results of initial studies evaluating the effects of cryotherapy in preventing mucositis due to 5-FU based chemotherapy regimens were promising. We concluded that oral cooling prevents 5-FU induced mucositis. This effective prophylactic treatment should be used in patients who are at increased risk for developing 5-FU induced mucositis.Öğe Prophylactic cranial irradiation in small cell lung cancer: A single-center experience.(Allied Acad, 2017) Temelli, Oztun; Bozdag, Nihal Kaplan; Eraslan, Fatma Aysun; Gulbas, Hulya; Gurocak, Simay; Dikilitas, MustafaObjective: Small-Cell Lung Cancer (SCLC) constitutes about 15% of all lung cancers. It tends to frequently metastasize to the brain. Prophylactic Cranial Irradiation (PCI) is performed, when the penetration of chemotherapeutic agents to brain is insufficient. The aim of this study was to report our single-center experience with PCI in SCLC cases. Methods: We retrospectively reviewed 28 patients with SCLC diagnosed between March 2007 and November 2016. Cranial Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) was performed from all patients to exclude metastasis before PCI. Radiation Therapy (RT) was conducted using two different instruments: a three-dimensional conformal RT-based Linear Accelerator (LINAC) instrument was used until 2013 and an Intensity-Modulated Radiation Therapy (IMRT) thereafter. All patients were treated with a total of 25-36 Gy with fraction doses of 2-2.5 Gy. Overall survival was estimated in all patients. Results: The mean age was 56 (range: 36 to 72) y. Only one of the patients was female, while the remaining patients were all males. Twenty two patients (78.5%) were in limited stage SCLC, while six patients (21.5%) were in the extensive stage. Seventeen patients died, while 11 of them survived. The mean survival was 35 months, while it was 40 months for limited stage and 17 months for extensive stage (p=0.027). One, two, and five-year OS rates were 81.4%, 58%, and 17%, respectively. Four (14%) patients developed brain metastasis during follow-up. Of these patients, two were treated with Whole Brain RT (WBRT), one with Stereotactic RT (SBRT), and the other with best supportive care. Conclusion: Our study results suggest that PCI is a safe, low-toxicity treatment modality used to prevent brain metastases in SCLC cases.Öğe A rare case Of gastric cancer: Isolated vaginal metastasis(Mosby-Elsevier, 2020) Gulmez, Ahmet; Dikilitas, MustafaGastric cancer is one of the most common cancers worldwide. The vast majority of gastric cancer is adeno-carcinoma histologically. The majority of gastric cancer patients show distant metastasis at the time of diagnosis. Because they are diagnosed with metastatic disease, most often they are inoperable ovarian metastasis is a well-known metastasis of gastric cancer. Vaginal metastasis happens by the local spreading of ovarian or uterine metastasis. This study reports a gastric cancer case that presented with isolated vaginal metastasis in the absence of ovarian or uterine metastasis (C) 2020 Elsevier Inc. All rights reserved.Öğe A rare granular cell tumor of the vulva: a case report(Kare Publ, 2015) Bozdag Kaplan, Nihal; Dursun, Ibrahim Hakki; Dikilitas, Mustafa; Harputluoglu, Hakan; Yilmaz, Ercan; Sahin, NurhanGranular cell tumors are rare tumors, usually located subcutanesously or intramucosal. Most frequent presentation is in the head and neck region especially in the tongue, 5-15% of the cases are vulvar. Originating from Scwhan cells, these tumors are usually benign and only 1-3% of the cases have malign behaviour. As these tumors have an agressive course and do not respond to chemo-radiation, to mention the importance of early diagnosis we present this case.Öğe Small Cell Neuroendocrine Tumor of the Larynx: Two Case Reports(Kare Publ, 2017) Temelli, Oztun; Bozdag, Nihal Kaplan; Akatli, Aysenur; Yaslikaya, Serhat; Dikilitas, MustafaNeuroendocrine tumors of the larynx account for<1% of all laryngeal cancers. Laryngeal small cell carcinomas of the neuroendocrine type (SCNC) account for <0.5% of all laryngeal tumors. We report two cases of 65-and 75-year old men with small cell carcinoma of the supraglottic larynx. The patients were treated with induction chemotherapy (cisplatin-etoposide) and chemoradiotherapy (cisplatin-etoposide). The first patient was alive until 26 months from diagnosis. However, multiple brain metastases developed in the second patient, and he died 16 months after diagnosis. Small cell neuroendocrine carcinomas are very aggressive neoplasms. A combination of platinum-based chemotherapy and radiotherapy is the mainstay of the treatment for SCNC, which is considered to be a systemic disease.Öğe Stomach metastasis of malignant melanoma(2019) Bilgic, Yilmaz; Mehraliyev, Elkin; Akatli, Aysenur; Dikilitas, Mustafa; Cagin, Yasir Furkan; Erdogan, Mehmet Ali; Evren, Bahri; Harputluoglu, Murat MuhsinDear Editor, Malignant melanoma develops as a result of malignant transformation of melanocytes. Melanocytes in the body are found in the skin, mucosa, eye and nervous system. Primary skin melanomas are responsible for 1-2% of deaths in the world. Although the incidence of melanoma increases with age, it is most commonly seen between the ages of 20-45 (1). It is the 5th most common cancer in the United States. Because of its aggressive behavior and high rate of metastasis, its prognosis are poor. Life expectancy of 10 years is 75-80%. The mean survival time in distant metastasis cases is 6-9 months (2). Malignant melanomas are rare in the gastrointestinal tract, although small bowel, large bowel and anorectal metastasis are common and metastasis to the stomach is rare (3). We aimed to present gastric metastasis in a 71-year-old woman with malignant melanomaÖğe Stomach metastasis of malignant melanoma(2019) Bilgic, Yilmaz; Mehraliyev, Elkin; Akatli, Ayşe Nur; Dikilitas, Mustafa; Cagin, Yasir Furkan; Erdogan, Mehmet Ali; Evren, Bahri; Harputluoglu, Murat MuhsinÖğe Survival and prognostic factors in patients with brain metastasis: Single center experience(Zerbinis Medical Publ, 2016) Ekici, Kemal; Temelli, Oztun; Dikilitas, Mustafa; Dursun, Ibrahim Halil; Kaplan, Nihal Bozdag; Kekilli, ErsoyPurpose: The purpose of this study was to evaluate the clinical status, prognostic factors and treatment modalities affecting survival in patients with brain metastasis. We aimed to evaluate the whole brain radiation therapy (WBRT) outcomes of patients with brain metastasis in our center. Methods: Clinical data of 315 patients referred to our center between 2004 and 2014 with metastatic brain cancers were collected and analysed for possible relationships between survival time, age, gender, Karnofsky performance status (KPS), recursive partitioning analysis (RPA), primary tumor, number of brain lesions, surgery, radiation therapy scheme, extracranial metastatic status and primary disease control status. Results: The average patient age of onset was 58 years. The primary tumor site was lung (68%), breast (12%), melanoma (4%), colorectal (1.6%), sarcoma (1.3%) and unknown primary disease (4.4%). The rest of the patients had other primary sites. Eighty four (26.6%) patients had single brain metastasis, 71 (22.5%) had 2 or 3 lesions, and 159 (50.4%) patients had more than 3 lesions. Leptomeningeal involvement was seen in combination of paranchymal involvement in 11 (3.5%) patients. Fifty patients had undergone surgical resection. WBRT was delivered to all of the patients. Median overall survival was 6.7 months (95% CI, 5.80-7.74). Median overall survival of patients treated with combination of surgery and WBRT was significantly better compared with those treated with WBRT alone (13.5 vs 5.5 months, p=0.0001). One- and 2- year survival was 17 and 4.7%, respectively. Conclusions: The present study concludes that brain metastasis is common in cancer patients. The best overall survival was obtained by surgery+NBRT in good-condition patients. Treatment should be tailored on an individual basis to all these patients.Öğe Why Adjuvant and Neoadjuvant Therapy Failed in HCC. Can the New Immunotherapy Be Expected to Be Better?(Springer, 2020) Dikilitas, MustafaIntroduction HCC remains a challenging disease with its unique characteristics and aggressive behavior. Although there are some curative-intent treatments such as liver transplantation and surgical resection, they themselves did not cure the patients with relatively high recurrence rates. Several modalities including local ablation methods like TACE or TARE, systemic treatments such as chemotherapy, tyrosine kinase inhibitors or antiviral therapies are tested in adjuvant or neoadjuvant setting, but none of them offered a survival benefit (except antiviral therapy in HBV-related HCC). Conclusion After a decade of plateau in drug development, ICPIs came into podium with their different mechanism of action consistent with immunogenic nature of the disease and with high expectations, and ongoing trials will show if these agents can satisfy unmet demand in this area.
