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Öğe Can diffusion weighted magnetic resonance imaging (DW-MRI) be an alternative to 18f-FDG PET/CT (18f fluorodeoxyglucose positron emission tomography) in nasopharyngeal cancers?(Scientific Publishers India, 2017) Yildirim, Ismail Okan; Ekici, Kemal; Dogan, Metin; Temelli, Oztun; Kekilli, Ersoy; Saglik, Semih; Erbay, FatihObjective: This study aimed to evaluate correlations, if any, between the ADC (Apparent Diffusion Coefficient) measurements in MRI (Magnetic Resonance Imaging) and SUV max (Standardized Uptake Value) in F-18-FDG PET/CT in patients with nasopharyngeal cancers and to investigate whether DW-MRI (Diffusion Weighted MRI) can be an alternative to F-18-FDG PET/CT in the evaluation of the response to treatment and prognosis in those patients. Methods: This study was performed between January 2015 and February 2016 at Inonu University Medical Faculty, Department of Radiology on 22 patients who were diagnosed with nasopharyngeal cancer by histopathological evaluation at Department of Pathology of the same faculty. Diffusion weighted images were obtained using 1.5 T MRI in all patients. F-18-FDG PET/CT images were obtained approximately 1-2 weeks after the diffusion-weighted images. Results: Two groups were created according to the histological subtypes as keratinized (n: 8) and non-keratinized (n: 14) among the 22 cases with a definitive histopathological diagnosis of nasopharyngeal cancer. No statistical difference was found between the groups in terms of SUVmax, SUVmean and ADC mean values (p> 0.05). ADC mean values measured in patients with nasopharyngeal cancer were statistically significantly and negatively correlated with SUV max (r=-0.619, p< 0.001) and SUV mean values (r=-0.677, p< 0.001). Conclusion: Even though there are anatomic and patient-related limitations of the DW-MRI in nasopharyngeal cancers, we suggest that it may be a complementary and alternative method of F-18-FDG PET/CT in the evaluation of treatment response and prognosis detection in nasopharyngeal cancers.Öğe Dosimetric comparison of helical tomotherapy, intensity-modulated radiation therapy, volumetric-modulated arc therapy, and 3-dimensional conformal therapy for the treatment of T1N0 glottic cancer(Elsevier Science Inc, 2016) Ekici, Kemal; Pepele, Eda K.; Yaprak, Bahaddin; Ternelli, Oztun; Eraslan, Aysun F.; Kucuk, Nadir; Altinok, Ayse Y.Various radiotherapy planning methods for T1N0 laryngeal cancer have been proposed to decrease normal tissue toxicity. We compare helical tomotherapy (HT), linac-based intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT), and 3-D conformal radiotherapy (3D-CRT) techniques for T1N0 laryngeal cancer. Overall, 10 patients with T1N0 laryngeal cancer were selected and evaluated. Furthermore, 10 radiotherapy treatment plans have been created for all 10 patients, including HT, IMRT, VMAT, and 3D-CRT. IMRT, VMAT, and HT plans vs 3D-CRT plans consistently provided superior planning target volume (PTV) coverage. Similar target coverage was observed between the 3 IMRT modalities. Compared with 3D-CRT, IMRT, HT, and VMAT significantly reduced the mean dose to the carotid arteries. VMAT resulted in the lowest mean dose to the submandibular and thyroid glands. Compared with 3D-CRT, IMRT, HT, and VMAT significantly increased the maximum dose to the spinal cord It was observed that the 3 IMRT modalities studied showed superior target coverage with less variation between each plan in comparison with 3D-CRT. The 3D-CRT plans performed better at the Dmax of the spinal cord. Clinical investigation is warranted to determine if these treatment approaches would translate into a reduction in radiation therapy-induced toxicities. (C) 2016 American Association of Medical Dosimetrists.Öğe Effects of Administering Dietetics to Cancer Patients Receiving Radiotherapy on Preventing and Decreasing Malnutrition(2015) Bayır, Berna; Aylaz, Rukuye; Ekici, KemalAbstract: The aim of this research was to determine the effect of dietetics in preventing and reducing malnutrition in cancer patients receiving radiotherapy. This study enrolled 147 cancer patients receiving radiotherapy who had just started treatment at Inonu University, Malatya, Turkey. All of the enrolled patients had just started radiotherapy, could communicate readily, and agreed to take part in the study. The data were obtained using patient information sheets, the Subjective Global Assessment Scale (SGA), and anthropometric measurements. Weight measurements were performed in the experimental group after education and revealed that weight increased in 23% of patients, decreased in 40.5%, and remained stable in 36.5% of subjects. In the control group, 23.3% of patients exhibited an increase in weight, 43.8% experienced a decrease, and 32.9% remained stable. Statistical analyses revealed a significant difference among groups after education (p<0.05). The use of dietetics (nutrition education) reduced malnutrition. Therefore, nurses should administer dietetics regularly to patients undergoing radiotherapy to reduce malnutritionÖğe Effects of Molsidomine on Retinopathy and Oxidative Stress Induced by Radiotheraphy in Rat Eyes(Taylor & Francis Inc, 2017) Ozer, Murat Atabey; Polat, Nihat; Ozen, Serkan; Parlakpinar, Hakan; Ekici, Kemal; Polat, Alaaddin; Vardi, NigarPurpose: To determine the role of Molsidomine in preventing radiation-induced retinopathy after head and neck region irradiation of rats with a single radiation dose of 15 Gy. Materials and Methods: Male Wistar albino rats were randomly grouped into five as follows: (1) control group rats, which were applied through an intraperitoneal (i.p.) vehicle without radiotherapy (RT); (2) RT group rats received a single dose of 15 Gy irradiation and after daily 0.1 ml vehicle i.p. for 5 consecutive days; (3) molsidomine (MOL) group rats were treated for 5 consecutive days by i.p. with 4 mg/kg/day MOL; (4) irradiation plus MOL group (RT+MOL) rats received irradiation and after 10 days single daily i.p. dose of MOL for 5 consecutive days; and (5) MOL+RT group rats were treated for 5 consecutive days by i.p. with MOL before RT. At the end of the work the rats were sacrificed under high-dose anesthesia on the 16(th) day and then eye tissues were taken for histopathological, immunohistochemical (caspase-3), and biochemical analyses (superoxide dismutase [SOD], glutathione peroxidase [GSH], and malondialdehyde [MDA]). Results: RT significantly decreased both the content of GSH and the activity of SOD, and significantly increased the production of MDA level in the rat eyes. MOL treatment significantly increased the SOD and GSH levels and significantly decreased the MDA production (p < 0.0001). In addition, RT significantly increased the number of ganglion cells (GCs; p = 0.001), whereas especially pretreatment with MOL improved (p = 0.013). RT led to significant retinopathy formation, and MOL therapy protected the retina from radiation-induced retinopathy (p < 0.0001). Conclusions: We suggest that MOL is a powerful antioxidant and free radical scavenger that prevents the rat eyes from radiation-induced retinopathy and oxidative stress.Öğe Effects of molsidomine on retinopathy and oxidative stress Induced by radiotheraphy in rat eyes(Current Eye Research, 2016) Özer, Murat Atabey; Polat, Nihat; Özen, Serkan; Ekici, Kemal; Polat, Alaaddin; Vardı, Nigar; Tanbek, Kevser; Yıldız, Azibe; Parlakpınar, HakanPurpose: To determine the role of Molsidomine in preventing radiation-induced retinopathy after head and neck region irradiation of rats with a single radiation dose of 15 Gy. Male Wistar albino rats were randomly grouped into five as follows: (1) control group rats, which were applied through an intraperitoneal (i.p.) vehicle without radiotherapy (RT); (2) RT group rats received a single dose of 15 Gy irradiation and after daily 0.1 ml vehicle i.p. for 5 consecutive days; (3) molsidomine (MOL) group rats were treated for 5 consecutive days by i.p. with 4 mg/kg/day MOL; (4) irradiation plus MOL group (RT+MOL) rats received irradiation and after 10 days single daily i.p. dose of MOL for 5 consecutive days; and (5) MOL+RT group rats were treated for 5 consecutive days by i.p. with MOL before RT. At the end of the work the rats were sacrificed under high-dose anesthesia on the 16th day and then eye tissues were taken for histopathological, immunohistochemical (caspase-3), and biochemical analyses (superoxide dismutase [SOD], glutathione peroxidase [GSH], and malondialdehyde [MDA]). RT significantly decreased both the content of GSH and the activity of SOD, and significantly increased the production of MDA level in the rat eyes. MOL treatment significantly increased the SOD and GSH levels and significantly decreased the MDA production (p < 0.0001). In addition, RT significantly increased the number of ganglion cells (GCs; p = 0.001), whereas especially pretreatment with MOL improved (p = 0.013). RT led to significant retinopathy formation, and MOL therapy protected the retina from radiation-induced retinopathy (p < 0.0001). We suggest that MOL is a powerful antioxidant and free radical scavenger that prevents the rat eyes from radiation-induced retinopathy and oxidative stress.Öğe Efficacy of stereotactic radiotherapy as salvage treatment for recurrent malignant gliomas(Imprimatur Publications, 2014) Ekici, Kemal; Ozsekee, Naciye; Mayadagli, Alpaslan; Kocak, Mihriban Erdogan; Olmezoglu, AliPurpose: To evaluate the efficacy and toxicity of CyberKnife stereotactic radiotherapy (SRT) for recurrent glial tumors previously treated with high-dose radiotherapy. Methods: CyberKnife SRT was performed in 37 patients with recurrent glial tumors who presented to our hospital between January 2007 and March 2012. The patients were subjected to a dose ranging from 20 to 28 Gy using the CyberKnife system with an average of two fractions. The median follow-up duration after SRT was 14 months (range 1.8-57). Results: The median survival time of the patients after recurrence was 22.3 months (95% confidence interval/95% Cl 12.5-32). The median survival times of the high- and low-grade patients were 29 and 19 months, respectively. No significant toxicity due to radiation was noticed during the follow-up period. No factor influencing mortality was found in either the univari ate or multivariate analysis.. Conclusion: SRT using CyberKnife is an effective and safe treatment choice for recurrent glial tumors. SRT achieves a more favorable outcome in the treatment of recurrent tumors, particularly in high-grade onesÖğe Endometrium kanserinde postoperatif radyoterapi: tedavi sonuçları ve prognostik faktörler(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2014) Temelli, Öztun; Gürocak, Şimay; Kekilli, Ersoy; Ekici, KemalAmaç: Bu çalışmayla postoperatif radyoterapi uygulanan hastalarda, tümöre ve tedaviye bağlı prognostik faktörlerin, lokal ve bölgesel kontrol, genel sağkalım ve hastalıksız sağkalım üzerindeki etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Adjuvan eksternal radyoterapi ve brakiterapi uygulanan 61 endometrium kanserli hasta retrospektif olarak değerlendirilmiştir. Hastaların yaşı, tümör diferansiasyonu, tümör evresi, lenfovasküler invazyon, seroza invazyonu, myometrial invazyon, endoservikal tutulum, adneks tutulumu, lenf nodu tutulumu, sigara kullanımı, hipertansiyon ve diyabet hastalığı, hormon replasman tedavisi alıp almaması, doğum sayısı, menopoz yaşı, kemoterapi durumu, vajinal brakiterapi, radyoterapi şekli ve dozları, lokal nüks değerlendirilmiştir. Bulgular: Altmış bir hastanın 53’ü (%87) endometrioid adenokarsinom, 8’i (%13) ise diğer adenokarsinom (seröz, müsinöz, clear cell, mikst tip) histolojisine sahipti. Hastaların 53’üne (%87) Total abdominal histerektomi+ bilateral salfingooferektomi + bilateral pelvik lenf nodu diseksiyonu (TAH+BSO+BPLND), 8 hastaya (%13) sadece TAH+BSO yapılmış. Otuz hastaya konvansiyonel, 23 hastaya ise konformal radyoterapi uygulanmıştır. Sekiz hastaya ise eksternal radyoterapi uygulanmamış sadece brakiterapi uygulaması yapılmıştır. İki yıllık genel sağkalım %93.4; 5 yıllık genel sağkalım %80.3 olarak bulunmuştur. Ortalama sağkalım 51 aydır. Hastalıksız sağkalım 2 yıllık ve 5 yıllık sırasıyla %85.2 ve %77 olarak tespit edildi. Genel sağkalım üzerine, serozal invazyon olması (p=0.034) anlamlı bulundu. Sonuç: Endometrium kanserinde postoperatif radyoterapi efektif ve güvenli bir yöntemdir.Öğe Erkeklerde Meme Kanseri ve Tedavi Özellikleri Breast(Kartal Eğitim ve Araştırma Hastanesi Tıp Dergisi, 2015) Temelli, Öztun; Ekici, Cemal; Ekici, KemalÖz: Amaç: Bu çalışmamızda amacımız kliniğimizde tedavi edilen erkek meme kanseri (EMK) olgularını literatür bilgisi ışı- ğında sunmaktır. Gereç ve Yöntem: Bu geriye dönük çalışmada Haziran 2004 ile Ocak 2013 tarihleri arasında kliniğimizde incelenen ve tedavi edilen 15 erkek hastanın kayıtları incelendi. Hasta yaşı, tümörün hangi memeden geliştiği, tümör evresi, histopatolojik özellikler, genetik özellikler, adjuvan tedaviler ve sağkalım süreleri analiz edildi. Bulgular: Hastalar 44-82 yaşları arasında, ortalama 62 yaşındaydı. Tümör 11 hastada sol memede, dört hastada sağ memede yerleşimli idi. AJCC 2010 evrelemesine göre altı hasta evre 2, dört hasta evre 3A, üç hasta evre 3B ve iki hasta evre 3C idi. Hastalarımızın tamamı invaziv duktal karsinomdu. Hastalarımızın hepsine modifiye radikal mastektomi sonrası adjuvan kemoterapi ve radyoterapi uygulanmıştı. Hastalıksız sağkalım medyan 46 (12-108) ay bulundu. Sonuç: Erkek meme kanserleri kadın meme kanserlerine benzer klinik, histopatolojik ve prognostik özellikler göstermekte olup, aynı prensiplerle tedavi edilmelidir. Erkek meme kanserine erken evrede tanı konulur ve uygun tedavi yapılırsa prognoz iyi görünmektedir. Başlık (İngilizce): Cancer in Men and Treatment Characteristics Öz (İngilizce): Background: The aim of this study was to evaluate cases of male breast cancer treated at our clinic. Methods: We reviewed retrospectively the medical records of 16 male breast cancer patients who were treated in our clinic between June 2004 and January 2013. Patient age, tumor localization, tumor stage, histopathologic characteristics, genetic properties, adjuvant therapy, and survival were analyzed. Results: Patients ranged in age from 44 to 82 and the average age was 62. Tumors were localized in the left breast in 11 patients and in the right breast in 4 patients. Using the AJCC 2010 staging, 6 patients were stage 2, 4 patients were stage 3A, 3 patients were stage 3B, and 2 patients were stage 3C. All of the cases involved invasive ductal carcinoma. In all patients, modified radical mastectomy followed by adjuvant chemotherapy and radiotherapy was administered. The median disease free survival was 46 months (12-108). Conclusion: Male breast cancer is associated with clinical, histopathological and prognostic features that are similar to female breast cancer and should be treated based on the same principles. Early diagnosis and treatment can result in good prognosis for male patients with breast cancer.Öğe Fractionated stereotactic radiosurgery for vestibular schwannomas using cyberknife: A single institution experience(Pakistan Medical Assoc, 2016) Kocak, Mihriban Erdogan; Sengul, Adem; Ekici, Kemal; Olmezoglu, Ali; Seseogullari, OzgurObjective: To assess tumour control, hearing preservation status, and complication ratio after fractionated stereotactic radiosurgery/radiotherapy by using CyberKnife device in patients with vestibular schwannomas. Methods: This retrospective study was conducted at Izmir Ataturk Research and Tranining Hospital, Turkey, and comprised data of vestibular schwannomas patients treated with stereotactic radiosurgery/radiotherapy from March 2010 to December 2013. The patients were subjected to a dose ranging from 12 to 30Gy using CyberKnife system with an average of three fractions. SPSS 17 was used for data analysis. Paired t-test and Pearson's chi-square test were used to compare clinical parameters between groups. P<0.05 was considered significant. Results: Of the 41 patients, 26(63.4%) were women and 15(36.6%) were men. The median follow-up duration after stereotactic radiosurgery/radiotherapy was 25 months (interquartile range: 9-44 months). Radiographic control evaluation ratio was 95.7% with a median follow- up of 3 years (IQR: 18.5 months). Results of 23(56%) patients showed stabile response, 17(42%) regression response and 1(2%) progression response. There were no statistically significant changes between pre- and post-stereotactic radiosurgery/radiotherapy symptoms (p>0.05). One (2.4%) patient reported new onset facial paresis. Conclusion: Stereotactic radiosurgery/radiotherapy treatment of vestibular schwannomas resulted in a good ratio of tumour control. Hearing preservation status and ratios of toxicity were comparable to published literature.Öğe Gliomatozis serebride radyoterapinin yeri: iki olgu deneyimi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2015) Temelli, Öztun; Eraslan, Aysun Fatma; Yaprak, Bahaddin; Ekici, KemalGliomatozis serebri, oldukça nadir görülen, beyinde en az iki lobu tutan, nöral yapıların korunduğu, diffüz neoplastik glial hücre proliferasyonudur. Oligodedroglial komponent varlığı prognoz açısından daha iyidir. Olgularımız 33 yaşında bayan ve 58 yaşında erkek hastadır. Birinci olgumuzda stereotaktik biyopsi yapılmış. Grade 2, astrositom olarak değerlendirilmiş. İkinci olgumuz ise biyopsi sonucu Grade 3, Gliomatozis serebri ile uyumlu tümör infiltrasyonu olarak değerlendirilmiş. Hastalarımıza Helikal Tomoterapi cihazında sırasıyla 44 Gy ve 50 Gy eksternal radyoterapi uygulandı. Hastalar tedaviyi iyi tolere etti ve tedavi süresince grade 1 cilt reaksiyonu dışında akut komplikasyon gözlenmedi. Gliomatozis serebride radyoterapi volümü, tedavi dozu tartışmalıdır. Tüm beyin veya parsiyel radyoterapi uygulanabilmektedir.Öğe Helical Tomotherapy and Its Benefits(Turgut Özal Tıp Merkezi Dergisi, 2014) Ekici, Kemal; Temelli, Öztun[Abstract Not Acailable]Öğe Is helical tomotherapy-based intensity-modulated radiotherapy feasible and effective in bilateral synchronous breast cancer? A two-center experience(Imprimatur Publications, 2016) Ekici, Kemal; Gokce, Tumay; Karadogan, Ilker; Eraslan, Aysun Fatma; Akcay, Cimen; Temelli, Oztun; Pepele, Eda KayaPurpose: This study describes the early clinical results and dosimetric parameters of intensity-modulated radiation therapy (IMRT) using a tomotherapy device in patients with primary bilateral synchronous breast cancer (PSBBC). Methods: Fourteen patients with bilateral breast cancer were treated with tomotherapy between January 2011 and October 2014. The treatment planning objectives were to cover 95% of the planning target volume using a 95% isodose, with a minimum dose of 90% and a maximum dose of 107%. The organs at risk (OAR), such as the lungs, heart, esophagus and spinal cord, were contoured. Acute toxicity was recorded during and after radiation therapy. Results: The advantages included better treatment conformity with lower dosages to minimize the risk to susceptible organs, such as the lungs, heart and spinal cord. There was improved coverage of the planning target volume, including the regional nodes, without any field junction problems. The median homogeneity index was 0.13 and the median conformity index 1.32. The median V20, V15, V10 and V5 for the total lungs were 18.5, 23.3, 24.2 and 60%, respectively. Skin acute toxicity was grade 1 in 72% and grade 2 in 14% of the patients. Esophageal acute toxicity was grade 1 in 43% of the patients. Conclusion: Tomotherapy delivers treatment that is well-tolerated, with high homogeneity and coverage indexes and the capability to reduce the irradiation dose received by the lungs and heart in PSBBC patients. This technique is therefore feasible and safe for the treatment of bilateral breast cancer.Öğe Kafa tabanı tümörlerinde helikal tomoterapi ile uygulanan yoğunluk ayarlı ve görüntü eşliğinde radyoterapi: iki olgu sunumu(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2015) Ekici, Kemal; Temelli, Öztun; Ekici, Cemal; Durak, AkifKafa tabanı tümörlerinde cerrahi uygulanmazsa prognoz kötüdür ve tedavi çoğunlukla primer hastalığı kontrol altına alıp hasta için tatminkar yaşam kalitesi sağlamayı amaçlar. Kliniğimize başvuran 2 kafa tabanı tümörüne helikal tomoterapi ile uygulanan yoğunluk ayarlı radyoterapi sonuçları tartışılmıştır. Her iki hastamızda da subjektif yakınmalarda azalma görülmüştür. Hastalarımıza ortalama 54 Gy radyoterapi uygulanmıştır Bu makalede kafa tabanı tümörü nedeniyle cerrahi rezeksiyon uygulanamayan 2 hastada helikal tomoterapinin etkinliği tartışılmaya çalışılmıştır.Öğe Measurement of Strain Imaging, Troponin-I and Brain Natriuretic Peptide Levels in Radiotherapy- Induced Cardiac Injury(2016) Ekici, Kemal; Çakal, Beytullah; Baydar, Onur; Cakal, Sinem D.; Karaca, Oğuz; Omaygenc, M Onur; Mayadağlı, AlpaslanRadyoterapi (RT) göğüs bölgesine uygulandığında en çok perikard olmak üzere myokard, kalp damarları ve koroner damarlara za-rar verir. Bu çalışmanın amacı RT uygulanmış hastalarda sol ventrikül disfonksiyonunu ve myokard hasarını kardiyak biyobelirteçler, Troponin I (TnI) ve Beyin Natriüretik Peptip (BNP) seviyelerini ölçmek ve erken kardiyovasküler erken belirtileri strain rate görüntüleme (SRG) ile RT öncesi ve sonrası belirlemektir. Bu çalışmaya Ocak 2011 ile Ekim 2013 yılları arasında 35 toraks bölgesi kanseri alındı. Otuz beş hastanın 22'si sol meme kanseri ve 13'ü sol taraf akciğer kanseri idi. SR görüntüleme ve TnI, BNP seviyelerine tedavi öncesi ve sonrası bakıldı. Akciğer kanseri hastalarına 40-60 Gy arası (ortalama, 54.9 ± 8.9 Gy) doz ve meme kanseri hastalarına 50-60 Gy (ortalama, 51.6 ± 4.9 Gy) doz uygulandı. BNP ve TnI seviyelerinde tedavi öncesi ve sonrası istatistiki olarak bir anlamlılık görülmedi. Sol ventrikül ejeksiyon fraksiyonu (SVEF) tedavi öncesi ve tedavi sonrası bir aylık dönemde değişmedi. Fakat, sağ ventrikül gerilimi (SVG) ve sol ventrikül gerilimi (SVG) SRG değerleri tedavi sonrası bir aylık dönemde daha düşük bulundu. Bu çalışmanın sonuçlarına göre, RT hasarının kardiyak fonksiyon üzerindeki erken sonuçlarını tespit etmek konvansiyonel ekokardiyografiye göre SR görüntüleme ile daha duyarlı bir metoddur.Öğe Measurement of Strain Imaging, Troponin-I and Brain Natriuretic Peptide Levels in Radiotherapy-Induced Cardiac Injury(Akad Doktorlar Yayinevi, 2016) Ekici, Kemal; Cakal, Beytullah; Baydar, Onur; Mayadagli, Alpaslan; Cakal, Sinem D.; Karaca, Oguz; Omaygenc, M. OnurRadiotherapy (RT) of the thorax can damage the pericardium, myocardium, heart valves, and coronary vessels, with the pericardium being the most frequently damaged. The objectives of this study were to evaluate RT-induced left ventricular dysfunction and myocardial injury by measuring cardiac biomarkers, troponin I (TnI) and brain natriuretic peptide (BNP), as well as determin cardiotoxicity and early signs of cardiovascular dysfunction using strain rate imaging (SRI) prior to and following RT. This study included 35 patients diagnosed with thoracic malignancy between January 2011 and October 2013. Of the 35 patients, 22 had left-sided lung cancer and 13 had left-sided breast cancer. SRI was performed and TnI and BNP levels were measured prior to and following RT. A total radiation dose of 40-60 Gy (mean, 54.9 +/- 8.9 Gy) was applied in lung cancer patients and 50-60 Gy (mean, 51.6 +/- 4.9 Gy) was applied in breast cancer patients. No significant difference was observed in TnI or BNP levels prior to and one month following RT. The left ventricular ejection fraction (LVEF) did not differ prior to or after the first month of RT. However, lower right ventricular strain (RVS) and left ventricular strain (LVS) SRI values were detected within the first month following RT. From the results of this study, we conclude that SRI is a sensitive method to detect RT-induced changes in cardiac function that are not typically detected by conventional echocardiographic methods and cardiac biomarkers.Öğe Outcomes of radiotherapy in early stage glottic laryngeal carcinoma: a single center experience(Medicine Science, 2016) Ekici, Kemal; Temelli, Oztun; Eraslan, Ayse Fatma; Gurocak, Simay; Kaplan Bozdag, Nihal; Elkiran, Emin Tamer; Kekilli, Ersoy; Kizilay, Ahmet[Abstract Not Acailable]Öğe Postoperative Radiotherapy for Endometrial Cancer: Treatment Results and Prognostic Factors(Turgut Özal Tıp Merkezi Dergisi, 2014) Temelli, Öztun; Gürocak, Şimay; Kekilli, Ersoy; Ekici, KemalÖz: Amaç: Bu çalışmayla postoperatif radyoterapi uygulanan hastalarda, tümöre ve tedaviye bağlı prognostik faktörlerin, lokal ve bölgesel kontrol, genel sağkalım ve hastalıksız sağkalım üzerindeki etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Adjuvan eksternal radyoterapi ve brakiterapi uygulanan 61 endometrium kanserli hasta retrospektif olarak değerlendirilmiştir. Hastaların yaşı, tümör diferansiasyonu, tümör evresi, lenfovasküler invazyon, seroza invazyonu, myometrial invazyon, endoservikal tutulum, adneks tutulumu, lenf nodu tutulumu, sigara kullanımı, hipertansiyon ve diyabet hastalığı, hormon replasman tedavisi alıp almaması, doğum sayısı, menopoz yaşı, kemoterapi durumu, vajinal brakiterapi, radyoterapi şekli ve dozları, lokal nüks değerlendirilmiştir. Bulgular: Altmış bir hastanın 53 ü (%87) endometrioid adenokarsinom, 8 i (%13) ise diğer adenokarsinom (seröz, müsinöz, clear cell, mikst tip) histolojisine sahipti. Hastaların 53 üne (%87) Total abdominal histerektomi+ bilateral salfingooferektomi + bilateral pelvik lenf nodu diseksiyonu (TAH+BSO+BPLND), 8 hastaya (%13) sadece TAH+BSO yapılmış. Otuz hastaya konvansiyonel, 23 hastaya ise konformal radyoterapi uygulanmıştır. Sekiz hastaya ise eksternal radyoterapi uygulanmamış sadece brakiterapi uygulaması yapılmıştır. İki yıllık genel sağkalım %93.4; 5 yıllık genel sağkalım %80.3 olarak bulunmuştur. Ortalama sağkalım 51 aydır. Hastalıksız sağkalım 2 yıllık ve 5 yıllık sırasıyla %85.2 ve %77 olarak tespit edildi. Genel sağkalım üzerine, serozal invazyon olması (p=0.034) anlamlı bulundu. Sonuç: Endometrium kanserinde postoperatif radyoterapi efektif ve güvenli bir yöntemdir.Öğe The Role of Radiotherapy in Gliomatosis Cerebri: Two Case Reports(2015) Temelli, Öztun; Eraslan, Aysun Fatma; Yaprak, Bahaddin; Ekici, KemalAbstract: Gliomatozis serebri, oldukça nadir görülen, beyinde en az iki lobu tutan, nöral yapıların korunduğu, diffüz neoplastik glial hücre proliferasyonudur. Oligodedroglial komponent varlığı prognoz açısından daha iyidir. Olgularımız 33 yaşında bayan ve 58 yaşında erkek hastadır. Birinci olgumuzda stereotaktik biyopsi yapılmış. Grade 2, astrositom olarak değerlendirilmiş. İkinci olgumuz ise biyopsi sonucu Grade 3, Gliomatozis serebri ile uyumlu tümör infiltrasyonu olarak değerlendirilmiş. Hastalarımıza Helikal Tomoterapi cihazında sırasıyla 44 Gy ve 50 Gy eksternal radyoterapi uygulandı. Hastalar tedaviyi iyi tolere etti ve tedavi süresince grade 1 cilt reaksiyonu dışında akut komplikasyon gözlenmedi. Gliomatozis serebride radyoterapi volümü, tedavi dozu tartışmalıdır. Tüm beyin veya parsiyel radyoterapi uygulanabilmektedir.Öğe 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 Timik Epitelyal Tümörlerde Prognostik Faktörler ve Radyoterapinin Yeri: Tek Merkez Deneyimi(Okmeydanı Tıp Dergisi, 2017) Temelli, Öztun; Ekici, Kemal; Kekilli, ErsoyÖz: Amaç: Timik epitelyal tümörler (TET) nadir görülür ve tüm kanserlerin yaklaşık %0,2-1,5'ini oluştururlar. Bu çalışmanın amacı, radyoterapi uygulamış olduğumuz timik epitelyal tümörlü hastaların lokal kontrol ve sağkalımlarını ayrıca bunlara etki eden faktörleri incelemektir.Gereç ve Yöntem: 2004-2015 tarihleri arasında TET tanısı ile radyoterapi (RT) uyguladığımız 18 olgunun klinik özellikleri Dünya Sağlık Örgütü (DSÖ) histolojik sınıflaması ve Masoaka evreleme sistemi ile korelasyonu retrospektif olarak incelendi. Bulgular: Olgularımızın erkek/kadın oranı 10/8'dir. Ortanca yaş 49 idi. Hastaların 15'i timoma ve 3'ü timik karsinom şeklinde idi. Olgular Masaoka evrelemesine göre Evre I %5,6 (n=1), Evre II %50 (n=9), Evre III %16,7 (n=3) ve Evre IV %27,7 (n=5) şeklinde dağılmıştır. Ortalama genel sağkalım (GSK) ve hastalıksız sağkalım (HSK) tüm olgular için 88 ay ve 70 ay oldu. Beş yıllık GSK ve HSK sırasıyla %45 ve %50 oldu. Masaoka evre I-II ve III-IV için sırasıyla, GSK, 99 ay ve 82 ay (p=0,708); HSK, 96 ay ve 96 ay (p=0.564) bulundu. Beş yıllık GSK evre I-II'de %50 ve evre III-IV'de %40 olarak belirlendi.Sonuç: Timik epitelyal tümörlerde cerrahi, tedavinin esasını oluşturur. Adjuvan RT yüksek risk grubunda lokal kontrolü artırmada etkili, düşük toksisiteye sahip bir tedavi şeklidir. Başlık (İngilizce): Prognostic Factors and Radiotherapy in Thymic Epithelial Tumors: A Single Institutional Experience Öz (İngilizce): Objective: Thymic epithelial tumors (TETs) are relatively rare tumors and represent about 0.2-1.5% of all malignancies. Aim of our study is to retrospectively evaluate the local control and survival and the factors affecting them in patients who received radiotherapy.Material and Methods: We retrospectively analysed clinical features of TET and the correlation of World Health Organisation (WHO) histologic classification and Masaoka staging system with radiotherapy modalities in 18 patients from 2004 to 2015.Results: Our patients' male/female ratio was 10/8. Median age was 49 . Fifteen patients were thymoma and 3 patients were thymic carcinoma. According to Masaoka staging; patients were distributed as Stage I 5.6% (n=1), Stage II 50% (n=9), Stage III 16.7% (n=3) and Stage IV 27,7% (n=5). Overall survival (OS) and disease free survival (DFS) were 88 months and 70 months respectively in all cases. Five years OS and DFS were 45% and 50%. For Masaoka stage I-II and III-IV; OS was 99 months and 82 months (p=0.708); DFS was 96 months and 96 months (p=0.564) was found respectively. Five years OS was 50% for stage I-II and 40% for stage III-IV.Conclusion: Surgical resection is the mainstay treatment of thymomas. Adjuvant radiotherapy achieved good local control and showed an acceptable toxicity profile in patients with high-risk thymoma.
