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Öğe An ambiguous phenomenon of radiation and drugs: Recall reactions(Karger, 2007) Caloglu, Murat; Yurut-Caloglu, Vuslat; Cosar-Alas, Rusen; Saynak, Mert; Karagol, Hakan; Uzal, CemThe term 'radiation recall' describes an acute inflammatory reaction in previously irradiated areas after the administration of certain inciting systemic agents. It was first described in 1959 by D'Angio that dermatitis is related to the application of actinomycin D on the skin. Though this reaction occurs frequently on the skin, it may also be seen in the oral mucosa, the larynx, esophagus, small intestine, lungs, muscle tissue, and brain. Most drugs associated with recall reactions are cytotoxics, however, several other drugs may also elicit the phenomenon. Although this phenomenon is well known, its etiology is not understood. Radiation recall reactions are generally associated with megavoltage radiotherapy. The time interval between the completion of radiotherapy and the recall reaction ranges from days to years. The recall reaction occurs on average 8 days (3 days to 2 months) after the application of the promoting agent. Although no standard treatment exists, some authors suggest discontinuation of the inciting drug and the use of corticosteroids or nonsteroidal anti-inflammatory agents.Öğe Amifostine use in radiation-induced kidney damage(Springer Heidelberg, 2008) Kaldir, Mine; Cosar-Alas, Rusen; Cermik, Tevfik Fikret; Yurut-Caloglu, Vuslat; Saynak, Mert; Altaner, Semsi; Caloglu, MuratPurpose: To assess the degree of protective effects of amifostine on kidney functions via semiquantitative static renal scintigraphy and histopathologic analysis. Material and Methods: 30 female albino rats were divided into three equal groups as control (CL), radiotherapy alone (RT), and radiotherapy + amifostine (RT+AMI). The animals in the CL and RT groups were given phosphate-buffered saline, whereas the animals in the RT+AMI group received amifostine (200 mg/kg) by intraperitoneal injection 30 min before irradiation. RT and RT+AMI groups were irradiated with a single dose of 6 Gy using a Co-60 unit at a source-skin distance of 80 cm to the whole right kidney. They were followed up for 6 months. CL, RT, and RT+AMI groups underwent static kidney scintigraphy at the beginning of the experiment and, again, on the day before sacrificing. Histopathologically, tubular atrophy and fibrosis of the kidney damage were evaluated. Results: After irradiation, the median value of right kidney function was 48% (44-49%) and 50.5% (49%-52%) in RT and RT+AMI groups, respectively (p = 0.0002). Grade 1 kidney fibrosis was observed to be 60% in the RT group, while it was only 30% in the RT+AMI group. Grade 2 kidney fibrosis was 30% and 0% in the RT and RT+AMI group, respectively. Grade 1 tubular atrophy was 70% and 50% in the RT and RT+AMI group, respectively. Grade 2 tubular atrophy effect was the same in both groups (10%). Conclusion: Static kidney scintigraphy represents an objective and reproducible method to noninvasively investigate kidney function following irradiation. Amifostine produced a significant reduction in radiation-induced loss of renal function.Öğe Capecitabine-related intracranial hypotension syndrome mimicking dural metastasis in a breast cancer patient: Case report and review of the literature(Medknow Publications, 2010) Cosar-Alas, Rusen; Alas, Aykan; Ozen, Alaattin; Denizli, Bengu; Saynak, Mert; Uzunoglu, Sernaz; Aydogdu, NurettinSpontaneous intracranial hypotension (SICH) is an entity, which is secondary to iatrogenic manipulation and breaching of dura. Postural headache in patients should be suspected, cranial magnetic resonance imaging (MRI) is essential for precise diagnosis. Hallmark of MRI is regular shape of pachymeningeal gadolinium enhancement and subdural effusion. It may mimic central nervous system (CNS) metastasis. Prevention of such cases from receiving cranial radiotherapy by misinterpretation of the gadolinium enhancement as CNS metastasis is an important issue. Capecitabine is an antineoplastic agent, of which metabolites can cross blood-brain barrier in CNS via epithelial tissue. It may cause decrease in CSF production. SICH might be the clinical reflection of this decrease in CSF production. Review of the English literature revealed limited data because of the very little experience with oncologic patients suffering from intracranial hypotension. We report a case of spontaneous intracranial hypotension during capecitabine treatment. Patient was completely well following drug discontinuation and supportive treatment.Öğe Comparison of Protective Effects of L-Carnitine and Amifostine on Radiation-induced Toxicity to Growing Bone: Histopathology and Scintigraphy Findings(Asian Pacific Organization Cancer Prevention, 2010) Yurut-Caloglu, Vuslat; Durmus-Altun, Gulay; Caloglu, Murat; Usta, Ufuk; Saynak, Mert; Uzal, Cem; Cosar-Alas, RusenPurpose: The aim of the present study was to evaluate the radioprotective efficacy of L-carnitine (LC) in growing bones in comparison to amifostine. Materials and Methods: Sixty two-week-old Wistar albino rats were randomly assigned to six equal groups: Group 1, control (CONT); Group 2, irradiation alone (RT); Group 3, amifostine plus irradiation (AMI+RT); Group 4, L-carnitine plus irradiation (LC+RT); Group 5, amifostine alone (AMI); Group 6, L-carnitine alone (LC). The rats in the AMI+RT, LC+RT and RT groups were irradiated individually with a single dose of 20 Gy to the left femur. LC (300mg/kg) and amifostine (200mg/kg) were applied 30 min before irradiation. The animals were scanned for bone area, mineral content and bone mineral density (BMD) by DEXA and the 99mTc methylene diphosphonate uptake ratio (MUR) was calculated by bone scintigraphy. Histopathological analysis of bone and cartilage was also carried out after euthanasia. Results: Pretreatment with LC or amifostine reduced the radiation-induced damage in growing bone (p=0.007 and p=0.04 respectively) and in the epiphysial cartilage (p=0.002 and p=0.015 respectively). The protective effect of LC was similar to that of amifostine on both growing bone and on the epiphysial cartilage. The mean left-femur BMD values were significantly higher in the LC+RT (p=0.02) and AMI+RT (p=0.01) groups than in the RT group. but did not differ with the two protective agents. Pretreatment with AMI (p=0.002) and LC (p=0.01) improved the MUR. Conclusions: L-carnitine is equally as effective as amifostine at protecting growing bone against single dose irradiation damage.Öğe Cutaneous metastasis of epidermoid carcinoma of the larynx: a case report(Kare Publ, 2006) Ibis, Kamuran; Ibis, Cem; Yurut-Caloglu, Vuslat; Altaner, Semsi; Caloglu, Murat; Karagol, Hakan; Cosar-Alas, RusenThe frequency of distant metastasis of epidermoid carcinoma of the larynx is between 6.5-7.2%. The common sites of metastasis are lung, liver and bone. Cutaneous metastasis is very rare. A 56-year-old male with locally advanced larynx carcinoma who received curative radiochemotheraphy a year ago was presented to our department with subcutaneous nodular lesions, and fatigue. Physical examination revealed 0.5 cm sized, and 1x1cm sized subcutaneous nodular lesions in the right arm, and in the parasternal area, respectively. Histopathologic examination confirmed the skin metastasis of epidermoid carcinoma of the larynx. The patient has profound anemia, hypercalcemia, hypernatremia, and hyperglicemia with complicated diabetic foot. Although the symptomatic treatment began immediately, the patient died on the third day of hospitalisation. Cutaneous metastasis may be the first sign of local failure, of distant metastasis, or even of the undetected laryngeal carcinoma with poor prognosis.Öğe Factors affecting local control, distant recurrence and survival in patients with locally advanced bladder cancer treated by definitive radiotherapy or chemoradiotherapy(Kare Publ, 2006) Caloglu, Murat; Yurut-Caloglu, Vuslat; Saynak, Mert; Cosar-Alas, Rusen; Karagol, Hakan; Kaplan, Mustafa; Ibis, KamuranOBJECTIVES Treatment results of 34 patients with bladder cancer admitted to Department of Radiation Oncology, Medicine Faculty of Trakya University between October 1997 and June 2005 were retrospectively analyzed. Prognostic factors associated with survival were determined. METHODS Their median age was 69 years (range 44-93). Thirty patients (88%) were male and 4 patients (12%) were female. Histopathological diagnosis was transitional cell carcinoma in 20 (59%) patients. Chemotherapy was administered concomitantly with radiotherapy to the 11 (32.35%) of the patients. The median radiotherapy dose was 62.5 (35-68) Gy. The median follow-up was 22 months (5-76 months). Median survival and median disease-free survival were 14.2 months (3.8-57.5) and 10 months (0-55), respectively. RESULTS Three years loco-regional control, metastasis free survival, disease free survival and overall survival rates were 76.59 , 72.2%, 55% and 41.1%, respectively. Epidermoid carcinoma histopathology (p=0.002), not performing concomitant chemotherapy (p=0.003), applying carboplatin instead of cisplatin with radiotherapy (p=0.004) and not conducting complete TURB (p=0.008) were significant poor prognostic factors on loco-regional control. Undifferentiated cell type (p=0.012) and not performing concomitant chemotherapy (p=0.046) were significant adverse factors on distant metastases. Factors that affect overall survival were tumor in stage T-4 (p=0.05), hemoglobin value below 10 g/dl (p=0.032) and not performing concomitant chemo-radiotherapy (p=0.017) and complete TURB (p=0.049). CONCLUSION Complications of radiotherapy were acceptable. For the treatment of muscle invasive locally advanced bladder cancer, RT combined with cisplatin is an acceptable treatment option. Moreover, complete TURB before RT is important both for local control and for survival.Öğe HISTOPATHOLOGICAL AND SCINTIGRAPHIC COMPARISONS OF THE PROTECTIVE EFFECTS OF l-CARNITINE AND AMIFOSTINE AGAINST RADIATION-INDUCED LATE RENAL TOXICITY IN RATS(Wiley-Blackwell Publishing, Inc, 2009) Caloglu, Murat; Yurut-Caloglu, Vuslat; Durmus-Altun, Gulay; Oz-Puyan, Fulya; Ustun, Funda; Cosar-Alas, Rusen; Saynak, MertThe aim of the present study was to compare the protective effects of l-carnitine and amifostine against radiation-induced late nephrotoxicity using technetium-99m diethylenetriaminepentaacetic acid scintigraphy and histopathological examination. Seventy-one Albino rats were randomly divided into six groups as follows: (i) AMI + RAD (n = 15), 200 mg/kg, i.p., amifostine 30 min prior to irradiation (a single dose of 9 Gy); (ii) LC + RAD (n = 15), 300 mg/kg, i.p., l-carnitine 30 min prior to irradiation; (iii) LC (n = 10), 300 mg/kg, i.p., l-carnitine 30 min prior to sham irradiation; (iv) AMI (n = 10), 200 mg/kg, i.p., amifostine 30 min prior to sham irradiation; RAD (n = 11), 1 mL/kg, i.p., normal saline 30 min prior to irradiation; and (vi) control (n = 10), 1 mL/kg, i.p., normal saline 30 min prior to sham irradiation. Scintigraphy was performed before treatment and again 6 months after treatment. Kidneys were examined by light microscopy and a histopathological scoring system was used to assess the degree of renal damage. The main histopathological findings were proximal tubular damage and interstitial fibrosis. Glomerular injury was similar in all groups. Tubular degeneration and atrophy were less common in the AMI + RAD group than in the RAD group (P = 0.011 and P = 0.015, respectively), as well as in the LC + RAD group compared with the RAD group (P = 0.028 and P = 0.036, respectively). Interstitial fibrosis in the AMI + RAD and LC + RAD groups was significantly less than that in the RAD group (P = 0.015 and P = 0.015, respectively). The highest total renal injury score (9) was seen in the RAD group. On scintigraphy, there were significant differences in post-treatment time to peak count (T(max)) and time from peak count to half count (T(1/2)) values (P = 0.01 and 0.02, respectively) between groups in the right kidney. In the control and RAD groups, the T(1/2) of the right kidney was 8 +/- 2 and 21 +/- 2 min, respectively. The T(max) values for the AMI + RAD and LC + RAD groups (2.8 +/- 0.2 and 3.2 +/- 0.2 min, respectively) were similar to those in the control group (2.5 +/- 0.3 min). Based on the results of the present study, l-carnitine and amifostine have comparable and significant protective effects against radiation-induced late nephrotoxicity.Öğe Hypertrophic osteoarthropathy associated with lung cancer: a case report(Kare Publ, 2007) Ozen, Alaattin; Saynak, Mert; Kocak, Zafer; Bayir-Angin, Gulden; Uregen, Burcu; Cosar-Alas, Rusen; Cicin, IrfanMalignant neoplasms are sometimes associated with a variety of paraneoplastic rheumatic syndromes. Hypertrophic osteoarthropathy is one of these syndromes and the vast majority of cases are associated with intra thoracic neoplasms mainly broncogenic cancer. Hypertrophic osteoarthropathy (HOA) is characterized by clubbed fingers and periosteal new bone formation. Etiologically, it can be divided into primary and secondary HOA. The major clinical manifestation was severe bilateral leg pain. The pathogenesis of the disease remains unclear. Bone scintigraphy is a sensitive method to detect HOA. In this case, a 49-year-old man who had hypertrophic pulmonary osteoarthropathy associated with advanced stage non-small cell lung carcinoma is presented and a review of the literature is performed.Öğe The importance of pretreatment performance status and LDH level in patients with stage III-IV nasopharyngeal carcinoma(Kare Publ, 2009) Yurut-Caloglu, Vuslat; Caloglu, Murat; Karagol, Hakan; Cosar-Alas, Rusen; Kocak, ZaferOBJECTIVES To evaluate the prognostic factors in patients treated with radiotherapy for locally advanced nasopharyngeal carcinoma. METHODS Forty-eight patients (37 males, 11 females) treated between September 1999 and September 2007 were assessed retrospectively. RESULTS Ten patients (21%) recurred loco-regionally. Gender (p=0.022), Eastern Cooperative Oncology Group (ECOG) performance status (PS) (p<0.0001), hemoglobin (Hb) (p=0.0035), and lactate dehydrogenase (LDH) (p=0.032) were prognostic for loco-regional control. On multivariate analysis, only PS (p<0.003) remained significant. Eighteen (38%) patients had distant metastases. On univariate analysis, PS (p=0.022), Hb (p=0.002), alkaline phosphatase (ALP) (p=0.004), LDH (p=0.007), and completion of radiotherapy (p=0.014) were prognostic for distant metastasis. On Cox regression analysis, only LDH (p=0.001) remained significant. There were 27 deaths at the time of analysis. On logrank analysis, PS (p=0.012), completion of radiotherapy (p<0.0001), metastasis (p=0.018), and LDH (p=0.018) were prognostic for overall survival. On Cox regression analysis, only LDH (p=0.026) remained significant. CONCLUSION The pre-treatment LDH was prognostic for distant metastasis and overall survival while PS was prognostic for loco-regional control.Öğe Inguinal lymph node as the only evidence of progressive lung cancer(Soc Portuguesa Pneumologia, 2008) Kocak, Zafer; Saynak, Mert; Oz-Puyan, Fulya; Cicin, Irfan; Cosar-Alas, Rusen; Caloglu, Murat; Altiay, GundenizTumours that metastasise to groin nodes most frequently originate in genital and reproductive organs, skin, rectum or anus, or urinary bladder(1,2). However, rare cases of inguinal metastases from tumours above the diaphragm have been reported and only three of them had an inguinal metastasis which was recognised antemortem and reported in detail in the English medical literature(3-5). The primary tumours of these cases were malignant mesothelioma, salivary duct and breast carcinoma. In this paper, we report a case of carcinoma of the lung metastatic to an inguinal lymph node as the only evidence of progressive lung cancer.Öğe Lung, bone, skeletal muscles and cutaneous metastases from adenoid cystic carcinoma of the parotid gland: a case report and review of the literature(Humana Press Inc, 2007) Yurut-Caloglu, Vuslat; Caloglu, Murat; Ozyilmaz, Filiz; Saynak, Mert; Cosar-Alas, Rusen; Karagol, Hakan; Bayir-Angin, GuldenAdenoid cystic carcinoma is the second most common malignancy of the major and minor salivary glands after mucoepidemoid carcinoma. The risk of distant metastases is approximately 20-50%. Although bone, the central nervous system and the other organs may become involved, the lungs are favored sites for metastases. Skeletal muscle and cutaneous metastases from adenoid cystic carcinoma of the parotid gland are extremely rare. In this case, a 40-year-old man with lung and bone metastases followed by skeletal muscle and cutaneous metastases from adenoid cystic carcinoma of the right parotid gland is presented.Öğe Palliative radiotherapy for malign melanoma: a case report(Kare Publ, 2006) Yurut-Caloglu, Vuslat; Caloglu, Murat; Tokatli, Fusun; Kocak, Zafer; Cosar-Alas, Rusen; Ibis, Kamuran; Karagol, HakanMalignant melanoma is a skin cancer with poor prognosis. Historically melanoma has been thought of as a relatively radioresistant tumour. Nowadays, radiation delivered according to hypofractionated schedule is the most used, although there are few data confirm that this schedule improves the therapeutic impact. We report a case, with stage IV malignant melanoma, whose tumoral bleeding was palliated successfully giving 20 Gy external radiotherapy in 5 fractionations.Öğe Paraneoplastic syndrome of non-small cell lung carcinoma: A case with pancytopenia, leukocytoclastic vasculitis, and hypertrophic osteloarthropathy(Elsevier Ireland Ltd, 2007) Cosar-Alas, Rusen; Yurut-Caloglu, Vuslat; Karagol, Hakan; Caloglu, Murat; Yalcin, Omer; Turgut, Burhan; Saynak, MertVarious remote effects of cancer or paraneoplastic syndromes (PNS) are common in lung cancer, and may be the manifestation of the disease or its recurrence. The symptoms may be endocrine, neuromuscular or musculoskeletal, cardiovascular, cutaneous, hematologic, gastrointestinal, renal, or miscellaneous in nature. Since the symptoms of paraneoplastic syndromes may occur before the local symptoms of the primary tumor, it might be helpful in the early diagnosis of malignancy. We present a 65-year-old man with multiple paraneoplastic syndrome forms consisting of pancytopenia leukocytoclastic vasculitis and hypertrophic pulmonary osteoarthropathy, associated with non-small cell lung carcinoma. (c) 2007 Elsevier Ireland Ltd. All rights reserved.Öğe Pleomorphic liposarcoma of the pectoralis major muscle in an elderly man: Report of a case and review of literature(Medknow Publications, 2009) Sezer, Atakan; Tuncbilek, Nermin; Usta, Ufuk; Cosar-Alas, Rusen; Cicin, IrfanPrimary liposarcoma of the pectoral major muscle is extremely rare. We report a case of liposarcoma of the pectoral major muscle which was treated with surgical excision and postoperative radiotherapy. A 70-year-old man admitted with left-sided painless progressively growing breast mass. Radiological investigation revealed liposarcoma of the pectoralis major muscle. The patient was treated by surgical removal. Pathological diagnosis was pleomorphic liposarcoma. The patient had postoperative radiotherapy and free of disease for 9 months. Surgical excision and postoperative radiotherapy is the most favored treatment strategy. Careful follow-up is mandatory for detecting recurrences.Öğe Prevention of radiation-induced liver and kiney toxicity: a role for amifostine(Kare Publ, 2007) Uguzalp-Kaldir, Mine; Yurut-Caloglu, Vuslat; Cosar-Alas, Rusen; Cermik, Tevfik Fikret; Altaner, Semsi; Eskiocak, Sevgi; Saynak, MertOBJECTIVES To investigate the protective effect of amifostine against radiation induced liver and kidney injury of rats, using scintigraphic and histopathologic parameters. METHODS Female Wistar Albino rats were randomly allocated to 3 groups: control, radiotherapy alone (RT), and amifostine+RT (n=10). Single-dose of 600 cGy X-ray was performed with a single field compromised liver and right kidney. Amifostine was administered intraperitoneally at a dose of 400 mg/kg, 30 minutes before irradiation. Scintigraphic evaluation was performed before irradiation and the end of the study at 6 nd month. Histopathologic examinations were performed post mortem. RESULTS A clear protective effect of amifostine against radiation-induced late dam age in liver and kidney was found with scintigraphic evaluaticn. In addition, amifostine reduced the decrease of histopathologic changes for both of the tissues. CONCLUSION The results showed that amifostine significantly reduced radiation-induced liver and kidney toxicity and therefore warrant additional study in a clinically relevant fractionated model.Öğe Recurrent solitary fibrous tumor of the pleura: significant response to radiotherapy(Humana Press Inc, 2010) Saynak, Mert; Bayir-Angin, Gulden; Kocak, Zafer; Oz-Puyan, Fulya; Hayar, Murat; Cosar-Alas, Rusen; Karamustafaoglu, AltemurSolitary fibrous tumor (SFT) of the pleura is an uncommon neoplasm with non-specific symptoms and non-pathognomonical radiological findings. Surgery allows establishment of a definitive diagnosis as well as a cure of the disease. The role of radiotherapy or chemotherapy in the management of the disease is unclear because of the rarity of the disease and the successful results of the surgical treatment. Long-term clinical follow-up may be useful for the patients with SFT because of the potential adverse biological behavior of this tumor, which may lead to repeated recurrences and/or malignant transformation. We reported a 66-year-old woman with recurrence of SFT in the right lung, which had significant response to external thoracic radiotherapy.Öğe Toxic epidermal necrolysis after cranial radiotherapy and anticonvulsant treatment: a case report(Kare Publ, 2006) Cosar-Alas, Rusen; Caloglu, Murat; Yurut-Caloglu, Vuslat; Saynak, Mert; Karagol, Hakan; Kocak, Zafer; Uzal, CemToxic epidermal necrolysis (TEN) is rare, but, it has been known life treating reaction. It's a mucocutaneous reaction resulting from hypersensitivity to a variety of agents including most anticonvulsants. We report a case of TEN whit occured in a patient with metastatic non-small cell lung carcinona before whole-brain radiation therapy (WBRT) and then received phenytoin (300 mg day-1).