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Öğe The association between the mean heart dose, mean lung dose, tumor location and RT-associated heart and lung toxicity(Elsevier Science Inc, 2005) Marks, LB; Kocak, Z; Zhou, S; Yu, X; Light, K; Anscher, MS; Kahn, D[Abstract Not Available]Öğe Challenges in defining radiation pneumonitis in patients with lung cancer(Elsevier Science Inc, 2005) Kocak, Z; Evans, ES; Zhou, SM; Miller, KL; Folz, RJ; Shafman, TD; Marks, LBPurpose: To assess the difficulty of assigning a definitive clinical diagnosis of radiation (RT)-induced lung injury in patients irradiated for lung cancer. Methods: Between 1991 and 2003, 318 patients were enrolled in a prospective study to evaluate RT-induced lung injury. Only patients with lung cancer who had a longer than 6-month follow-up (251 patients) were considered in the current analysis. Of these, 47 of 251 patients had Grade >= 2 (treated with steroids) increasing shortness of breath after RT, thought possibly consistent with pneumonitis/fibrosis. The treating physician, and one to three additional reviewing physicians, evaluated the patients or their medical records, or both. The presence or absence of confounding clinical factors that made the diagnosis of RT-induced uncertain lung injury were recorded. Results: Thirty-one of 47 patients (66%) with shortness of breath had classic pneumonitis, i.e., they responded to steroids and had a definitive diagnosis of pneumonitis. In 13 of 47 patients (28%), the diagnosis of RT-induced toxicity was confounded by possible infection; exacerbation of preexisting lung disease (chronic obstructive pulmonary disease); tumor regrowth/progression; and cardiac disease in 6, 8, 5, and 1 patients, respectively (some of the patients had multiple confounding factors and were counted more than once). An additional 3 patients (6%) had progressive shortness of breath and an overall clinical course more consistent with fibrosis. All 3 had evidence of bronchial stenosis by bronchoscopy. Conclusions: Scoring of radiation pneumonitis was challenging in 28% of patients treated for lung cancer owing to confounding medical conditions. Recognition of this uncertainty is needed and may limit our ability to understand RT-induced lung injury. (c) 2005 Elsevier Inc.Öğe Clinical parameters and treatment results in recurrent granulosa cell tumor of the ovary(Academic Press Inc Elsevier Science, 2003) Uygun, K; Aydiner, A; Saip, P; Kocak, Z; Basaran, M; Dincer, M; Topuz, EObjectives. The objectives of this study were to evaluate the patients' characteristics and treatment results for 11 recurrent granulosa cell tumors (GCT) of the ovary. Methods. Tumor registries were screened retrospectively for all patients treated between 1979 and 1999 for ovarian tumors at the University of Istanbul. All information about these patients was obtained from operation, pathology, and follow-up reports. Then the clinical data were extracted. The patients were classified in stages according to FIGO criteria. There were 952 ovarian carcinomas, of which 45 were GCT. Eleven of 45 patients (24%) developed recurrent disease on follow-up. Results. All patients but one had advanced (III-IV) disease at diagnosis. The median progression-free interval (PFI) was 16 months (range, 5-39 months) with a marked difference in PFI between patients receiving (24 months) and not receiving (8 months) initial chemotherapy. Among patients received chemotherapy (six patients), two complete and two partial responses were observed, for an overall response rate of 67%. The median survival for all patients was 26 (4-73) months with a longer survival (38 versus 8 months) for patients retreated with a platinum-containing regimen. Conclusions. Despite the fact that small number of treated cases does not allow an adequate evaluation, retreatment with cis-platinum-containing regimens may be the treatment of choice for patients with recurrent disease. (C) 2003 Elsevier Science (USA). All rights reserved.Öğe Fatal hepatic veno-occlusive disease in an adult patient with Wilms' tumour(Elsevier Science London, 2003) Uygun, K; Kocak, Z; Cicin, I; Caloglu, M[Abstract Not Available]Öğe Granulosa cell tumor of the ovary - Retrospective analysis of 45 cases(Lippincott Williams & Wilkins, 2003) Uygun, K; Aydiner, A; Saip, P; Basaran, M; Tas, F; Kocak, Z; Dincer, MAdult granulosa cell tumors of the ovary are rare neoplasms, accounting for less than 5% of all ovarian malignancies. In addition to the tumor stage, residual disease, patient age, tumor size, extent of surgery, and also some histologic factors have been reported to be of prognostic importance. Tumor registries were screened for all patients treated between 1979 and 1998 for ovarian tumors at the University of Istanbul. There were 952 ovarian carcinomas, of which 47 were granulosa cell tumors. All charts were reviewed, and the clinical data were extracted. Prognostic factors and treatment results were evaluated retrospectively. The median follow-up was 84 (range: 6-141 months) months. According to univariate analysis, there were only two significant factors for overall survival (OS): stage and presence of residual disease. The OS of the 23 patients with early stage (mean, 122 months; median, unreached) was significantly (p = 0.0001) better than the OS of the 22 patients with advanced stage (mean, 34 months; median, 21 months). A significant difference (p = 0.0004) in OS was also observed between patients with residual (mean, 42 months; median, 21 months) and nonresidual (mean, 108 months; median, unreached) disease. In a multivariate analysis, only stage remained statistically significant (p = 0.0001). The overall 5-year survival rate was 55% and median survival after recurrence was 21 months. Despite the small number of patients, the study showed that stage and macroscopic residual disease are significant prognostic factors. The benefit of chemotherapy and radiotherapy remains controversial.Öğe The impact of pre-radiotherapy surgery on radiation-induced lung injury(Elsevier Science London, 2005) Kocak, Z; Yu, X; Zhou, SM; D'Amico, TA; Hollis, D; Kahn, D; Tisch, AAims: The use of postoperative radiation therapy (PORT) is predicated by an assessment of the potential benefits and risks, including radiation-induced lung injury. In this study, the risk of radiation-induced lung injury is assessed in patients who received PORT, and compared with a group of patients who received radiation without prior surgery, to determine if surgery increases the risk of radiation pneumonitis. Materials and methods: From 1991 to 2003, 251 patients with lung cancer were enrolled into a prospective study to assess radiation-induced lung injury. All patients received three-dimensional-planned, external-beam radiotherapy. One hundred and seventy-seven patients with over 6-months follow-up were eligible. For the current analysis, 49 patients (28%) had surgical intervention before radiotherapy. The rates of Grade 2 symptomatic pneumonitis in subgroups, based on the type of pre-radiation surgery, were computed and compared using Fisher's Exact Test. To consider the confounding factor of irradiated lung volume, patient subgroups were further defined on the basis of the mean lung dose. Results: Surgical procedures included pneumonectomy (n = 9), lobectomy (n = 16), wedge resection (n = 8) and exploration without resection (n = 16). Radiation-induced lung injury occurred in 33 out of 177 (19%) patients, including 18% of the surgical group and 19% of the non-surgical group. Additionally, no statistically significant difference was found in the rate of radiation-induced lung injury based on the extent of resection. Conclusions: The incidence of pneumonitis is similar in the surgical and non-surgical groups. Thus, PORT may be safely given to selected patients after surgical exploration or resection. (c) 2005 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.Öğe Intrathoracic desmoid tumor of the posterior mediastinum with transdiaphragmatic extension. Report of a case(Pensiero Scientifico Editor, 2000) Kocak, Z; Adli, M; Erdir, O; Erekul, S; Cakmak, AWe report on a de nova desmoid tumor of the posterior mediastinum with transdiaphragmatic extension in a 40-year-old man, The tumor was inoperable because of its location and the invasion of adjacent structures. Although extremely rare, desmoid tumors of the posterior mediastinum should be considered in the differential diagnosis of posterior mediastinal masses.Öğe Isolated bilateral sixth nerve palsy secondary to metastatic carcinoma: a case report with a review of the literature(Elsevier Science Bv, 2003) Kocak, Z; Celik, Y; Uzal, MC; Uygun, K; Kaya, M; Albayram, SIsolated sixth nerve palsies usually occur in the vasculopathic age group and are often associated with diabetes mellitus, hypertension, and atherosclerosis but also occur in the presence of skull base tumors. However, isolated bilateral sixth nerve palsies are an extremely rare complication of skull base lesions due to metastatic neoplasms. A case of a 46-year-old man with metastatic small-cell carcinoma of the lung that developed acute bilateral abducens nerve palsies is presented. Although this appears to be an isolated case, metastasis to the skull base must be included in the differential diagnosis of isolated bilateral sixth nerve palsies. (C) 2003 Elsevier B.V. All rights reserved.Öğe Isolated bone metastasis in testicular germ cell tumors: A case report and review of the literature(Karger, 2006) Uygun, K; Karagol, H; Kocak, Z; Cicin, I; Yalcin, O; Caloglu, M; Simsek, OBackground: In testicular germ cell tumors ( GCT), bone metastases are usually seen late in the disease progress and are almost always associated with involvement of other sites. However, isolated bone metastasis is an extremely rare finding in these patients. Case Report: A 43-year-old man was admitted to the neurosurgery department of our hospital suffering from dysarthria, ataxia, headaches and a progressive swelling above the parietooccipital region of the skull. Radiological, biochemical and pathologic tests showed that the lesion of the skull was an isolated skull metastasis as an initial manifestation of nonseminomatous GCT of the testis. Discussion: When a young patient presents with bone pain or painless swelling, even if it is an unusual site and isolated, testicular GCT should be considered as a differential diagnosis, as these lesions could be the first evidence of metastatic GCT.Öğe Pituitary metastasis mimicking a macroadenoma from carcinoma of the larynx: A case report(Pensiero Scientifico Editor, 2001) Uzal, MC; Kocak, Z; Doganay, L; Tokatli, F; Caloglu, M; Kilincer, CMetastatic tumors of the pituitary gland are not commonly diagnosed during life in cancer patients. The occurrence of symptomatic lesions is also very unusual and difficult to differentiate clinically and radiologically from pituitary adenomas. Furthermore, a single intrasellar metastasis from laryngeal carcinoma mimicking a pituitary adenoma is an extremely rare pathological finding. We report on the clinical, radiological, and pathological findings in a patient with laryngeal carcinoma who had a symptomatic solitary pituitary gland metastasis that was recognized antemortem.Öğe The potential cardioprotective effects of amifostine in irradiated rats(Elsevier Science Inc, 2004) Tokatli, F; Uzal, C; Doganay, L; Kocak, Z; Kaya, M; Ture, M; Kurum, TPurpose: The aim of this study is to determine the cardioprotective efficacy of amifostine. The study consists of researching the relationship between plasma brain natriuretic peptide levels and the electrical and morphologic changes in irradiated rats with or without amifostine. Methods and Materials: Sixty Wistar albino rats were divided into 4 groups, and their hearts were given 15 Gy/fraction with Co-60. In Groups I and II, the rats were killed after 24 hours to detect early effects; in Groups III and IV, the rats were killed 100 days after irradiation to detect late effects. Before irradiation, Groups I and III received 0.9% saline solution, whereas Groups II and IV received amifostine (200 mg/kg). Twenty rats were used as a control group. Results: On the 100th day, mild myocardial degeneration was detected in 5 rats (33%) from Group III (no amifostine). This percentage was statistically different from that of Group IV (treated with amifostine) and the controls (p = 0.042). There was no statistically significant difference between the mean plasma brain natriuretic peptide values of the groups (p > 0.05). There was no significant difference in electrocardiographies between the groups. There was no correlation between continuous variables. Conclusion: In the amifostine group (IV) on the 100th day, there was no myocardial degeneration, suggesting that amifostine has a cardioprotective effect. (C) 2004 Elsevier Inc.Öğe Prospective assessment of models to predict radiation pneumonitis based on dosimetric/functional parameters(Elsevier Science Inc, 2005) Kocak, Z; Zhou, S; Kahn, D; Hollis, D; Clough, R; Folz, RJ; Anscher, MS[Abstract Not Available]Öğe Rising lung cancer deaths among younger individuals: Lung carcinoma in a patient at the age of 26(Karger, 2004) Kocak, Z; Uzal, MC; Uygun, K[Abstract Not Available]Öğe Sequential pulmonary effects of radiotherapy detected by functional and radiological end points in women with breast cancer(Elsevier Science London, 2005) Tokatli, F; Kaya, M; Kocak, Z; Ture, M; Mert, S; Unlu, E; Alkaya, FAims: To determine the pulmonary effects of locoregional irradiation on clinical and sub-clinical radiographic and functional end points in women with breast cancer, and whether the course of these end points is affected by laterality. Materials and methods: Twenty patients (10 irradiated on the left side and 10 irradiated on the right side) were prospectively evaluated for changes in pulmonary function tests, Tc-99m DTPA (diethylenetriamine pentaacetic acid) lung clearance scintigraphy and high-resolution computed tomography (HRCT) at 6, 16 and 52 weeks after radiotherapy. Tc-99m DTPA clearance, expressed as the biological half-time, T (1/2), was computed from the time-activity curves for 10 min for each lung. The irradiated lung volume was calculated for each patient. Results: The mean irradiated lung volume was 6.4% +/- 2 (range 3-11 %) for the entire population. In the whole study population, two (10%) patients, who were irradiated on the left side, had mild symptomatic radiation pneumonitis in the follow-up period. There was a statistically significant gradual reduction in all pulmonary function test values during the follow-up period. For patients irradiated on the left side, Tc-99m DTPA clearance T-1/2 values were statistically significantly decreased during the follow-up period (P = 0.03), but the decrease was not statistically significant for patients irradiated on the right side (P = 0.62). Tc-99m DTPA clearance T-1/2 values were statistically significantly decreased in the irradiated lung compared with the opposite lung, and no improvement was seen at week 52 after radiotherapy. The number of patients with changes on HRCT scans increased after radiotherapy, reaching a maximum at 16 weeks, when 80% of patients had changes. There was subsequent partial recovery 52 weeks after radiotherapy. Conclusion: Locoregional irradiation for breast cancer may cause sub-clinical irreversible impairment of radiological and functional pulmonary parameters. The increase in clearance rate of Tc-99m DTPA may be more prominent for patients with left-sided breast cancer. Tokatli, F. et al. (2005). (C) 2005 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.Öğe Unusual metastatic site in a case of carcinoma of the hypopharynx: Nasal tip(B C Decker Inc, 2005) Kocak, Z; Uygun, K; Uzal, MC; Cicin, I; Yalcin, O[Abstract Not Available]
