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Öğe Awareness of Invasive Micropapillary Breast Carcinoma is an Essential Requirement(Galenos Publ House, 2023) Nurlu, Dilek; Saynak, Mert; Ozler, Talar; Cosar, Rusen[Abstract Not Available]Öğe Breast Cancer Radiotherapy-induced Cardiotoxicity(Kare Publ, 2022) Nurlu, Dilek; Cosar, Rusen; Parlar, Sule; Uzal, CemIn the multimodality treatment of breast cancer, adjuvant radiotherapy (RT) has an important role in achieving local control and increasing survival. Cardiac toxicity due to breast RT, especially left-sided breast RT, is rare but clearly recognizable. As overall survival rates are steadily increasing, long-term toxicities also become increasingly important in terms of late cardiac events, possibly caused by RT. Even small doses for the heart are thought to increase the risk of cardiac toxicity. Advanced radiation techniques such as intensity-modulated radiation therapy, volumetric-modulated arc RT, deep inspiration breath-hold techniques, and prone positioning for pendular breast can eliminate the heart from the primary beams. In addition to mean heart dose, breast cancer RT planning should also include constraints for cardiac subvolumes. Especially for patients who have pre-existing such as cardiovascular disease, diabetes mellitus, dyslipidemia, arterial hypertension, lifestyle factor (tobacco smoking, alcohol, physical inactivity, and poor nutrition), and physicians have to be careful about cardiotoxicity. Radiation oncologists and cardiology specialists should provide closely cooperating regular and long-term followup. This will provide the improvement of patient outcomes.Öğe Breast Cancer Subtypes and Prognosis: Answers to Subgroup Classification Questions, Identifying the Worst Subgroup in Our Single-Center Series(Dove Medical Press Ltd, 2022) Cosar, Rusen; Sut, Necdet; Ozen, Alaattin; Tastekin, Ebru; Topaloglu, Sernaz; Cicin, Irfan; Nurlu, DilekPurpose: Many studies report the triple negative breast cancer (TNBC) as the worst subgroup, as such patients do not benefit from anti-hormonal therapy and human epidermal growth factor receptor 2 (HER2) antagonists. While HER2 overexpression was a poor prognostic factor in breast cancer before trastuzumab (Herceptin) was available, TNBC is often reported as the worst BC subgroup since targeted therapy is currently not possible. Since the patience-specific experiences and the current literature did not always align, we aimed to determine the BC subgroup with the shortest survival in our center.Methods: The records of patients with BC who were admitted to Trakya University Faculty of Medicine Department of Medical and Radiation Oncology between July 1999 and December 2019 were reviewed. Patients were divided into four main groups (Luminal A, Luminal B, TNBC, and HER2-enriched) according to the St Gallen International Consensus Panel and four subgroups in accordance with estrogen receptor, progestin receptor and HER2 positivity. Patient characteristics, treatment characteristics and clinical outcomes of the four main subgroups were evaluated. Survival curves were generated using the Kaplan-Meier method, and the significance of survival differences among the selected variables was compared by using the Log rank test. Factors affecting disease-free survival (DFS) and overall survival (OS) were analyzed by Cox regression analysis.Results: Statistical analysis was performed on 2017 patients, after excluding patients with phyllodes tumor, carcinoma-in-situ and missing information from a total of 2474 patients with BC. There were 952 (47.1%) patients in the Luminal A group, 236 (34.1%) in the Luminal B group, 236 (11.7%) in the TNBC group and 142 (7.1%) patients in the HER2 enriched group. HER2-enriched patients had the shortest survival (p < 0.001), with 113.70 +/- 7.17 months of DFS and 125.45 +/- 3.03 months of OS. For patients who received Herceptin, DFS was 101.50 +/- 6.4 months and OS was 118.14 +/- 6.16. Patients who did not receive Herceptin had 92.79 +/- 18 months of DFS and 94.44 +/- 15.23 months of OS.Conclusion: The HER2-enriched subgroup had the worst prognosis despite receiving targeted therapy. While the duration of DFS and OS had no significant difference between TNBC and Luminal A-B subgroups, HER2 enriched subgroup had significantly shorter survival when compared to any other subgroup. HER2-enriched subgroup had a 10-fold greater risk of death compared to the Luminal A subgroup.Öğe Classifying invasive lobular carcinoma as special type breast cancer may be reducing its treatment success: A comparison of survival among invasive lobular carcinoma, invasive ductal carcinoma, and no-lobular special type breast cancer(Public Library Science, 2023) Cosar, Rusen; Sut, Necdet; Topaloglu, Sernaz; Tastekin, Ebru; Nurlu, Dilek; Ozler, Talar; Senodeyici, EylulPurposeThe literature contains different information about the prognosis of invasive lobular carcinoma of breast cancer (BC). We aimed to address the inconsistency by comparatively examining the clinical features and prognosis of invasive lobular carcinoma patients in our university and to report our experience by dividing our patients into various subgroups. Patients and methodsRecords of patients with BC admitted to Trakya University School of Medicine Department of Oncology between July 1999 and December 2021 were reviewed. The patients were divided into three groups (No-Special Type BC, Invasive Lobular Special Type BC, No-Lobular Special Type BC). Patient characteristics, treatment methods and oncological results are presented. Survival curves were generated using the Kaplan-Meier method. Statistical significance of survival among the selected variables was compared by using the log-rank test. ResultsThe patients in our study consisted of 2142 female and 15 male BC patients. There were 1814 patients with No-Special Type BC, 193 patients with Invasive Lobular Special Type BC, and 150 patients with No-Lobular Special Type BC. The duration of disease-free survival (DFS) was 226.5 months for the No-Special Type BC group, 216.7 months for the No-Lobular Special Type BC group, and 197.2 months for the Invasive Lobular Special Type BC group, whereas the duration of overall survival (OS) was 233.2 months for the No-Special Type BC group, 227.9 for the No-Lobular Special Type BC group, and 209.8 for the Invasive Lobular Special Type BC group. The duration of both DFS and OS was the lowest in the Invasive Lobular Special Type BC group. Multivariate factors that were significant risk factors for OS were Invasive Lobular Special Type BC histopathology (p = .045), T stage, N stage, stage, skin infiltration, positive surgical margins, high histological grade, and mitotic index. Modified radical mastectomy, chemotherapy, radiotherapy and use of tamoxifen and aromatase inhibitors for more than 5 years were significant protective factors for overall survival. ConclusionThe histopathological subgroup with the worst prognosis in our study was Invasive Lobular Special Type BC. Duration of DFS and OS were significantly shorter in Invasive Lobular Special Type BC than No-Lobular Special Type BC group. The classification of Invasive Lobular BC under the title of Special Type BC should be reconsidered and a more accurate treatment and follow-up process may be required.Öğe Radiotherapy-induced Cardiotoxicity After the Treatment of Pulmonary and Mediastinal Solid Tumors(Kare Publ, 2022) Saynak, Mert; Turkkan, Gorkem; Nurlu, Dilek; Ozguven, YildirayThoracic tumors are extremely common and radiotherapy plays an important role in the treatment of these malignancies. Cardiac radiation exposure which is inevitable during thoracic radiotherapy may damage the heart muscle, valves, or coronary arteries. If a malignant thoracic disease can be successfully treated with the contribution of radiotherapy, long-term cardiac toxicity will become a critical factor in determining survival. Therefore, radiation oncologists have recently focused on efforts to provide local disease control without causing toxicity. Over time, advances in radiotherapy techniques have made it possible to significantly limit the dose of cardiac structures while effectively treating the thoracic tumor. Intensity-modulated radiotherapy techniques are beneficial in reducing the cardiac dose and therefore cardiac toxicity. Advanced particle radiotherapy applications such as proton therapy have the potential to improve tumor cell killing efficiency and reduce the risk of cardiac complications. Close and longterm cooperation between radiation oncologists and cardiologists is important in the follow-up of patients undergoing thoracic radiotherapy.Öğe Ratlarda radyoterapiye bağlı gelişen akut mesane toksisitesinde amifostin ve l-karnitin etkinliklerinin histopatolojik olarak karşılaştırılması(Trakya Üniversitesi Tıp Fakültesi, 2011) Nurlu, Dilek; Çaloğlu, Vuslat YürütTedavi amaçlı, pelvis bölgesine uygulanacak yüksek doz radyoterapinin mesane üzerinde ciddi ve çeşitli yan etkileri olabilmektedir. Günümüzde kanser tanı ve tedavisinde sağlanan gelişmeler, kanserli hastaların sağkalım süresini uzatması nedeniyle, kanser tedavisinin akut ve geç etkilerini ön plana çıkarmıştır. Normal dokuları, radyasyonun olumsuz etkilerinden koruma amaçlı radyoprotektör ajanlar önemli bir araştırma konusu haline gelmiştir. Çalışmamızda, radyoterapiden önce uygulanan amifostin ve karnitin ardından mesanesi ışınlanan 12 haftalık ratlarda, etkili bir radyoprotektör olduğu bilinen amifostin ile karnitinin radyoterapiye bağlı mesane hasarından koruyucu etkinliğinin karşılaştırılması amaçlanmıştır. Kontrol, radyoterapi, amifostin ardından radyoterapi ve karnitin ardından radyoterapi grubu olmak üzere dört grup oluşturulmuş, radyoterapi gruplarına mesane alanına tek fraksiyonda 20 Gy radyoterapi uygulanmıştır. Deney gruplarına radyoterapiden 30 dakika önce amifostin 200 mg/kg ve karnitin 300 mg/kg dozunda intraperitoneal olarak uygulanmıştır. Radyoterapide 5 gün sonra ratlara ötenazi uygulanıp, histopatolojik inceleme yapılmıştır. Mesane dokusu, histopatolojik olarak epitel desquamasyonu, epitel rejenerasyonu, stroma ödemi, stromada fibrosiz, stromada iltihap, damarlanma artışı ve damar duvar kalınlığı açısından değerlendirilmiştir. Radyoterapiye amifostin eklenmesinin sadece radyoterapi grubuna göre epitelyal desquamasyon ve damar duvar kalınlığındaki artışı azalttığı gösterilmiştir. Ancak radyoterapiye karnitin eklenmesinin kontrol grubuna göre epitel desquamasyon ve damar duvar kalınlığında koruyucu etkisi bulunamamıştır. Her iki maddenin de stroma ödemi açısında koruyucu etkisi saptanmamıştır. Bununla birlikte amifostinin, karnitine göre epitel desquamasyon ve damar duvar kalınlığı açısından koruyucu etkisi daha belirgindir.Öğe An unusual presentation of Merkel cell carcinoma(2012) İbiş, Kamuran; Saynak, Mert; Akalın, Taner; Nurlu, Dilek; Uzunoğlu, SernazYetmişbir yaşındaki erkek hastanın sırt ağrısı şikayetiyle hastaneye başvurusu sonrasında yapılan tetkiklerinde sol paravertebral alan ikinci vertebra düzeyinde kitle tespit edilmiş ve kitlenin en blok rezeksiyonu sonrasında histopatolojik olarak Merkel hücreli karsinom tanısı konmuştur. Postoperatif birinci ayında manyetik rezonans incelemede aynı alanda tespit edilen ve inoperabl olarak değerlendirilen kitle hastalığın hızlı ilerlediğini düşündürdü. Hasta radyokemoterapinin 6. gününde pnömoni sonucunda ortaya çıkan solunum yetersizliği nedeniyle hayatını kaybetti. Bu çok nadir görülebilecek bir olgu olmakla birlikte, intratorasik kitlelerin ayırıcı tanısında Merkel hücreli karsinom da düşünülmelidir.