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    Evaluation of prognostic factors and comparison of systemic treatment modalities in patients with recurrent or metastatic endometrial carcinoma
    (Humana Press Inc, 2006) Karagol, Hakan; Saip, Pinar; Uygun, Kazim; Kucucuk, Seden; Aydiner, Adnan; Topuz, Erkan
    Background: Prognostic factors related to survival in patients with inoperable metastatic or recurrent endometrial carcinoma (MREC) have remained unclear due to lack of clinical trials.The management of these patients is also controversial.This study was performed to compare the efficacy and toxicity profiles of two different systemic therapies (chemotherapy vs hormonal therapy) given for the treatment of patients with MREC and to identify the impact of various prognostic factors on the survival. Methods: Between 1992 and 2004, 44 patients with MREC were admitted to our oncology department. Four cases were excluded from this retrospective study because of lack of data in their charts. Age, presence of other systemic diseases (such as diabetes mellitus, hypertension), histological type, tumor grade, staae, disease-free interval, site of recurrence or metastasis, systemic treatment modality, overall response to treatment, and duration of time to progression were evaluated as prognostic factors. Cox regression analysis was per-formed for identification of independent prognostic factors and differences between patients characteristics of two treatment groups were calculated by the chi-square or t test. Results: The median follow-up was 18 mo (range 3-113). The overall response rates for chemotherapy and hormonal therapy group were 42% and 41 %, respectively (p > 0.05). The median time to progression was 4 mo for the chemotherapy group and 5 mo for the hormonal therapy group (p > 0.05). The median survival after metastasis or recurrence was I I mo for the chemotherapy group and 16 mo for the hormonal therapy group (p > 0.05). In the group of chemotherapy, grade 3-4 hematologic and northematologic toxicities were seen in eight and two, patients, respectively. No grade 3-4 toxicities were noted in patients treated with hormonal C therapy. In multivariate analysis, only time to progression (p = 0.001) and grade (p = 0.04) were the independent prognostic factors on survival after metastasis or recurrence. Conclusion: Histological differentiation and duration of time to progression are predictive factors for survival after metastasis or recurrence in the whole group. The efficacy of two different groups of treatment in these patients appears to be similar. But the chemotherapy may have some disadvantageous in terms of toxicity. This study supports a future randomized prospective trial of hormonal therapy vs chemotherapy in patients with MREC.
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    Factors related to recurrence after pathological complete response to postoperative chemotherapy in patients with epithelial ovarian cancer
    (Pensiero Scientifico Editor, 2009) Karagol, Hakan; Saip, Pinar; Eralp, Yesim; Topuz, Samet; Berkman, Sinan; Ilhan, Ridvan; Topuz, Erkan
    Aims and background. It has been appreciated for some time that the lack of detection of ovarian cancer at clinical and pathological (second-look laparotomy) evaluation is not synonymous with cure. The goal of this study was to define clinical risk factors for recurrence after complete pathological response to postoperative chemotherapy in patients with epithelial ovarian cancer. Methods. Fifty-seven patients who met the inclusion criteria of our study were evaluated. The characteristics (age, menopausal status, histological subtype, tumor grade, presence of ascites at diagnosis, type of omentectomy, FIGO stage, and residual tumor volume after primary surgery) of patients with and those Without tumor recurrence were compared. Results. The median follow-up was 52 months (range, 15-142 months). The overall survival rates of the patients were 100%, 96%, and 87% at 1, 3 and 5 years, respectively At the time of the study analysis, 21 of 57 (37%) patients had recurrent disease. The median time to recurrence was 16 months. Recurrences were most frequent in the pelvis and abdominal cavity (38%). Age, menopausal status, stage at diagnosis, and residual tumor volume after initial surgery were significantly related to the risk of recurrence in univariate analysis (P = 0.039, 0.038, 0.004, and 0.000, respectively). Residual tumor volume after initial surgery-was found to be the only significant independent prognostic factor (P = 0.049, HR: 0.16, 95% CI: 0.02-0.99). Conclusion. We believe it is necessary to conduct randomized studies on this issue because insight into predictors of recurrence after pathological complete response to postoperative chemotherapy could be used to select patients for trials of consolidation therapy.
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    Non-pharmacological interventions used by cancer patients during chemotherapy in Turkey
    (Elsevier Sci Ltd, 2011) Can, Gulbeyaz; Erol, Ozgul; Aydiner, Adnan; Topuz, Erkan
    Purpose: Although there are many non-pharmacological practices being recommended for symptom management, most patients prefer to use pharmacological interventions. This study assesses the non-pharmacological interventions used by cancer patients for symptom management during chemotherapy and the factors affecting its use. Method: This study was conducted at the Istanbul University Institute of Oncology. Turkey, with 202 patients. Personal characteristics, illness-related characteristics, symptom severity and non-pharmacological interventions used by the patients were assessed by using Patient Description Form, ECOG and Nightingale Symptom Assessment Scale. Results: Most of the patients in this study were living in Istanbul, 58.4% were women, 78.7% were married and their mean age was 48.82 +/- 1.44. Most of the patients experienced different symptoms related to chemotherapy, but only a small number of patients preferred to use and benefited from the non-pharmacological interventions in their symptom management. There were different factors affecting the well-being of the patients, but only being young was found to be an important variable in the use of psychological interventions (OR 3.06 [95% Cl 1.17-7.96]). Conclusions: Physicians remain the central figure in the treatment of cancer patients, so oncologists and oncology nurses should be more proactive and innovative in their patient care, education, and counseling to maximize the use of non-pharmacological interventions that may be helpful in symptom management. Further research evaluating the use and effectiveness of non-pharmacological interventions on symptom management in cancer patients is needed. (C) 2010 Elsevier Ltd. All rights reserved.
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    Quality of life and complementary and alternative medicine use among cancer patients in Turkey
    (Elsevier Sci Ltd, 2009) Can, Gulbeyaz; Erol, Ozgul; Aydiner, Adnan; Topuz, Erkan
    Aim: The purpose of this study was to assess the relationships between quality of life and use of complementary and alternative medicine (CAM) among Turkish cancer patients. Methods: This cross-sectional study was conducted in Istanbul University Institute of Oncology, Turkey. Two-hundred patients were invited and informed consent was obtained, however 179 cancer patients completed the study. The Patient Characteristics form, The Nightingale Symptom Assessment Scale and The Functional Assessment of Cancer Therapy Scale were used in the evaluation of the patients' characteristics and quality of life. Results: Some form of CAM had been used by 71.5% of the sample. Frequently used CAM methods appeared to be religious practices (68.2%) and only 37.4% of the patients used herbs. However, female patients, single patients, and individuals with metastatic disease and worse quality of life showed a tendency to use CAM more often. More than one-third of our patients began to use CAM immediately after being diagnosed with cancer and factors associated with CAM use varied according to the type of CAM. Although CAM use did not affect the patients' quality of life, logistic regression analysis revealed that gender, type of cancer diagnosis and education level were important factors to be considered in different CAM therapies. Conclusion: CAM use is common in cancer patients in Turkey. More discussion about CAM use should take place between patients and health professionals to inform the patients' decisions. (C) 2009 Elsevier Ltd. All rights reserved.
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    Yolk sac tumours of the ovary: Evaluation of clinicopathological features and prognostic factors
    (Elsevier Ireland Ltd, 2009) Cicin, Irfan; Saip, Pinar; Guney, Nese; Eralp, Yesim; Ayan, Inci; Kebudi, Rejin; Topuz, Erkan
    Objective: To evaluate the clinicopathological prognostic features, factors and outcomes of chemotherapy in ovarian yolk sac tumours (YST). Study design: We reviewed the medical records of 32 women with ovarian YST treated from 1990 to 2006 at two centres. Results: The median follow-up was 36 months. The median age was 22 (range, 9-68). Two patients were postmenopausal. The most common symptoms at diagnosis included abdominal swelling or mass (72%) and abdominopelvic pain (62%). The location of the tumour was bilateral in 2 cases. Eight patients were in stage I, 4 patients in stage II, 17 patients in stage III, and 3 patients in stage IV. Eighteen patients underwent unilateral salpingo-oophorectomy, two bilateral salpingo-oophorectomy and two cystectomy, while 10 patients had total abdominal hysterectomy and two bilateral salpingo-oophorectomy. Of 32 patients who received postoperative chemotherapy, 27 were treated with a bleomycin/etoposide/cisplatin (BEP) regimen. Seventy-two percent of patients were alive at the last follow-up visit. Ten (31%) patients suffered from a recurrence of the disease with a median time to recurrence of 8 months (range, 6-28 months). The most common site of recurrence was the intra-abdominal space, with 8 patients. Only one patient who had recurrence could be salvaged. Fertility-sparing surgery was found at least as effective as radical surgery. While age, histology (mixed vs. pure), stage, tumour size, ascites, and marker levels were not found as prognostic factors, the presence of residual tumour (P = 0.014) and BEP chemotherapy (P = 0.016) were significant prognostic factors in univariate analysis. Conclusions: In patients with ovarian YST, fertility-sparing surgery is as effective as radical surgery. Optimal cytoreductive surgery and standard BEP regimen are the most decisive prognostic factors. In these tumours, adjunctive therapeutic modalities to eradicate intra-abdominal disease and effective salvage therapy strategies are needed. (C) 2009 Elsevier Ireland Ltd. All rights reserved.