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Öğe Assessment of pituitary function in patients with nasopharyngeal carcinoma: the effect of radiotherapy(2019) Akagunduz, Ozlem Ozkaya; Yurekli, Banu Sarer; Simsir, Ilgin Yildirim; Esassolak, MustafaRadiotherapy (RT) plays a very important role in nasopharyngeal carcinoma (NPC). the pituitary gland can be affected by radiation due to its proximity to the nasopha-ryngeal cavity. Our aim is to demonstrate the effect of radiotherapy given for NPC on anterior pituitary function with basal pituitary hormones and provocative tests. Patients with NPC that were treated with definitive chemoradioherapy were reviewed retrospectively. Serum ACTH, GH, PRL, FSH, LH, TSH and cortisol, DHEAS, IGF-1, E2, testosterone, fT3, fT4 levels were recorded to evaluate pituitary function. Insulin tolerance test was performed to investigate hypothalamic-pituitary-adrenal axis and GH -IGF-1 axis. Comparison between early tumor stage and advanced tumor stage for pituitary dysfunction was done. the median time interval between the RT and endocrinologic evaluation was 4.0 (1-13) years. ACTH deficiency was found to be most common hormonal problem with a frequency of 73.7%. of these 71.4% were mild adrenal deficiencies. GH deficiency was seen in 60% of patients. fT3, TSH, GH and IGF-1 levels were significantly lower in patients with advanced tumor stage compared with early tumor stage (p = 0.033, p = 0.022, p = 0.043, p = 0.022, respectively). Growth hormone deficiency was found in all of advanced and in 43% of early tumor stage patients (p = 0.017). We found higher rates of ACTH and GH deficiencies followed by gonadotropin, corticotropin and thyrotropin deficiency. Basal pituitary hormones will not be sufficient to evaluate anterior pituitary failure. Annual and systematic dynamic tests together with basal anterior pituitary hormones would be neededÖğe Evaluation of the Radiation Dose-Volume Effects of Optic Nerves and Chiasm by Psychophysical, Electrophysiologic Tests, and Optical Coherence Tomography in Nasopharyngeal Carcinoma(Sage Publications Inc, 2017) Akagunduz, Ozlem Ozkaya; Yilmaz, Suzan Guven; Yalman, Deniz; Yuce, Berna; Biler, Elif Demirkilinc; Afrashi, Filiz; Esassolak, MustafaPurpose: To evaluate the radiation dose-volume effects of optic nerves and chiasm by visual psychophysical, electrophysiologic tests, and optical coherence tomography in patients with locally advanced nasopharyngeal carcinoma. Materials and Methods: A series of visual tests including visual acuity, visual field, contrast sensitivity, visual evoked potential, and optical coherence tomography were administered to 20 patients with locally advanced (T3-T4) nasopharyngeal carcinoma who were treated with definitive chemoradiotherapy. Volume that received 55 Gy (V-55), mean dose (D-mean), highest dose to 5% of the volume (D-5), and maximum dose (D-max) for optic nerves and chiasm were evaluated for each patient. Cutoff values were identified as V-55: 50%, D-mean: 50 Gy, D-5: 55 Gy, and D-max: 60 Gy. The effects of radiation dose-volume on ophthalmologic tests were evaluated. Results: Ophthalmological evaluation revealed optic neuropathy with simultaneous retinopathy in 6 eyes of 4 patients and radiation retinopathy alone in both eyes of 1 patient. Regarding radiation dose-volume effects of the optic nerve, significant detrimental effect of all parameters was observed on visual acuity. Visual field and contrast sensitivity were affected significantly with V-55 50% and D-mean 50 Gy. Visual evoked potential latency was affected significantly with D-mean 50 Gy, D-5 55 Gy, and D-max 60 Gy. For the chiasm, significant detrimental effect of all parameters was observed on visual acuity as well. Retinal nerve fiber layer thickness and visual evoked potential amplitude were not affected by any of the dose-volume parameters neither optic nerves nor chiasm. Conclusion: The volume receiving the threshold dose, mean dose, and 5% of the volume receiving the maximum dose are important parameters besides maximum dose to optic nerves and chiasm. A comprehensive ophthalmological evaluation including visual field, contrast sensitivity, visual evoked potential latency, and amplitude should be performed for these patients. Visual evoked potential latency is an objective predictor of vision loss before the onset of clinical signs.Öğe Local recurrence outcomes after breast conserving surgery and adjuvant radiotherapy in ductal carcinoma in situ of the breast and a comparison with ECOG E5194 study(Churchill Livingstone, 2018) Akagunduz, Ozlem Ozkaya; Ergen, Arzu; Erpolat, Petek; Gultekin, Melis; Yildirim, Berna Akkus; Parvizi, Murteza; Ikiz, Didem; Oksuz, Didem Colpan; Onal, Cem; Yildiz, Ferah; Ozsaran, ZeynepPurpose: Turkish Radiation Oncology Study Group investigated local recurrence rates and prognostic factors in patients with ductal carcinoma in situ (DCIS) of the breast treated with breast conservative surgery (BCS) followed by radiotherapy (RT) and Eastern Cooperative Oncology Group (ECOG) Study E5194 were compared with the original study. Patients and methods: Totally 252 patients were evaluated retrospectively. Prognostic factors that might influence local control (age, nuclear grade, comedo necrosis, surgical margins, tumor size, hormone receptor status) were compared. The eligibility criteria of ECOG 5194 were stratified into two groups as in the original study and were compared for local control. Results: The median follow-up time was 59 (21-220) months. Local recurrence was observed in 9 patients (3.6%) who had invasive carcinoma (3 patients) and DCIS (6 patients). Ten years local control rates was 91.8% respectively. We found that the risk of ipsilateral breast recurrence was significantly higher in women younger than 50 years old (p = 0.016). In addition, a statistically significant trend was found in patients with tumor larger than 1 cm and HER2 positive tumors (p = 0.051, p = 0.068 respectively). When 12-year results were compared with the ECOG 5194, adjuvant RT produced an absolute difference of 11% in low-intermediate and 20% in high grade in local control. Conclusion: In our study, the 10-year local control rate was 92% and younger than 50 years old was the most important unfavorable prognostic factor for local recurrence. There was provided 20% absolute local control with adjuvant radiotherapy which eligibility criteria of ECOG 5194 high grade group. (C) 2018 Elsevier Ltd. All rights reserved.Öğe Multi-institutional analysis of cervical esophageal carcinoma patients treated with definitive chemoradiotherapy: TROD 01-005 study(Tech Science Press, 2023) Guler, Ozan Cem; Oymak, Ezgi; Yazici, Gozde; Akagunduz, Ozlem Ozkaya; Cetinayak, Oguz; Erpolat, Petek; Aksoy, AtilThe aim of this study was to examine the prognostic factors and treatment outcomes of cervical esophageal carcinoma (CEC) patients who underwent definitive chemoradiotherapy (CRT). The clinical data of 175 biopsy -confirmed CEC patients treated with definitive CRT between April 2005 and September 2021 were retrospectively analyzed. The prognostic factors predicting overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS) were assessed in uni-and multivariable analyses. The median age of the entire cohort was 56 years (range: 26-87 years). All patients received definitive radiotherapy with a median total dose of 60 Gy, and 52% of the patients received cisplatin-based concurrent chemotherapy. The 2-year OS, PFS, and LRFS rates were 58.8%, 46.9%, and 52.4%, respectively, with a median follow-up duration of 41.6 months. Patients' performance status, clinical nodal stage, tumor size, and treatment response were significant prognostic factors for OS, PFS, and LRFS in univariate analysis. Non-complete treatment response was an independent predictor for poor OS (HR = 4.41, 95% CI, 2.78-7.00, symbolscript < 0.001) and PFS (HR = 4.28, 95% CI, 2.79-6.58, symbolscript < 0.001), whereas poor performance score was a predictor for worse LRFS (HR = 1.83, 95% CI, 1.12-2.98, symbolscript = 0.02) in multivariable analysis. Fifty-two patients (29.7%) experienced grade II or higher toxicity. In this multicenter study, we demonstrated that definitive CRT is a safe and effective treatment for patients with CEC. Higher radiation doses were found to have no effect on treatment outcomes, but a better response to treatment and a better patient performance status did.Öğe Radiation-Associated Chronic Dysphagia Assessment by Flexible Endoscopic Evaluation of Swallowing (FEES) in Head and Neck Cancer Patients: Swallowing-Related Structures and Radiation Dose-Volume Effect(Sage Publications Inc, 2019) Akagunduz, Ozlem Ozkaya; Eyigor, Sibel; Kirakli, Esra; Tavlayan, Emin; Cetin, Zeynep Erdogan; Kara, Gulsen; Esassolak, MustafaPurpose We aimed to restore dose-volume parameters of swallowing-related structures (SRSs) by evaluating long-term swallowing dysfunctions after radiotherapy (RT) in head and neck cancer patients (HNCPs). Materials and Methods Head and neck cancer patients whose pharyngeal region was involved in RT portal and treated with definitive RT/chemoradiotherapy (CRT) were included in the analyses. Patients underwent objective swallowing assessment by flexible endoscopic evaluation of swallowing (FEES). Volumes of SRSs that received 55 Gy (V-55) (mean dose [D-mean]) were evaluated according to the dose-volume histograms of each patient. For every SRS, optimal dose-volume cut-off values were determined by receiver operating characteristic curve analysis. Results Fifty-five patients at a median 20 months (range, 12-26 months) after their treatments were evaluated. There was a strong negative correlation between FEES scores and dose-volume parameters of SRS (r <= -0.5, P < .0001). According to our results, middle pharyngeal constrictor (MPC) and inferior pharyngeal constrictor (IPC) had a D-mean > 57 Gy, base of tongue (BOT) D-mean > 50 Gy, supraglottic larynx (SGL) and glottic larynx (GL) D-mean > 55 Gy, and cervical esophagus (CE) D-mean > 45 Gy. MPC V-55 > 70%, IPC V-55 > 50%, BOT V-55 > 65%, CE V-55 > 40%, and SGL and GL V-55 > 50% were significant predictors for dysphagia. Conclusion It was found that dysphagia correlates strongly with dose-volume parameters of SRSs. IPC, SGL, and CE were found to be structures significantly associated with dysphagia.Öğe Radiation-Induced Ocular Surface Disorders and Retinopathy: Ocular Structures and Radiation Dose-Volume Effect(Korean Cancer Association, 2022) Akagunduz, Ozlem Ozkaya; Yilmaz, Suzan Guven; Tavlayan, Emin; Baris, Mine Esen; Afrashi, Filiz; Esassolak, MustafaPurpose This study aimed to evaluate the radiation-induced adverse effects on ocular structures in head and neck cancer patients and investigate the radiation dose-volume effects on the cornea, lacrimal gland, retina, optic nerve and chiasm. Materials and Methods A total of 38 eyes of 19 patients were included in this prospective, cohort study. All patients underwent complete ophthalmological examination in addition to contrast sensitivity, visual field and visual evoked potentials (VEP) tests. Ophthalmological examinations and psychophysical tests were performed in 6th, 12th, 18th, 24th months and in the last visit. The relationship between the ophthalmologic findings, and the radiation doses below and above the cut-off values was evaluated. Results Contrast sensitivity decrease and visual field deterioration were observed in 42% of the patients in the last visit (median 26 months) whereas a prolonged latency and decreased amplitude of P100 wave in VEP was observed in 58% and 33% of the eyes, respectively at 24th month. Totally 16 patients (84.2%) developed dry eye disease and eight of them received radiotherapy below tolerance doses and had mild to moderate dry eye findings. Radiation-induced retinopathy was observed in three of the eyes in eight patients who received radiation above tolerance dose. Conclusion Head and neck cancers treated with radiotherapy, resulted in various ophthalmic complications. All patients who are treating with radiotherapy should be evaluated by an ophthalmologist in terms of anterior and posterior segment damage, even if the radiation dose is below the tolerance limit.
