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Öğe Acute hematological and metabolical side effects of chemoradiotherapy for inoperabl cervical cancer(Elsevier Ireland Ltd, 2021) Nasuhbeyoglu, E. D.; Alanyali, S.; Aras, B. A.; Ozsaran, Z.[No Abstract Available]Öğe Adjuvant Radiotherapy in Cervical Cancer Patients: TROD Gynecologic Group Study(Elsevier Science Inc, 2020) Gultekin, M.; Esen, C. S. Beduk; Balci, B.; Alanyali, S.; Yildirim, B. Akkus; Ergen, S. A.; Ozsaran, Z.[No abstract available]Öğe Comparison of hematologic toxicity between 3DCRT and IMRT planning in cervical cancer patients after concurrent chemoradiotherapy: a national multi-center study(I R O G Canada, Inc, 2014) Erpolat, O. P.; Alco, G.; Caglar, H. B.; Igdem, S.; Saran, A.; Dagoglu, N.; Aslay, I.; Ozsaran, Z.; Demirci, S.; Keven, E.; Guney, Y.; Akmansu, M.; Kilic, D.; Bayman, E.; Etiz, D.; Mandel, N. M.Purpose: To compare the incidence and severity of acute and chronic hematologic toxicity (HT) in patients treated with three-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) for curative treatment of cervical cancer and to ascertain the dosimetric parameters of two techniques associated with acute and chronic HT. Materials and Methods: A total of 127 patients with cervical cancer receiving concomitant pelvic radiotherapy (RT) and cisplatin were evaluated. Pelvic bone marrow (BM) was contoured for each patient and divided into five sub-regions: lumbosacrum (LS), ilium (IL), lower pelvis (LP), pelvis (P), and whole pelvis (WP). The volume of each BM region receiving 10,20,30, and 40 Gy was calculated (V10, -V20, -V30, and -V40). The lowest level of hemoglobin, leukocyte, neutrophil, and platelet counts were obtained during chemoradiotherapy and six months after RT. The nadir values were graded according to Common Terminology Criteria for Adverse Events (version 3.0). Results: Grade 2 or greater acute anemia, leukopenia, neutropenia, thrombocytopenia was observed in 2%, 41.5%, 12%,and 0% in 3DCRT group and in 27%, 53%, 24.5%, and 4.5% in IMRT group, respectively. Grade 2 or greater chronic anemia, leukopenia, neutropenia, and thrombocytopenia was observed in 11%, 10%, 6%, and 0% in 3DCRT group and in 11%, 9%, 4.5%, and 0% in IMRT group, respectively. LS-V30,40; IL-V10,20,30,40; LP-V10,20,40; P-V10,20,30,40, and TP-V10,20,30,40 were significantly reduced with IMRT planning compared to 3DCRT planning. Logistic regression analysis of potential predictors showed that none of the dosimetric parameters were significant for predicting acute and chronic HT. Conclusion: The present findings showed that IMRT planning reduced irradiated BM volumes compared to 3DCRT planning. However, no difference between the two techniques was observed in terms of acute and chronic HT. Further studies are needed to confirm these results.Öğe Evaluation of acute and late radiation morbidity in patients with gynaecologic malignancy using the RTOG criteria and Franco-Italian glossary(I R O G Canada, Inc, 2008) Yildirim, G.; Ozsaran, Z.; Yalman, D.; Kamer, S.; Aras, A.Purpose: The purpose of this study was to evaluate acute and late radiation morbidity in patients with gynaecologic malignancy using the RTOG criteria and Franco-Italian glossary, and to compare the usefulness and disadvantages of each system. Materials and Methods: Between February 2001 and February 2003, 107 patients with gynaecologic malignancy who received either radical or adjuvant external radiotherapy intracavitary brachytherapy or radiochemotherapy were enrolled in this study. The patients were evaluated before radiotherapy and weekly during radiotherapy for acute morbidity using the RTOG grading system and Franco-Italian glossary. Postradiotherapy evaluation was done one month after radiotherapy and at 3-month intervals thereafter. Median follow-up duration was 17 months. Morbidity was graded and recorded according to each scoring system. Results: Median age was 46 years (range 37-82). Sixty-four patients (59.8%) had endometrial cancer. Radical radiotherapy was applied to 26 patients because of inoperability and 81 patients received postoperative radiotherapy. Biologically effective doses for the bladder, rectum and vagina were 98.39, 103.54 and 121.81, respectively, for late morbidity (BED3); 70.88, 72.84 and 80.92, respectively, for acute morbidity (BED,,). According to the RTOG grading system acute morbidity rate for the genitourinary and gastrointestinal systems, and skin were 52.3%, 83.2% and 63.5%, respectively. Late morbidity rate for the bladder, colon-rectum, skin and vagina were 16.8%, 20.6%, 47.7% and 51.4%, respectively. The morbidity rate for the bladder, nonspecific abdominal, hematopoietic system, uterus-vulva-vagina, skin and rectum were 35.4%, 29.9%, 5.6%, 60.8%, 40.1 % and 32.7%, respectively using the Franco-Italian glossary. In patients with carcinoma of the vulva - whose treatment fields were wider - acute morbidity rate according to RTOG criteria was higher (p = 0.057); photon energy (6 My rather than 1.25 MV) (p = 0.01) and treatment interruption of more than eight days (p = 0.019) were correlated with decreased long-term morbidity. According to the Franco-Italian glossary morbidity rates were higher in patients who received chemotherapy (p = 0.047), both external radiotherapy and brachytherapy (p = 0.022) and treatment interruption of less than eight days (p = 0.019). Conclusion: There is no common language between the RTOG grading system and Franco-Italian glossary for defining and scoring radiation morbidity. Up to date no standard and well-defined system has been developed for recording and reporting acute and late radiation morbidity in gynaecologic malignancy, but rather it depends on the subjective evaluation and experience of a radiation oncologist and subjective complaints of the patient, and sometimes on clinical findings. A standard and well-defined user friendly objective scoring system is needed to define and predict the morbidity rate more properly.Öğe Evaluation of anxiety level during intracavitary brachytherapy applications in patients with gynecologic malignancy(Pergamon-Elsevier Science Ltd, 2005) Yalman, D.; Kamer, S.; Ozsaran, Z.; Celik, O.; Bolukbasi, Y.; Bildilk, O.; Haydaroglu, A.Öğe Evaluation of anxiety levels during intracavitary brachytherapy applications in women with gynecological malignancies(I R O G Canada, Inc, 2007) Kamer, S.; Ozsaran, Z.; Celik, O.; Bildik, O.; Yalman, D.; Bolukbasi, Y.; Haydaroglu, A.Purpose: To evaluate the anxiety levels of women treated for gynecological malignancies using intracavitary brachytherapy. Methods: Anxiety levels prior to and after intracavitary brachytherapy application and factors influencing anxiety levels were evaluated. Women were evaluated for quality of life and psychological status before each brachytherapy application using the Hospital Anxiety and Depression Scale (HADS). Scores were grouped as follows: 0-7 = normal, 8-10 = borderline, 11-21 = abnormal. Women were also questioned about other factors which could affect anxiety levels such as marital status, education level, number of pregnancies and prior surgical history. Results: Between January 2003 and August 2004, 146 women with a median age of 56 years were evaluated (range: 27-80). Eighty-six women had cervix uteri carcinoma and 63 had endometrial carcinoma. Sixty-seven women were premenopausal and 85 women were postmenopausal. The median pregnancy number was three (range = 0-10). Eighty-nine women had at least three children. Sixty-seven women had had previous operations. One hundred and twenty-five women were married and 24 women were unmarried or widowed. Before treatment, the anxiety scores were scored as normal in 49 (32%), borderline in 41 (28%), and abnormal in 59 (40%). Anxiety levels were lower in 69 women during the last application as compared with the pretreatment levels (p = 0.00). Marital status and pregnancy number showed a significant correlation with anxiety scores (p = 0.04). Age, level of education or having had a previous operation showed no significant correlation with anxiety level. Conclusion: These results indicate that intracavitary brachytherapy is associated with anxiety. Women need to be given detailed information before the brachytherapy application to reduce anxiety. Additional studies are needed to determine it.Öğe Evaluation of treatment results and prognostic factors in early-stage cervical carcinoma patients treated with postoperative radiotherapy or radiochemotherapy(I R O G Canada, Inc, 2012) Demirci, S.; Ozsaran, Z.; Ozsaran, A.; Yavas, F.; Demircioglu, B.; Hanhan, M.; Dikmen, Y.; Aras, A. B.Purpose: To investigate the clinical features, prognostic factors, and treatment outcome in early-stage cervical carcinoma patients treated with postoperative radiotherapy (RT)/radiochemotherapy (RCT). Methods: The records of 256 Stage IB and 11 cervical cancer patients treated with postoperative RT/RCT from 1992-2007 were retrospectively reviewed. Median age of the patients was 47 (range: 25-78). Two hundred one (78.6%) patients had squamous cell carcinoma and 29(11.3%) had adenocarcinoma. One hundred and eighty-seven (73.0%) had FIGO Stage IB and 69 (27%) had Stage II disease. Concomitant cisplatin-based chemotherapy was administered to 47 (18.4%) patients. Metastatic lymph node ratio (MLNR), defined as number of metastatic lymph nodes divided by the number of dissected lymph nodes, was 0 in 142 (55.5%) patients, from 1% to 10% in 27 (10.5%) and > 10% in 31(12.1%) patients. Results: Median follow-up duration was 60.5 months (range: 6-202 months). Five-year locoregional control (LRC), disease-free survival (DFS), disease specific survival (DSS) and overall survival (OS) rates were 90.8%, 83.4%, 91.2%, and 85%, respectively. In multivariate analysis; bulky tumor (> 4 cm) was shown as an important prognostic factor for LRC, DFS and DSS. Pretreatment hemoglobin level (< 10 g/dl) was associated with lower OS rate. Endometrial involvement was associated with lower LRC and DFS. Treatment break > 14 days showed significance for DFS and DSS. MLNR was found as a valuable prognostic factor for all endpoints (LRC, DFS, DSS and OS). The rate of grade 3-4 late toxicity was 3.6% and 2%, respectively. Conclusion: Postoperative RT/RCT is an effective treatment modality for early-stage cervical cancer patients with unfavorable features and provides satisfactory local control and survival rates with low morbidity.Öğe Lymphovascular space invasion and positive peritoneal cytology are independent prognostic factors for lymph node metastasis and recurrence in endometrial cancer(I R O G Canada, Inc, 2018) Yildirim, N.; Bilgi, A.; Gokulu, S. G.; Akman, L.; Zekioglu, O.; Serin, G.; Ozdemir, N.; Alanyali, S.; Ozsaran, Z.; Ozsaran, A. A.; Terek, M. C.Aim: The aim is to identify the risk factors for recurrence and lymphatic metastasis of endometrial cancer. Materials and Methods: Patients who were operated primarily for endometrial cancer between 2010-2016 were included. Parameters such as stage, grade, histology, depth of invasion, cytology status, lymphovascular space invasion (LVSI), and tumor size were recorded. Univariate and multivariate logistic regression models were used to identify pathological predictors of lymphatic dissemination and recurrence. Results: A total of 278 patients were evaluated. Mean age was 60. 80% were Stage I, 10% were Stage III, and 4% were Stage IV, and 36.7% of patients had LVSI. Lymphadenectomy was performed in 56% of patients and lymphatic metastasis was observed in 7.1% of patients. In 13 patients, recurrence occurred; seven were loco-regional and six were distant. Three patients who had recurrence (3/13) were in early stage. With multivariate analysis, LVSI [OR = 8.826;1.874-41.576 (95%CI),p = 0.006] and positive cytology [OR = 9.503;1.811-49.876 (95%CI),p = 0.008] were independent factors for recurrence in endometrial cancer. Additionally, for lymphatic metastasis. LVSI [OR = 6.195;1.258-30.506 (95%CI), p = 0.025] and positive cytology [OR = 14.258; 2.330-87.247 (95%CI), p = 0.004] were found as significant risk factors. Conclusion: LVSI and positive cytology are significant risk factors for lymphatic metastasis and recurrence in endometrial cancer. Patients who had these risk factors should be followed-up more cautiously in terms of recurrence.Öğe The management of painful bone metastases with biphosphonates and palliative radiotherapy: a retrospective evaluation of 372 cases(Zerbinis Medical Publ, 2009) Niang, U.; Kamer, S.; Ozsaran, Z.; Haydaroglu, A.; Kilciksiz, S.Purpose: The objective of this study was to evaluate the palliation of pain of bone metastases with biphoshonates and different radiotherapy protocols, in 372 cancer patients. Patients and methods: Patients were treated with one of the 3 different radiotherapy protocols: 30 Gy in 10 fractions (group A), 20 Gy in 5 fractions (group B) and 8 Gy in a single fraction (group C). Two patient groups were studied: one with radiotherapy alone and the second with biphosphonates plus radiotherapy. The severity of pain was recorded before treatment. According to the pain relief, two different groups were defined: palliation rate < 50% (limited palliation) and > 50% (partial palliation), including complete pain relief. Results: Overall limited and partial palliation rates were 20.2 and 79.8%, respectively (complete pain palliation 24.2%). In the group treated with both external radiotherapy and biphosphonates, limited and partial palliation rates were 19.5 and 80.4%, respectively (p=0.47). For 244 metastatic lesions treated with palliative radiotherapy alone, limited palliation rate was 20.4% and partial palliation rate 79.5%. No differences were detected between the groups with or without bithosphonates treatment in terms of pain palliation. According to the radiotherapy protocol, limited palliation rates in groups A, B, and C were 17.7, 20.3, and 28.5%, respectively (p=0.19, p=0.38, and p=0.26, respectively). Partial palliation rates were 82.2% in group A, 79.6% in group B and 71.4% in group C (p=0.42, p=0.21, and p=0.11, respectively). Similarly, no statistically significant differences were detected among the 3 radiotherogy schemes in terms of pain palliation. Conclusion: When combined with palliative radiotherapy, biphosphonates did not have any additive effects on pain palliation in the management of painful bone metastases. In addition, a single radiotherapy fraction provides equal pain palliation as multiple fractions.Öğe Molecular Resistance Mechanisms in the Treatment of Locally Advanced Cervical Cancer: HIF-1 alpha? ERCC1?(Elsevier Ireland Ltd, 2022) Sert, F.; Serin, G.; Ozturk, M.; Zekioglu, O.; Alanyali, S.; Ozsaran, Z.[No Abstract Available]Öğe Outcome and pronostic factors in malignant Mixed Mullerian Tumours and endometrial stromal sarcomas: a rare cancer network study(Pergamon-Elsevier Science Ltd, 2009) Schick, U.; Bolukbasi, Y.; Abdah-Bortnyak, R.; Thariat, J.; Caglar, H.; Ozsaran, Z.; Loessl, K.; Zwahlen, D.; Villette, S.; Vees, H.Öğe Outcome and pronostic factors in malignant Mixed Mullerian Tumours and endometrial stromal sarcomas: a rare cancer network study(Pergamon-Elsevier Science Ltd, 2009) Schick, U.; Bolukbasi, Y.; Abdah-Bortnyak, R.; Thariat, J.; Caglar, H.; Ozsaran, Z.; Loessl, K.; Zwahlen, D.; Villette, S.; Vees, H.Öğe Phase II study of loading-dose ibandronate treatment in patients in breast cancer and bone metastases suffering from moderate to severe pain(Amer Soc Clinical Oncology, 2010) Dizdar, O.; Altundag, M. K.; Ozkok, S.; Ozsaran, Z.; Saip, P.; Eralp, Y.; Komurcu, S.; Kuzhan, O.; Ozguroglu, M.; Karahoca, M.Öğe Postmastectomy RT Decision for Lymph Node Negative Patients: Turkish Radiation Oncology Society(Elsevier Ireland Ltd, 2018) Altinok, A.; Gursel, B.; Ergen, A.; Alanyali, S.; Ozsaran, Z.; Ay, A.; Metcalfe, E.; Akmansu, M.; Tepetam, H.; Altinok, P.; Altmisdortoglu, O.; Serarslan, A.; Bese, N.Öğe Postoperative radiotherapy in intermediate and high-risk Stage I endometrial cancer: analysis of prognostic factors and survival(I R O G Canada, Inc, 2008) Bolukbasi, Y.; Demirci, S.; Ozsaran, Z.; Yalman, D.; Hanhan, M.; Ozsaran, A.; Dikmen, Y.; Aras, A.Purpose: Patients with Stage IA Grade (G) III, Stage IB GII-III and Stage IC GI-II-III endometrial cancer who received postoperative adjuvant radiotherapy were evaluated in terms of local control, disease-free and overall survival rates and prognostic factors. Materials and Methods: Four hundred and three patients with Stage I endometrial cancer treated with radiotherapy from January 1990 to December 2003 at Ege University Faculty of Medicine Department of Radiation Oncology were reviewed retrospectively. According to our radiotherapy protocol patients with Stage IB G2 disease (149 patients) received only external radiotherapy and the remaining (254 patients) received both external radiotherapy and intracavitary brachytherapy. Results: Median age of the patients was 58 (range: 37-83). Nine patients (2.2%) had Stage IA, 196 (48.6%) had Stage IB and 198 (49.1%) had Stage IC disease. Histologic grade was 1 in 52 (12.9%) patients, 2 in 268 (66.5%) patients and 3 in 83 (20.6%) patients. Seventy-one (17.7%) patients had lymphovascular space invasion. Five-year locoregional relapse-free, distant-free, disease-free survival (DFS) and overall survival (OS) were 98.2%, 92.8%, 91.8% and 87.7%, respectively. In multivariate analysis, myometrial invasion and lymphovascular invasion were predictive factors for DFS and for OS prognostic factors were histologic type, myometrial invasion, and histologic grade. During radiotherapy 47.9% of the patients developed acute morbidity and 26.3% developed late morbidity, vaginal stenosis being the most frequent late morbidity. Conclusion: Postoperative adjuvant radiotherapy provides high locoregional control rates with acceptable toxicity in selected patients with Stage I endometrial carcinoma.Öğe REGIONAL RECURRENCE RATES OF STAGE I ENDOMETRIAL CARCINOMA PATIENTS TREATED WITH ADJUVANT BRACHYTHERAPY(Lippincott Williams & Wilkins, 2017) Alanyali, S.; Sert, F.; Gocen, F.; Temel, O.; Ozsaran, Z.; Yildirim, N.; Solmaz, U.; Gokcu, M.; Akman, L.; Terek, C.; Ozsaran, A.; Sanci, M.; Yildiz, H. I.; Ozkok, S.; Aras, A.Öğe REGIONAL RECURRENCE RATES OF STAGE I ENDOMETRIAL CARCINOMA PATIENTS TREATED WITH ADJUVANT BRACHYTHERAPY(Lippincott Williams & Wilkins, 2017) Alanyali, S.; Sert, F.; Gocen, F.; Temel, O.; Ozsaran, Z.; Yildirim, N.; Solmaz, U.; Gokcu, M.; Akman, L.; Terek, C.; Ozsaran, A.; Sanci, M.; Yildiz, H. I.; Ozkok, S.; Aras, A.Öğe Treatment results and prognostic factors for cervical cancer patients treated by radiochemotherapy with weekly cisplatin(I R O G Canada, Inc, 2007) Ozsaran, Z.; Kamer, S.; Yalman, D.; Akagunduz, O.; Aras, A.Objective: This retrospective trial aims to report the treatment results of patients with locally advanced cervical cancer treated by concomitant radiochemotherapy with weekly cisplatin. Methods: Between October 1999 and December 2003, 81 patients with FIGO Stages IB-IVA were treated at Ege University Faculty of Medicine Department of Radiation Oncology by radiochemotherapy with weekly cisplatin (40 mg/m(2)). Intracavitary high-dose rate brachytherapy was applied to 76 patients (93.8%) and five patients (6.2%) were treated with external radiotherapy alone. Early and late side-effects of the treatment were analyzed according to RTOG-EORTC criteria. Results: Median age was 55 years and the most frequent histology was epidermoid carcinoma. Median follow-up time was 42 months. Five-year overall, disease-free and local relapse-free survival rates were 69%, 77%, and 82%, respectively. The presence of low Hgb level (< 12g/dl), bulky tumor (> 4 cm), poor performance status, pelvic nodal involvement and limited early response to treatment had a significant impact on the local failure rate. Prognostic factors influencing disease-free survival were bulky tumor, performance status, pelvic nodal status, pretreatment Hgb level and limited early response to treatment. A significantly higher 5-year overall survival rate was observed in patients with good performance status, without pelvic nodal involvement, normal pretreatment Hgb level and complete response to treatment. Grade 3-4 side-effects were not observed in any patients. The most frequent acute side-effects were leukopenia, anemia, nausea and vomiting. Long-term side-effects were observed in 54% of patients. Conclusion: This series suggests that radiochemotherapy with weekly cisplatin is an effective and a safe treatment in locally advanced cervical cancer.Öğe Vaginal Cuff Treatment and Subsequent Quality of Life Related Recommendations in Radiation Oncology Practice: Turkish Oncology Group Study Survey Report(Elsevier Science Inc, 2018) Bolukbasi, Y.; Yildiz, F.; Ozsaran, Z.; Onal, C.; Sezen, D.; Selek, U.
