Browsing by Author "Atalar, Banu"

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Access to Radiation Therapy by Syrian Refugees Displaced to Turkey
(ELSEVIER INC, 2022-01-01) Dagoglu, Nergiz; Karaman, Sule; Atalar, Banu; Miller, Robert C.; Oral, Ethem N.
For over 10 years, the Syrian conflict has caused millions of people to leave their homeland, causing one of the biggest refugee crises in modern history. Considering its prevalence, cancer is an important care burden among Syrian refugees. Radiation therapy is one of the essential parts of cancer treatment, and radiation oncology departments must guarantee optimal cancer treatments even in such a challenging setting when patients are displaced forcefully from their homes. National and institutional measures are highlighted in this manuscript to provide suggestions for the delivery of care during refugee crises. There are two issues creating barriers to serving refugee populations: the loss of access to their original care records in Syria for those with a previous diagnosis of cancer referred for continuation of radiation therapy or reirradiation, and the effect of acute radiation therapy toxicity on treatment compliance. (c) 2022 The Authors. Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Adult Rhabdomyosarcoma: Clinical Features and Radiotherapy Outcomes-The Turkish Oncology Group (TOG) Bone and Soft Tissue Sarcoma Study Group
(KARE PUBL, 2018-01-01) Korkmaz Kirakli, Esra; Iribas, Ayca; Ergen, Arzu; Atalar, Banu; Adaoglu, Fulya; Onder Dincbas, Fazilet; Darendeliler, Emin; Anacak, Yavuz; Kamer, Serra
OBJECTIVE Although rhabdomyosarcoma (RMS) is the most frequent soft tissue sarcoma diagnosed in childhood, it represents only 2\%-5\% of adult soft tissue sarcomas. The aim of the present study was to better understand the clinical characteristics, treatment approaches, and outcomes of patients with adult RMS who received radiotherapy (RT) as a component of their multidisciplinary management since there are scarce data on adult RMS due to its rarity. METHODS The medical records of patients with adult RMS who were >= 18 years old and treated with RT between January 1995 and August 2016 in four different radiation centers were evaluated in terms of clinical characteristics, treatment, and follow-up data retrospectively. RESULTS There were 28 patients. The median age at diagnosis was 28 (19-53) years. The most common site of involvement was the head and neck (25\%), and parameningeal region involvement was prominent (92\%) among them. In general, unfavorable site of involvement was markedly higher than favorable ones (82\% vs. 18\%). Alveolar and pleomorphic subtypes compromised 75\% of the cases. Fifteen patients had surgery, 26 chemotherapy, 10 radical intent of RT, 9 adjuvant, 3 preoperative, and 6 palliative. The follow-up time was from 3 to 235 (median 18) months, disease-free survival was between 2 and 48 (median 12) months, and 5-year overall survival (OS) was 25\% (median OS 20 (4-235) months). There were significant differences in terms of survival according to histopathological subtypes (p: 0.017), risk groups (p<0.001), Intergroup Rhabdomyosarcoma Study Group (IRSG) grouping and IRSG staging (p<0.001). CONCLUSION Adult RMS has unfavorable clinical presentation and worse outcome compared with pediatric RMS. Histopathological subtype and risk grouping to define the prognosis used in pediatric cases also might be valid in adult RMS.
Akciğer Kanseri SBRT Uygulamalarının RTOG 0915 Protokolüne Uygun Doz Sınırlamalarına Göre Oluşturulan 3B Konformal Ark ve VMAT SBRT Planlarının Karşılaştırılması
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2017-03-01) Başlangıç, Burak; Güngör, Görkem; Aydın, Gökhan; Uluer, Melih; Karademir, Mustafa; Yapıcı, Bülent; Şahin, Bilgehan; Atalar, Banu; Özyar, Enis
ÖZET Bu çalışmada 20 erken evre küçük hücreli dışı akciğer kanseri hastasının (KHDAK), akciğer stereotactic body ra diation therapy (SBRT) için en son olarak yayımlanan Radiation Therapy Oncology Group 0915 (RTOG 0915) pro tokolünün fiziksel kabul kriterlerine göre tedavi planlamaları yapılmıştır. Planlamalar, volumetric modulated arc therapy (VMAT) ve 3B konformal ark teknikleri kullanarak 6MV düzleştirici filtreli (FF) ve 6MV düzleştirici filtresiz (FFF) enerji modlarında yapılmıştır. VMAT tekniği 3B konformal ark tekniği ile kıyaslandığında RTOG 0915 protokolünün yüksek ve orta doz saçılım kriterleri olan konformite indeksi (CI), orta doz saçılmalarını ifade eden %50 izodoz hacminin planning target volume (PTV) hacmine oranı, 2 cm uzaktaki % doz değeri göre istatistiksel olarak anlamlı sonuçlar ile birlikte daha iyi planlar ortaya koymuştur. Enerji modaliteleri kendi aralarında incelendiğinde FFF modu ile yapılan planlar FF modu ile yapılan planlara göre RTOG 0915 kriterleri bakımından daha avantajlı sonuçlar vermişlerdir. Çalışmanın bütünü ele alındığında VMAT-FFF tekniği, yüksek ve orta doz saçılmalarındaki avantajlarına bağlı ola rak akciğer SBRT tedavileri için en uygun teknik olarak bulunmuştur
Carotid blowout syndrome after intensity-modulated radiation therapy: A case report
(MARMARA UNIV, FAC MEDICINE, 2017-01-01) Sahin, Bilgehan; Atalar, Banu; Yakupoglu, Abdullah; Ozyar, Enis
Carotid blowout syndrome (CBS) is a rarely seen complication of head-neck surgery and radiation therapy. It may present by massive ear bleeding or epistaxis with high morbidity and mortality rates. Success rate of endovascular therapy or emergency surgery is unfortunately low because of massive bleeding and weakened vessel architecture. Here, we present a 45-year-old male with nasopharyngeal carcinoma and treated with intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. The patient was diagnosed with stage III (T3N2M0) carcinoma of the nasopharynx. Eight months after radiotherapy, he was admitted to hospital with the complaint of epistaxis. Right internal carotid angiography revealed a 4 mm pseudoaneurysm at the superior-anterior wall of the petrous and his bleeding was controlled by stenting in the same session. In this report we aimed to draw attention to this rare clinical situation that might enhance the chance of early diagnosis enabling less morbid treatment opportunities.
Çocukluk Çağı Supratentorial Yüksek Dereceli Glial Tümör: Olgu Sunumu
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2011-10-01) Silav, Gökalp; Atalar, Banu; Ilgaz Aydınlar, Elif; Er, Özlem; Sav, Aydın; Elmacı, İlhan
ÖZET Pediatrik yüksek dereceli glial tümörler erişkinlerde ortaya çıkan eşdeğerle rine göre belirgin sitogenetik ve moleküler farklılıklar gösterirler. Adjuvan tedavilere verdikleri yanıtlar açısından da erişkin yüksek dereceli glial tü mörlerden farklıdırlar. Maksimum güvenli tümör rezeksiyonu içeren cerrahi tedavi, hastaların yaşam sürelerinin uzamasını sağlamaktadır. Ayrıca, mo dern kemoterapi ajanları ve radyoterapideki gelişimlerde uygulanabilecek tedavilerin sınırlarını genişletmiştir. Bu olgu sunumu ile çocukluk çağı yük sek dereceli glial tümörlere güncel yaklaşımın irdelenmesi, tanı ve tedavide ortaya çıkan gelişmelerin değerlendirilmesi amaçlanmıştır
Current treatment strategies in malignant pleural mesothelioma with a treatment algorithm
(VIA MEDICA, 2019-01-01) Sayan, Mutlay; Eren, Mehmet Fuat; Gupta, Apar; Ohri, Nisha; Kotek, Ayse; Babalioglu, Ibrahim; Kaplan, Sedenay Oskeroglu; Duran, Ozge; Or, Ozlem Derinalp; Cukurcayie, Funda; Kurtul, Neslihan; Bicakci, Beyhan Ceylaner; Kutuk, Tugce; Senyurek, Sukran; Turk, Ali; Jabbour, Salma K.; Atalar, Banu
Malignant pleural mesothelioma (MPM) is a rare disease with a poor prognosis. The main therapeutic options for MPM include surgery, chemotherapy, and radiation therapy (RT). Although multimodality therapy has been reported to improve survival, not every medically operable patient is able to undergo all recommended therapy. With improvements in surgical techniques and systemic therapies, as well as advancements in RT, there has been a potential new paradigm in the management of this disease. In this review, we discuss the current literature on MPM management and propose a functional treatment algorithm.
Dealing with the gray zones in the management of gastric cancer: The consensus statement of the Istanbul Group
(AVES, 2019-01-01) Aytac, Erman; Aslan, Fatih; Cicek, Bahattin; Erdamar, Sibel; Gurses, Bengi; Guven, Koray; Falay, Okan; Karahasanoglu, Tayfun; Selcukbiricik, Fatih; Selek, Ugur; Atalar, Banu; Balik, Emre; Tozun, Nurdan; Rozanes, Izzet; Arican, Ali; Hamzaoglu, Ismail; Baca, Bilgi; Mandell, Nil Molinas; Saruc, Murat; Goksel, Suha; Demir, Gokhan; Agaoglu, Fulya; Yakicier, Cengiz; Ozbek, Ugur; Ozben, Volkan; Ozyar, Enis; Guner, Ahmet Levent; Er, Ozlem; Kaban, Kerim; Bolukbasi, Yasemin; Bugra, Dursun; Ahishali, Emel; Asian, Fatih; Boz-bas, Aysun; Hamzaoglu, Hulya; Karaman, Ahmet; Kucukmetin, Nurten Turkel; Vardareli, Eser Kutsal; Onder, Fatih Oguz; Sisman, Gurhan; Tiftikci, Arzu; Unal, Hakan Umit; Yapali, Suna; Acar, Sami; Agcaoglu, Orhan; Aghayeva, Afag; Akyuz, Ali; Atasoy, Deniz; Batik, Emre; Bayraktar, Ilknur Erenler; Bayram, Onur; Bilgic, Cagri; Bilgin, Ismail Ahmet; Can, Ugur; Dulgeroglu, Onur; Durukan, Ugur; Gencosmanoglu, Rasim; Gonenc, Murat; Gurbuz, Bulent; Kaya, Mesut; Omarov, Nail; Ozben, Volkan; Ozgur, Ilker; Ozoran, Emre; Sobutay, Erman; Uras, Cihan; Uymaz, Derya; Zenger, Serkan; Ozbek, Ugur; Yakicier, M. Cengiz; Afsar, Cigdem Usul; Bozkurt, Mustafa; Demir, Atakan; Er, Ozlem; Kanitez, Metin; Korkmaz, Taner; Mandel, Nil Molina; Mert, Askhan Guven; Ozer, Leyla; Sonmez, Ozlem; Tunali, Didem; Uluc, Basak Oyan; Yazar, Aziz; Yildiz, Ibrahim; Demirkurek, Cengiz; Guner, Ahmet Levent; Vardareli, Erkan; Armutlu, Aye; Baba, Fisun; Ersozlu, Ilker; Kapran, Yersu; Sahin, Davut; Abacioglu, Mehmet Ufuk; Bese, Nuran; Durankus, Nilufer Kilic; Gural, Zeynep; Ozyar, Enis; Sengoz, Meric; Sezen, Duygu; Caliskan, Can; Guven, Koray; Karaaslan, Ercan; Kizilkaya, Esref; Suleyman, Erdogan; Grp, Istanbul
The geographical location and differences in tumor biology significantly change the management of gastric cancer. The prevalence of gastric cancer ranks fifth and sixth among men and women, respectively, in Turkey. The international guidelines from the Eastern and Western countries fail to manage a considerable amount of inconclusive issues in the management of gastric cancer. The uncertainties lead to significant heterogeneities in clinical practice, lack of homogeneous data collection, and subsequently, diverse outcomes. The physicians who are professionally involved in the management of gastric cancer at two institutions in Istanbul, Turkey, organized a consensus meeting to address current problems and plan feasible, logical, measurable, and collective solutions in their clinical practice for this challenging disease. The evidence-based data and current guidelines were reviewed. The gray zones in the management of gastric cancer were determined in the first session of this consensus meeting. The second session was constructed to discuss, vote, and ratify the ultimate decisions. The identification of the T stage, the esophagogastric area, imaging algorithm for proper staging and follow-up, timing and patient selection for neoadjuvant treatment, and management of advanced and metastatic disease have been accepted as the major issues in the management of gastric cancer. The recommendations are presented with the percentage of supporting votes in the results section with related data.
Evaluation of response to stereotactic radiosurgery in patients with radioresistant brain metastases
(KOREAN SOC THERAPEUTIC RADIOLOGY \& ONCOLOGY, 2019-01-01) Sayan, Mutlay; Mustafayev, Teuta Zoto; Sahin, Bilgehan; Kefelioglu, Erva Seyma Sare; Wang, Shang-Jui; Kurup, Varsha; Balmuk, Aykut; Gungor, Gorkem; Ohri, Nisha; Weiner, Joseph; Ozyar, Enis; Atalar, Banu
Purpose: Renal cell carcinoma (RCC) and melanoma have been considered `radioresistant' due to the fact that they do not respond to conventionally fractionated radiation therapy. Stereotactic radiosurgery (SRS) provides high-dose radiation to a defined target volume and a limited number of studies have suggested the potential effectiveness of SRS in radioresistant histologies. We sought to determine the effectiveness of SRS for the treatment of patients with radioresistant brain metastases. Materials and Methods: We performed a retrospective review of our institutional database to identify patients with RCC or melanoma brain metastases treated with SRS. Treatment response were determined in accordance with the Response Evaluation Criteria in Solid Tumors. Results: We identified 53 radioresistant brain metastases (28\% RCC and 72\% melanoma) treated in 18 patients. The mean target volume and coverage was 6.2 +/- 9.5 mL and 95.5\% +/- 2.9\%, respectively. The mean prescription dose was 20 +/- 4.9 Gy. Forty lesions (75\%) demonstrated a complete/partial response and 13 lesions (24\%) with progressive/stable disease. Smaller target volume (p < 0.001), larger SRS dose (p < 0.001), and coverage (p = 0.008) were found to be positive predictors of complete response to SRS. Conclusion: SRS is an effective management option with up to 75\% response rate for radioresistant brain metastases. Tumor volume and radiation dose are predictors of response and can be used to guide the decision-making for patients with radioresistant brain metastases.
First 500 Fractions Delivered with a Magnetic Resonance-guided Radiotherapy System: Initial Experience
(CUREUS INC, 2019-01-01) Sahin, Bilgehan; Mustafayev, Teuta Zoto; Gungor, Gorkem; Aydin, Gokhan; Yapici, Bulent; Atalar, Banu; Ozyar, Enis
Objectives Improved soft-tissue visualization, afforded by magnetic resonance imaging integrated into a radiation therapy linear accelerator-based radiation delivery system (MR-linac) promises improved image-guidance. The availability of MR-imaging can facilitate on-table adaptive radiation planning and enable real-time intra-fraction imaging with beam gating without additional exposure to radiation. However, the novel use of magnetic resonance-guided radiation therapy (MRgRT) in the field of radiation oncology also potentially poses challenges for routine clinical implementation. Herein the early experience of a single institution, implementing the first MRgRT system in the country is reported. We aim to describe the workflow and to characterize the clinical utility and feasibility of routine use of an MR-linac system. Methods The ViewRay MRIdian MR-linac system consists of a split-magnet 0.35 T MR-imaging scanner with a double focused multi-leaf collimator (MLC) equipped 6MV linear accelerator. Unique to the system are the control console integrated on-table adaptive radiation therapy (oART) planning capabilities as well as automated beam gating based on real-time intra-fraction MR imaging. From the first day of clinical implementation, oART was performed according to physicians' discretion when medically indicated. All fractions were delivered under real-time imaging with soft tissue-based automated beam gating with individualized gating boundary settings. Patients actively assisted in breath-hold beam gating with the help of custom designed prismatic glasses allowing sight of a computer monitor mounted on the back wall just behind the MRI system bore. Patient demographics and treatment experience, indications for MRgRT including diagnosis and disease site, radiation dose prescribed and fractionation scheme, utilization of oART, respiratory gating settings, as well as duration of each treatment phase were analyzed. Results Between September 2018 and May 2019, 72 patients with 84 tumor sites were treated with MRgRT in 500 total fractions. Median patient age was 66 years (range: 28-83 years). Among 84 tumor sites, the most frequently treated regions were upper abdominal and pelvic (n = 36, 43\% and n = 29, 34\%, respectively). The most common diagnosis was prostate cancer, with 14 patients treated. In 69 patients (93.2\%) oART was used at least once during a treatment course. Twenty-nine targets (43.1\%) with significant breathing-related motion were treated in breath-hold with patient visual feedback. Median prescribed dose was 36.25 Gy (range: 24-70 Gy) in median five fractions (range: 3-28 fractions). A gating boundary of 3 mm around a gating region of interest (gROI) was most commonly used (range: 3-5 mm) with 95\% of the gROI (range: 93-97\%) required to be within the gating boundary for the beam to automatically engage. Mean total treatment time was 47 min (range: 21-125 min) and mean beam-on time was 16.7 min (range: 6-62 min). Conclusions MRgRT afforded by an MR-linac system has been successfully implemented into routine clinical use at our institution as the first system of its kind in Turkey. While the overall number of patients treated and fractions delivered is still limited, we have demonstrated the feasibility of both on-table adaptive radiation therapy as well as automated real-time beam gating on a daily basis in acceptable time schedules.
Improvement of conformal arc plans by using deformable margin delineation method for stereotactic lung radiotherapy
(WILEY, 2018-01-01) Gungor, Gorkem; Demir, Melek; Aydin, Gokhan; Yapici, Bulent; Atalar, Banu; Ozyar, Enis
Purpose: Stereotactic body radiotherapy (SBRT) is an established treatment technique in the management of medically inoperable early stage non-small cell lung cancer (NSCLC). Different techniques such as volumetric modulated arc (VMAT) and three-dimensional conformal arc (DCA) can be used in SBRT. Previously, it has been shown that VMAT is superior to DCA technique in terms of plan evaluation parameters. However, DCA technique has several advantages such as ease of use and considerable shortening of the treatment time. DCA technique usually results in worse conformity which is not possible to ameliorate by inverse optimization. In this study, we aimed to analyze whether a simple method-deformable margin delineation (DMD)-improves the quality of the DCA technique, reaching similar results to VMAT in terms of plan evaluation parameters. Methods: Twenty stage I-II (T1-2, N0, M0) NSCLC patients were included in this retrospective dosimetric study. Noncoplanar VMAT and conventional DCA plans were generated using 6 MV and 10 MV with flattening filter free (FFF) photon energies. The DCA plan with 6FFF was calculated and 95\% of the PTV was covered by the prescription isodose line. Hot dose regions (receiving dose over 100\% of prescription dose) outside PTV and cold dose regions (receiving dose under 100\% of prescription dose) inside PTV were identified. A new PTV (PTV-DMD) was delineated by deforming PTV margin with respect to hot and cold spot regions obtained from conventional DCA plans. Dynamic multileaf collimators (MLC) were set to PTV-DMD beam eye view (BEV) positions and the new DCA plans (DCA-DMD) with 6FFF were generated. Three-dimensional (3D) dose calculations were computed for PTV-DMD volume. However, the prescription isodose was specified and normalized to cover 95\% volume of original PTV. Several conformity indices and lung doses were compared for different treatment techniques. Results: DCA-DMD method significantly achieved a superior conformity index (CI), conformity number (CIPaddick), gradient index (R-50\%), isodose at 2 cm (D-2 (cm)) and external index (CD) with respect to VMAT and conventional DCA plans (P < 0.05 for all comparisons). CI ranged between 1.00-1.07 (Mean: 1.02)
Intensity modulated radiotherapy (IMRT) in bilateral retinoblastoma
(ASSOC RADIOLOGY \& ONCOLOGY, 2010-01-01) Atalar, Banu; Ozyar, Enis; Gunduz, Kaan; Gungor, Gorkem
Background. External beam radiotherapy (EBRT) for retinoblastoma has traditionally been done with conventional radiotherapy techniques which resulted high doses to the surrounding normal tissues. Case report. A 20 month-old girl with group D bilateral retinoblastoma underwent intensity modulated radiotherapy (IMRT) to both eyes after failing chemoreduction and focal therapies including cryotherapy and transpupillary thermotherapy. In this report, we discuss the use of IMRT as a method for reducing doses to adjacent normal tissues while delivering therapeutic doses to the tumour tissues compared with 3-dimensional conformal radiotherapy (3DCRT). At one year follow-up, the patient remained free of any obvious radiation complications. Conclusions. Image guided IMRT provides better dose distribution than 3DCRT in retinoblastoma eyes, delivering the therapeutic dose to the tumours and minimizing adjacent tissue damage.
Küçük Hücreli Akciğer Kanserinin Mide Metastazı: Olgu Sunumu
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2012-01-01) Çalıkuşu, Züleyha; Atalar, Banu; Tiftikçi, Arzu; Uğurluer, Gamze; Er, Özlem; Göksel, Süha
ÖZET Mideye kan yolu ile metastaz nadir görülen bir durumdur. Literatürde mi deye kan yolu ile en sık metastaz yapan karsinomlar sıklık sırasına göre, malign melanoma, meme kanseri ve akciğer kanseridir. Midenin metas tatik lezyonları sıklıkla asemptomatiktir. Bu hastalarda prognoz çok kö tüdür. Biz burada mide metastazı saptanan küçük hücreli akciğer karsi nomlu hastayı, nadir görülmesi nedeni ile literatür eşliğinde sunulması nı amaçladık.
Linguistic Validation of the Turkish Version of the MD Anderson Symptom Inventory - Head and Neck Cancer Module
(GALENOS PUBL HOUSE, 2016-01-01) Gunn, G. Brandon; Atalar, Banu; Mendoza, Tito R.; Cleeland, Charles S.; Selek, Ugur; Ozyar, Enis; Rosenthal, David I.
Background: The use of patient symptom reports with frequent symptom assessment may be preferred over the more commonly used health-related quality of life questionnaires. Aims: We sought to linguistically validate the Turkish version of the M.D. Anderson Symptom Inventory-Head and Neck module (MDASI-HN) patient reported outcome questionnaire. Study Design: Validation study. Methods: Following standard forward and backward translation of the original and previously validated English MDASI-HN into a Turkish version (T-MDASI-HN), it was administered to patients with head and neck cancer able to read and understand Turkish. Patients were then cognitively debriefed to evaluate their understanding and comprehension of the T-MDASI-HN. Individual and group responses are presented using descriptive statistics. Results: Twenty-six participants with head and neck cancer completed the T-MDASI-HN and accompanying cognitive debriefing. Overall, 97 percent of the individual TMDASI-HN items were completed. Average recorded time to complete the 28 item TMDASI-HN questionnaire was 5.4 minutes (range 2-10). Average overall ease of completion, understandability, and acceptability were favorably rated at 1.0, 1.1, and 0.2, respectively, on scales from 0 to 10. Only 5 of the 26 of participants reported trouble completing any single questionnaire items, namely the ``difficulty remembering{''} item for 3 individuals. Conclusion: The T-MDASI-HN is linguistically valid with ease of completion, relevance, comprehensibility, and applicability and it can be a useful clinical and research tool.
LONG-TERM RESULTS OF EXTREMITY SOFT TISSUE SARCOMAS LIMB-SPARING SURGERY AND RADIOTHERAPY
(ATHA COMUNICACAO \& EDITORA, 2019-01-01) Dogan, Ozlem Yetmen; Oksuz, Didem Colpan; Atalar, Banu; Dincbas, Fazilet Oner
Objective: To assess the prognostic factors and results of limb sparing surgery and postoperative radiotherapy (PORT) in patients with non-metastatic soft tissue sarcomas (STS) of the extremities. Methods: Between 1980-2007, 114 extremity-located STS treated with PORT were analyzed retrospectively. Tumors were mostly localized in the lower extremities (71,9\%). The median radiotherapy (RT) dose was 60.9 Gy. Chemotherapy was administered to 37.7\% of the patients. Tumor sizes were between 3-26 cm (median 7 cm). The three most frequent histological types included undifferentiated pleomorphic sarcoma (26.3\%), liposarcoma (25.4\%), and synovial sarcoma (13.2\%). The median follow-up for all patients was 60 months, and 81 months for survivors. Results: The 5- and 10-year local control (LC) rates were 77\% and 70.4\%, respectively
Long-term toxicity and survival outcomes after stereotactic ablative radiotherapy for patients with centrally located thoracic tumors
(WALTER DE GRUYTER GMBH, 2020-01-01) Atalar, Banu; Mustafayev, Teuta Zoto; Sio, Terence T.; Sahin, Bilgehan; Gungor, Gorkem; Aydin, Gokhan; Yapici, Bulent; Ozyar, Enis
Background. Stereotactic ablative radiotherapy (SABR) is effective for thoracic cancer and metastases
Magnetic resonance image-guided adaptive stereotactic body radiotherapy for prostate cancer: preliminary results of outcome and toxicity
(BRITISH INST RADIOLOGY, 2021-01-01) Ugurluer, Gamze; Atalar, Banu; Mustafayev, Teuta Zoto; Gungor, Gorkem; Aydin, Gokhan; Sengoz, Meric; Abacioglu, Ufuk; Tuna, Mustafa Bilal; Kural, Ali Riza; Ozyar, Enis
Objective: Using moderate or ultra-hypofractionation, which is also known as stereotactic body radiotherapy (SBRT) for treatment of localized prostate cancer patients has been increased. We present our preliminary results on the clinical utilization of MRI-guided adaptive radiotherapy (MRgRT) for prostate cancer patients with the workflow, dosimetric parameters, toxicities and prostate-specific antigen (PSA) response. Methods: 50 prostate cancer patients treated with ultrahypofractionation were included in the study. Treatment was performed with intensity-modulated radiation therapy (step and shoot) technique and daily plan adaptation using MRgRT. The SBRT consisted of 36.25 Gy in 5 fractions with a 7.25 Gy fraction size. The time for workflow steps was documented. Patients were followed for the acute and late toxicities and PSA response. Results: The median follow-up for our cohort was 10 months (range between 3 and 29 months). The median age was 73.5 years (range between 50 and 84 years). MRgRT was well tolerated by all patients. Acute genitourinary (GU) toxicity rate of Grade 1 and Grade 2 was 28 and 36\%, respectively. Only 6\% of patients had acute Grade 1 gastrointestinal (GI) toxicity and there was no Grade 2G1 toxicity. To date, late Grade 1 GU toxicity was experienced by 24\% of patients, 2\% of patients experienced Grade 2 GU toxicity and 6\% of patients reported Grade 2 GI toxicity. Due to the short follow-up, PSA nadir has not been reached yet in our cohort. Conclusion: In conclusion, MRgRT represents a new method for delivering SBRT with markerless soft tissue visualization, online adaptive planning and real-time tracking. Our study suggests that ultra-hypofractionation has an acceptable acute and very low late toxicity profile. Advances in knowledge: MRgRT represents a new markerless method for delivering SBRT for localized prostate cancer providing online adaptive planning and real-time tracking and acute and late toxicity profile is acceptable.
Magnetic Resonance Image-Guided Hypofractionated Ablative Radiation Therapy for Hepatocellular Carcinoma With Tumor Thrombus Extending to the Right Atrium
(CUREUS INC, 2022-01-01) Dincer, Neris; Ugurluer, Gamze; Mustafayev, Teuta Zoto; Gungor, Gorkem; Atalar, Banu; Guven, Koray; Ozyar, Enis
Hepatocellular carcinoma (HCC) presenting with tumor thrombus and inferior vena cave (IVC)/right atrium (RA) infringement point to an advanced-stage disease that is deemed inoperable. Stereotactic body radiotherapy is an emerging treatment option for this group of patients with promising outcomes in recent studies that are comparable to conventional treatment methods, namely, transarterial chemoembolization and transarterial radioembolization. Here, we report a case of HCC with RA extension through the IVC. The patient was referred to our clinic for treatment options, and he was found suitable for magnetic resonance imaging-guided radiotherapy (MRgRT). We treated the patient with MRgRT in five fractions to a total dose of 40 Gray. The tumor was tracked during the treatment sessions, and adaptive treatment planning was performed before each fraction. The patient tolerated the treatment well with no acute grade 3-4 toxicities. The last follow-up showed that the patient had a complete biochemical response and is now a candidate for an orthotopic liver transplant. To our knowledge, this report is the first to document the MRgRT treatment of an HCC with TT and RA extension. MRgRT is safe and feasible for this patient group and can be an effective bridging therapy for liver transplants.
Magnetic Resonance Imaging-Guided Online Adaptive Lattice Stereotactic Body Radiotherapy in Voluminous Liver Metastasis: Two Case Reports
(CUREUS INC, 2022-01-01) Dincer, Neris; Ugurluer, Gamze; Korkmaz, Latif; Serkizyan, Anatolia; Atalar, Banu; Gungor, Gorkem; Ozyar, Enis
Lattice Radiotherapy (LRT) is a technique in which heterogeneous doses are delivered to the target so large tumors can have optimal doses of radiation without compromising healthy tissue sparing. lb date, case reports and case series documented its application for bulky tumors mainly in the pelvic region. LRT not only provides dosimetric advantages but also promotes tumor control by triggering some radiobiological and immunological pathways. We report two cases of giant liver metastases for whom other treatment options were not suitable. We treated both patients with Magnetic Resonance Image-Guided Radiotherapy (MRgRT) with online adaptive LRT (OALRT) technique. Adaptive plans were generated before each fraction. Tumors were observed to have regressed interfractionally so the location and number of spheres were adapted to tumor size and daily anatomy of the surrounding organs at risk (OAR). Both patients had good treatment compliance without any Grade 3+ side effects. They are both under follow-up and report improvement. By reporting the first application of OALRT by using MRgRT in liver metastases, we show that MRgRT is a promising modality for LRT technique with better target and OAR visualization as well as online adaptive planning before each fraction according to the daily anatomy of the patient.
Magnetic Resonance Imaging-Guided Radiation Therapy for Early-Stage Gastric Mucosa-Associated Lymphoid Tissue Lymphoma
(CUREUS INC, 2022-01-01) Dincer, Neris; Ugurluer, Gamze; Gungor, Gorkem; Mustafayev, Teuta Zoto; Atalar, Banu; Ozyar, Enis
Lymphoid neoplasia derived from mucosa-associated lymphoid tissue (MALT
Management of symptomatic radiation necrosis after stereotactic radiosurgery and clinical factors for treatment response
(KOREAN SOC THERAPEUTIC RADIOLOGY \& ONCOLOGY, 2020-01-01) Sayan, Mutlay; Mustafayev, Teuta Zoto; Balmuk, Aykut; Mamidanna, Swati; Kefelioglu, Erva Seyma Sare; Gungor, Gorkem; Chundury, Anupama; Ohri, Nisha; Karaarslan, Ercan; Ozyar, Enis; Atalar, Banu
Purpose: Approximately 10\% of patients who received brain stereotactic radiosurgery (SRS) develop symptomatic radiation necrosis (RN). We sought to determine the effectiveness of treatment options for symptomatic RN, based on patient-reported outcomes. Materials and Methods: We conducted a retrospective review of 217 patients with 414 brain metastases treated with SRS from 2009 to 2018 at our institution. Symptomatic RN was determined by appearance on serial magnetic resonance images (MRIs), MR spectroscopy, requirement of therapy, and development of new neurological complaints without evidence of disease progression. Therapeutic interventions for symptomatic RN included corticosteroids, bevacizumab and/or surgical resection. Patient-reported therapeutic outcomes were graded as complete response (CR), partial response (PR), and no response. Results: Twenty-six patients experienced symptomatic RN after treatment of 50 separate lesions. The mean prescription dose was 22 Gy (range, 15 to 30 Gy) in 1 to 5 fractions (median, 1 fraction). Of the 12 patients managed with corticosteroids, 6 patients (50\%) reported CR and 4 patients (33\%) PR. Of the 6 patients managed with bevacizumab, 3 patients (50\%) reported CR and 1 patient (18\%) PR. Of the 8 patients treated with surgical resection, all reported CR (100\%). Other than surgical resection, age >= 54 years (median, 54 years