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Author: search.filters.author.Gural, ZeynepHas files: Yes

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    Bone health in breast cancer patients: A comprehensive statement by CECOG/SAKK Intergroup
    (CHURCHILL LIVINGSTONE, 2014-01-01) Rordorf, Tamara; Hassan, Azza Adel; Azim, Hamdy; Alexandru, Eniu; Er, Ozlem; Gokmen, Erhan; Gural, Zeynep; Mardiak, Jozef; Minchev, Velko; Peintinger, Florentia; Szendroi, Miklos; Takac, Itzok; Tesarova, Petra; Vorobiof, Daniel; Vrbanec, Damir; Yildiz, Ramazan; Yucel, Serap; Zekri, Jamal; Oyan, Basak
    Bone is the most common site of distant metastases in breast cancer that can cause severe and debilitating skeletal related events (SRE) including hypercalcemia of malignancy, pathologic fracture, spinal cord compression and the need for palliative radiation therapy or surgery to the bone. SRE are associated with substantial pain and morbidity leading to frequent hospitalization, impaired quality of life and poor prognosis. The past 25 years of research on the pathophysiology of bone metastases led to the development of highly effective treatment options to delay or prevent osseous metastases and SRE. Management of bone metastases has become an integral part of cancer treatment requiring expertise of multidisciplinary teams of medical and radiation oncologists, surgeons and radiologists in order to find an optimal treatment for each individual patient. A group of international breast cancer experts attended a Skeletal Care Academy Meeting in November 2012 in Istanbul and discussed current preventive measures and treatment options of SRE, which are summarized in this evidence-based consensus for qualified decision-making in clinical practice. (C) 2014 Elsevier Ltd. All rights reserved.
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    Evaluation of the relationship between serum ghrelin levels and cancer cachexia in patients with locally advanced nonsmall-cell lung cancer treated with chemoradiotherapy
    (WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2020-01-01) Uysal, Pelin; Afsar, Cigdem Usul; Sozer, Volkan; Inanc, Berrin; Agaoglu, Fulya; Gural, Zeynep; Fazlioglu, Nevin Gural; Cuhadaroglu, Caglar; Uzun, Hafize
    Background: Ghrelin plays a role in mechanisms related to cancer progression - including cell proliferation, invasion and migration, and resistance to apoptosis in the cell lines from several cancers. We investigated the role of ghrelin levels in cancer cachexia-anorexia in patients with locally advanced nonsmall-cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT). Materials and Methods: This study involved 84 NSCLC patients who had received concomitant CRT. Blood ghrelin levels were compared before and 3 months after CRT. Meanwhile, changes in body weight of the patients were also investigated with changes in ghrelin levels before and after CRT. Results: Ghrelin levels were significantly decreased in line with changes in patients' weights in patients receiving CRT (P < 0.001). Serum albumin levels and inflammatory-nutritional index were significantly decreased after radiotherapy (RT) (3.01 0.40 g/dL, 0.38 +/- 0.20) when compared with its baseline levels (3.40 +/- 0.55 g/dL,P < 0.001
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    Neoadjuvant hyperfractionated accelerated radiotherapy plus concomitant 5-fluorouracil infusion in locally advanced rectal cancer: A phase. study
    (BAISHIDENG PUBLISHING GROUP INC, 2018-01-01) Gural, Zeynep; Saglam, Sezer; Yucel, Serap; Kaytan-Saglam, Esra; Asoglu, Oktar; Ordu, Cetin; Acun, Hediye; Sharifov, Rasul; Onder, Semen; Kizir, Ahmet; Oral, Ethem N.
    AIM To evaluate the efficacy and tolerability of neoadjuvant hyperfractionated accelerated radiotherapy (HART) and concurrent chemotherapy in patients with locally advanced infraperitoneal rectal cancer. METHODS A total of 30 patients with histopathologically confirmed T2-3/N0+ infraperitoneal adenocarcinoma of rectum cancer patients received preoperative 42 Gy/1.5 Gy/18 days/bid radiotherapy and continuous infusion of 5-fluorouracil (325 mg/m(2)). All patients were operated 4-8 wk after neoadjuvant concomitant therapy. RESULTS In the early phase of treatment, 6 patients had grade III- IV gastrointestinal toxicity, 2 patients had grade III-IV hematologic toxicity, and 1 patient had grade V toxicity due to postoperative sepsis during chemotherapy. Only 1 patient had radiotherapy-related late side effects, i.e., grade IV tenesmus. Complete pathological response was achieved in 6 patients (21\%), while near-complete pathological response was obtained in 9 (31\%). After a median follow-up period of 60 mo, the local tumor control rate was 96.6\%. In 13 patients, distant metastasis occurred. Disease-free survival rates at 2 and 5 years were 63.3\% and 53\%, and corresponding overall survival rates were 70\% and 53.1\%, respectively. CONCLUSION Although it has excellent local control and complete pathological response rates, neoadjuvant HART concurrent chemotherapy appears to not be a feasible treatment regimen in locally advanced rectal cancer, having high perioperative complication and intolerable side effects. Effects of reduced 5-fluorouracil dose or omission of chemotherapy with the aim of reducing toxicity may be examined in further studies.
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    Outcomes of patients with anal cancer treated with volumetric-modulated arc therapy or intensity-modulated radiotherapy and concurrent chemotherapy
    (WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2021-01-01) Yucel, Serap; Kadioglu, Huseyin; Gural, Zeynep; Akgun, Zuleyha; Saglam, Esra Kaytan
    Aims: To evaluate the results of chemoradiation with intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) for the treatment of anal canal cancer patients at three institutions that had advanced devices. Materials and Methods: A retrospective analysis was performed for patients treated with 5-fluorouracil and mitomycin-based chemotherapy and IMRT or VMAT for anal cancer from 2011 to 2013. Complete response (CR) rates, colostomy-free survival (CFS), disease-free survival (DFS), overall survival (OS), and toxicities were investigated. Toxicities were evaluated with the Common Terminology Criteria for Adverse Events, Version 3.0. Results: Fifteen patients were included in the analysis. The majority of patients had T2 (53.3\%) and N0 (40\%) disease according to the staging system that was developed by the American Joint Committee on Cancer. CR was observed in 14 patients (93\%), and the median follow-up was 26 months (13-42 months). The 3-year CFS, DFS, and OS were 86\%, 86\%, and 88\%, respectively. Acute Grade 3 toxicities were observed as 6\% of hematological, 26\% of gastrointestinal, and 26\% of dermatological. Conclusion: Early results confirm that IMRT or VMAT for anal cancer treatment reduces acute toxicities while maintaining high control rates.
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    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.
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    Intensity-modulated Radiotherapy Planning at Mediastinal Lymphoma Treatment: Sandglass, Rainbow and Butterfly Techniques
    (KARE PUBL, 2022-01-01) Yucel, Serap; Gural, Zeynep; Agaoglu, Fulya
    OBJECTIVE We developed ``sandglass{''} technique using volumetric arc therapy (VMAT) with two avoidance sectors and make comparison between two intensity-modulated radiotherapy (IMRT) techniques, ``butterfly{''} with three anterior and two posterior beams, and ``rainbow{''} with five anterior beams. Conformity index (CI), homogeneity index MD, organ of risk doses, and monitor unit (MU) values are used as evaluation tools. METHODS IMRT and VMAT plans generated for 15 mediastinal lymphoma patients. Sandglass technique consists of two full arc with avoidance sectors (240 degrees-300 degrees and 60 degrees-120 degrees), butterfly technique with five static fields (0 degrees, 40 degrees, 160 degrees,190 degrees, and 330 degrees), and rainbow technique has five static fields (0 degrees, 20 degrees, 40 degrees, 320 degrees, and 345 degrees). The prescribed treatment dose was 30.6 Gy in 17 fractions. Dosirnetric data were compared using cross-paired sample t-test. RESULTS Lung V5 doses were 41.62-50.74\%, V20 doses were 12.72-16.21\%, heart mean doses were between 454 and 509 cGy, spinal cord max point doses were between 2210 and 2798 cGy, esophagus mean doses were between 1309 and 1409 eGyHI, CI, and MU values were calculated. Lung V20, mean esophagus, and mean heart and spinal cord max. point doses were observed significantly lower at sandglass technique (p=0.001, p=0.02, p=0.013, and p=0.001). CI is significantly better than other two techniques (rainbow p=0.000 and butterfly p=0.001). On the other hand, lung V5 doses significantly lower at rainbow technique (p=0.035), besides, III has significant advantage with respect to others. Sandglass has lower MU value with 484 MU. CONCLUSION Sandglass technique has remarkable advantageous for lung V20, heart, esophagus, spinal cord, CI, and MU. Treatment plans with lower critical organ doses have great importance in terms of late side effects in patients with long survival expectancy. Sandglass plan was preferable for mediastinal lymphoma.