Araştırma Çıktıları
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Item Estimation of secondary cancer risk after radiotherapy in high-risk prostate cancer patients with pelvic irradiation(WILEY, 2020-01-01) Haciislamoglu, Emel; Gungor, Gorkem; Aydin, Gokhan; Canyilmaz, Emine; Guler, Ozan Cem; Zengin, Ahmet Yasar; Yenice, Kamil MehmetWe aimed to estimate the risk of secondary cancer after radiotherapy (RT) in high-risk prostate cancer (HRPC) patients with pelvic irradiation. Computed tomography data of five biopsy-proven HRPC patients were selected for this study. Two different planning target volumes (PTV(1)and PTV2) were contoured for each patient. The PTV(1)included the prostate, seminal vesicles, and pelvic lymphatics, while the PTV(2)included only the prostate and seminal vesicles. The prescribed dose was 54 Gy for the PTV(1)with a sequential boost (24 Gy for the PTV2). Intensity-modulated RT (IMRT) and volumetric modulated arc therapy (VMAT) techniques were used to generate treatment plans with 6 and 10 MV photon energies with the flattening filter (FF) or flattening filter-free (FFF) irradiation mode. The excess absolute risks (EARs) were calculated and compared for the bladder, rectum, pelvic bone, and soft tissue based on the linear-exponential, plateau, full mechanistic, and specific mechanistic sarcoma dose-response model. According to the models, all treatment plans resulted in similar risks of secondary bladder or rectal cancer and pelvic bone or soft tissue sarcoma except for the estimated risk of the bladder according to the full mechanistic model using IMRT((6MVItem 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, EnisObjective: 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.Item Re-Irradiation of Non-Small Cell Lung Cell Cancer Recurrences with Stereotactic Body Radiotherapy(2016-01-01) Atalar, Banu; Sahin, Bilgehan; Gungor, Gorkem; Aydin, Gokhan; Yapici, Bulent; Ozyar, EnisItem Output factors of ionization chambers and solid state detectors for mobile intraoperative radiotherapy (IORT) accelerator electron beams(WILEY, 2019-01-01) Gungor, Goerkem; Aydin, Gokhan; Mustafayev, Teuta Zoto; Ozyar, EnisPurpose The electron energy characteristics of mobile intraoperative radiotherapy (IORT) accelerator LIAC((R)) differ from commonly used linear accelerators, thus some of the frequently used detectors can give less accurate results. The aim of this study is to evaluate the output factors (OFs) of several ionization chambers (IC) and solid state detectors (SS) for electron beam energies generated by LIAC((R)) and compare with the output factor of Monte Carlo model (MC) in order to determine the adequate detectors for LIAC((R)). Methods The OFs were measured for 6, 8, 10, and 12 MeV electron energies with PTW 23343 Markus, PTW 34045 Advanced Markus, PTW 34001 Roos, IBA PPC05, IBA PPC40, IBA NACP-02, PTW 31010 Semiflex, PTW 31021 Semiflex 3D, PTW 31014 Pinpoint, PTW 60017 Diode E, PTW 60018 Diode SRS, SNC Diode EDGE, and PTW 60019 micro Diamond detectors. Ion recombination factors (k(sat)) of IC were measured for all applicator sizes and OFs were corrected according to k(sat). The measured OFs were compared with Monte Carlo output factors (OFMC). Results The measured OFs of IBA PPC05, PTW Advanced Markus, PTW Pinpoint, PTW microDiamond, and PTW Diode E detectors are in good agreement with OFMC. The maximum deviations of IBA PPC05 OFs to OFMC are -1.6\%, +1.5\%, +1.5\%, and +2.0\%Item 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, EnisPurpose: 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)