Araştırma Çıktıları
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Item Impact of Oncotype DX Recurrence Score on Treatment Decisions: Results of a Prospective Multicenter Study in Turkey(CUREUS INC, 2016-01-01) Ozmen, Vahit; Atasoy, Ajlan; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Nilufer; Uras, Cihan; Ok, Engin; Demircan, Orhan; Isikdogan, Abdurrahman; Saip, PinarIntroduction: Breast cancer is the most common malignancy among Turkish women and the rate of early stage disease is increasing. The Oncotype DX (R) 21-gene assay is predictive of distant recurrence in ER-positive, HER2-negative early breast cancer. We aimed to evaluate the impact of the Recurrence Score (R) (RS) on treatment decisions and physician perceptions in Turkey. We also studied correlations between RS and routine risk factors. Patients and Methods: Ten academic centers across Turkey participated in this prospective trial. Consecutive breast cancer patients with pT1-3, pN0-N1mic, ER-positive, and HER2-negative tumors were identified at multidisciplinary tumor conferences. The initial treatment decision was recorded before tumor blocks were sent to the central laboratory. Each case was brought back to tumor conference after receiving the RS result. Both pre- and post-RS treatment decisions and physician perceptions were recorded on questionnaire forms. Correlations between RS and classical risk factors were evaluated using univariate and multivariate analyses. Results: Ten centers enrolled a total of 165 patients. The median tumor size was 2 cm. Of 165 patients, 57\% had low RS, 35\% had intermediate RS, and 8\% had high RS, respectively. The overall rate of change in treatment decision was 33\%. Initially, chemotherapy followed by hormonal therapy (CT+HT) was recommended to 92 (56\%) of all patients, which decreased to 61 (37\%) patients post-RS assay (p<0.001). Multivariate analysis indicated that progesterone receptor (PR) and Ki-67 scores were significantly related to RS. Conclusion: Oncotype DX testing may provide meaningful additional information in carefully selected patients.Item The Outcome of Patients with Triple Negative Breast Cancer: The Turkish Oncology Group Experience(AVES, 2014-01-01) Eralp, Yesim; Kilic, Leyla; Alco, Gul; Basaran, Gul; Dogan, Mutlu; Dincol, Dilek; Demirci, Senem; Icli, Fikri; Onur, Handan; Saip, Pinar; Haydaroglu, AyferObjective:Triple negative breast cancer (TNBC) is generally considered as a poorer prognostic subgroup, with propensity for earlier relapse and visceral involvement. The aim of this study is to evaluate the outcome of non-metastatic TNBC patients from different centers in Turkey and identify clinical and pathologic variables that may effect survival. Materials and Methods:Between 1993-2007, from five different centers in Turkey, 316 nonmetastatic triple negative breast cancer patients were identified with follow-up of at least 12 months. The data was collected retrospectively from patient charts. The prognostic impact of several clinical variables were evaluated by the Kaplan-Meier and Cox multivariate anayses. Results:Mean age at diagnosis was 49 years (range:24-82). The majority of the patient group had invasive ductal carcinoma (n:260, 82.3\%) and stage II disease (n:164Item Diagnostic Performance of AI for Cancers Registered in A Mammography Screening Program: A Retrospective Analysis(SAGE PUBLICATIONS INC, 2022-01-01) Kizildag Yirgin, Inci; Koyluoglu, Yilmaz Onat; Seker, Mustafa Ege; Ozkan Gurdal, Sibel; Ozaydin, Ayse Nilufer; Ozcinar, Beyza; Cabioglu, Neslihan; Ozmen, Vahit; Aribal, ErkinPurpose: To evaluate the performance of an artificial intelligence (AI) algorithm in a simulated screening setting and its effectiveness in detecting missed and interval cancers. Methods: Digital mammograms were collected from Bahcesehir Mammographic Screening Program which is the first organized, population-based, 10-year (2009-2019) screening program in Turkey. In total, 211 mammograms were extracted from the archive of the screening program in this retrospective study. One hundred ten of them were diagnosed as breast cancer (74 screen-detected, 27 interval, 9 missed), 101 of them were negative mammograms with a follow-up for at least 24 months. Cancer detection rates of radiologists in the screening program were compared with an AI system. Three different mammography assessment methods were used: (1) 2 radiologists' assessment at screening center, (2) AI assessment based on the established risk score threshold, (3) a hypothetical radiologist and AI team-up in which AI was considered to be the third reader. Results: Area under curve was 0.853 (95\% CI = 0.801-0.905) and the cut-off value for risk score was 34.5\% with a sensitivity of 72.8\% and a specificity of 88.3\% for AI cancer detection in ROC analysis. Cancer detection rates were 67.3\% for radiologists, 72.7\% for AI, and 83.6\% for radiologist and AI team-up. AI detected 72.7\% of all cancers on its own, of which 77.5\% were screen-detected, 15\% were interval cancers, and 7.5\% were missed cancers. Conclusion: AI may potentially enhance the capacity of breast cancer screening programs by increasing cancer detection rates and decreasing false-negative evaluations.Item Temporary Implant Irradiation: Survey of Turkish Society of Radiation Oncology Breast Cancer Study Group(GALENOS YAYINCILIK, 2021-01-01) Kaydihan, Nuri; Alco, Gul; Senocak, Mustafa Sukru; Bese, NuranObjective: To understand the clinical approach of radiation oncologists during the treatment of patients with breast reconstruction. Materials and Methods: A questionnaire survey was emailed to 105 active members of the Turkish Radiation Oncology Society, the Breast Cancer Study Group. The factors associated with radiation oncologists and their current practice was identified. Results: Fifty radiation oncologists (47.6\%) responded, and most of the responders (83\%) were physicians who treated >50 new breast cancer patients annually. The majority of the physicians worked in academic hospitals and had more than 15 years of work experience. The early reconstruction rate was noted to be low among patients with mastectomy (<10\% of the mastectomy patients) (p<0.05). Early implant irradiation with temporary tissue expander was noted to be a more common procedure. The majority of the respondents (68\%) preferred to irradiate an inflated implant (20\% total, 80\% partial). In addition, 22\% of the physicians declared that they routinely used bolus and that 60\% of them used it only for patients at a high risk of local recurrence factors. Conclusion: It can thus be concluded that variations exist between experienced radiation oncologists and others. Hypofractionation is not yet commonly practiced for patients with reconstruction in Turkey. A concrete consensus can be helpful to create a homogeneity in treatment decisions and practical applications.Item Evaluation of the association of SNP in carboxylesterase enzyme (CES1) with pharmacokinetic and adverse effects of capecitabine in breast and colorectal cancer patients(ISTANBUL UNIV, FAC PHARMACY, 2019-01-01) Yuksel, Merve Kurtan; Ozturk, Dilek; Oztas, Ezgi; Ozhan, Gul; Turker, Aylin Altanlar; Korkmaz, Taner; Okyar, Alper; Kara, Zeliha PalaCapecitabine is an oral prodrug and converted to 5-fluorouracil using three-step enzymatic pathways which include carboxylesterase (CES). Interindividual differences in the activities of drug-metabolizing enzymes may affect efficacy and toxicity. The aim of this study is to evaluate the association of Single nucleotide polymorphisms (SNP) in CES1 with the pharmacokinetic and adverse effects of capecitabine. Plasma samples were obtained from 7 breast and colorectal cancer patients who were treated with capecitabine-based chemotherapy (1000-1250 mg/m(2)) at 0.5, 1, 2, 3 and 4 hours following drug administration on their first day of the first cycle. The plasma concentrations of the capecitabine were determined by using a high-pressure liquid chromatography-UV detector. SNP (rs8192950) was genotyped using the reverse transcription-polymerase chain reaction. Patients were found to have heterozygote (57\%), wild (29\%), and mutant (14\%) distributions of genotypes (p=0.909). The mean plasma area under the curve (AUC(0-4h)) was 4.60 +/- 2.25 mu g.h/mL, and maximum plasma concentration (C-max) was 3.19 +/- 2.5 mu g/mL. There were no statistically significant differences between genotypes and AUC values (p=0.2236) and the most frequently observed side effects were diarrhea (p=0.1028), asthenia (p=0.6456), anemia (p=0.6456), emesis (p=0.3499). This is the first study evaluating an association of genetic variation in CES1 (rs8192950) with pharmacokinetic and adverse effects of capecitabine. Therefore, additional study in larger groups of patients is required to support our study.Item CYP19A1 Genetic Polymorphisms rs4646 and Osteoporosis in Patients Treated with Aromatase Inhibitor-Based Adjuvant Therapy(AVES, 2016-01-01) Mazzuca, Federica; Botticelli, Andrea; Mazzotti, Eva; La Torre, Marco; Borro, Marina; Marchetti, Luca; Maddalena, Chiara; Gentile, Giovanna; Simmaco, Maurizio; Marchetti, PaoloObjective: Third-generation aromatase inhibitors (AI) are potent suppressors of aromatase activity. The aim of this study was to measure the incidence of adverse effects in breast cancer patients treated with AI-based adjuvant therapy and the relationship with the CYP19A1 genotypes. Materials and Methods: Forty-five postmenopausal breast cancer patients (46-85 yrs) in AI adjuvant treatment were genotyped for the rs4646 polymorphisms of CYP19A1 gene and three variations were identified. Toxicities were registered at each follow-up medical examination, and classified in accord with the Common Terminology Criteria for Adverse Events. Results: Twenty-four (53.3\%) patients presented the GG genotypeItem 3D Automated Breast Ultrasound System: Comparison of Interpretation Time of Senior Versus Junior Radiologist(AVES, 2019-01-01) Arslan, Aydan; Ertas, Gokhan; Aribal, ErkinObjective: This study aimed to compare the automated breast ultrasound system (ABUS) reading time of breast radiologist to a radiology resident independent of the clinical outcomes. Materials and Methods: One hundred women who underwent screening ABUS between July and August 2017 were reviewed retrospectively. Each study was examined sequentially by a breast radiologist who has more than 20 years of experience in breast radiology and third year resident who has 6 months of experience in breast radiology. Data were analyzed with Spearman' correlation, Wilcoxon Signed Ranks Test and Kruskal-Wallis Test and was recorded. Results: The mean age of patients was 42.02 +/- 11.423 years (age range16-66). The average time for senior radiologist was 223.36 +/- 84.334 seconds (min 118 max 500 seconds). The average time for junior radiologist was 269.48 +/- 82.895 seconds (min 150 max 628 seconds). There was a significant difference between the mean time of two radiologists (p=0.00001). There was a significant difference regarding the decrease in the reading time throughout study with the increase of number of cases read by the breast radiologist (p<0.05)Item Role of Sentinel Lymph Node Biopsy During Contralateral Prophylactic Mastectomy(ISTANBUL TRAINING \& RESEARCH HOSPITAL, 2020-01-01) Kara, Halil; Arikan, Akif Enes; Dulgeroglu, Onur; Uras, CihanIntroduction: Contralateral prophylactic mastectomy (CPM) is the removal of the opposite breast with the aim of risk reduction in cases of unilateral breast carcinoma. Routine use of sentinel lymph node biopsy (SLNB) at the time of CPM is controversial due to low occult breast cancer risk. This study aims to determine the rate of occult breast carcinoma and to evaluate whether SLNB should be performed during CPM. Methods: Ninety-four patients who underwent CPM between 2009 and 2018 were evaluated retrospectively. Occult breast carcinoma detection rate and approach to axilla were evaluated. Results: Occult invasive breast carcinoma was detected in three patients (3.2\%): two invasive ductal carcinoma and one multifocal invasive lobular carcinoma. Axillary staging was performed in second session. SLNB was performed in two patients and a micro-metastasis in one of four sentinel lymph nodes (SLN) was detected in one patient. Axillary lymph node dissection was performed in one patient in whom SLN was not detected. Conclusion: SLNB can be performed in patients with suspicious lesion in the absence of biopsy or in patients with high-risk of occult breast cancer (postmenopausal, high Gail score, lobular histology, multi-centric tumor, ipsilateral high-risk lesion)