Araştırma Çıktıları

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    The potential role of MR-guided adaptive radiotherapy in pediatric oncology: Results from a SIOPE-COG survey
    (ELSEVIER IRELAND LTD, 2021-01-01) Seravalli, Enrica; Kroon, Petra S.; Buatti, John M.; Hall, Matthew D.; Mandeville, Henry C.; Marcus, Karen J.; Onal, Cem; Ozyar, Enis; Paulino, Arnold C.; Paulsen, Frank; Saunders, Daniel; Tsang, Derek S.; Wolden, Suzanne L.; Janssens, Geert O.
    Background and purpose: Magnetic resonance guided radiotherapy (MRgRT) has been successfully implemented for several routine clinical applications in adult patients. The purpose of this study is to map the potential benefit of MRgRT on toxicity reduction and outcome in pediatric patients treated with curative intent for primary and metastatic sites. Materials and methods: Between May and August 2020, a survey was distributed among SIOPE- and COG-affiliated radiotherapy departments, treating at least 25 pediatrics patients annually and being (candidate) users of a MRgRT system. The survey consisted of a table with 45 rows (clinical scenarios for primary (n = 28) and metastatic (n = 17) tumors) and 7 columns (toxicity reduction, outcome improvement, PTV margin reduction, target volume daily adaptation, online re-planning, intrafraction motion compensation and on-board functional imaging) and the option to answer by `yes/no'. Afterwards, the Dutch national radiotherapy cohort was used to estimate the percentage of pediatric treatments that may benefit from MRgRT. Results: The survey was completed by 12/17 (71\% response rate) institutions meeting the survey inclusion criteria. Responders indicated an `expected benefit' from MRgRT for toxicity/outcome in 7\% (for thoracic lymphomas and abdominal rhabdomyosarcomas)/0\% and 18\% (for mediastinal lymph nodes, lymph nodes located in the liver/splenic hilum, and liver metastases)/0\% of the considered scenarios for the primary and metastatic tumor sites, respectively, and a `possible benefit' was estimated in 64\%/46\% and 47\%/59\% of the scenarios. When translating the survey outcome into a clinical perspective a toxicity/outcome benefit, either expected or possible, was anticipated for 55\%/24\% of primary sites and 62\%/38\% of the metastatic sites. Conclusion: Although the benefit of MRgRT in pediatric radiation oncology is estimated to be modest, the potential role for reducing toxicity and improving clinical outcomes warrants further investigation. This fits best within the context of prospective studies or registration trials.
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    Outcome of Patients With Metastatic Chromophobe Renal Cell Carcinoma Treated With Sunitinib
    (ALPHAMED PRESS, 2016-01-01) Keizman, Daniel; Sarid, David; Lee, Jae L.; Sella, Avishay; Gottfried, Maya; Hammers, Hans; Eisenberger, Mario A.; Carducci, Michael A.; Sinibaldi, Victoria; Neiman, Victoria; Rosenbaum, Eli; Peer, Avivit; Neumann, Avivit; Mermershtain, Wilmosh; Rouvinov, Keren; Berger, Raanan; Yildiz, Ibrahim; Grp, Turkish Oncology
    Background. Sunitinib is a standard treatment for metastatic clear cell renal cell carcinoma (mccRCC). Data on its activity in the rare variant of metastatic chromophobe renal cell carcinoma (mchRCC), are limited. We aimed to analyze the activity of sunitinib in a relatively large and homogenous international cohort of mchRCC patients in terms of outcome and comparison with mccRCC. Methods. Records from mchRCC patients treated with first-line sunitinib in 10 centers across 4 countries were retrospectively reviewed. Univariate and multivariate analyses of association between clinicopathologic factors and outcome were performed. Subsequently, mchRCC patients were individually matched to mccRCC patients. We compared the clinical benefit rate, progression-free survival (PFS), and overall survival (OS) between the groups. Results. Between 2004 and 2014, 36 patients (median age, 64 years
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    Factor analysis of the SRS-22 outcome assessment instrument in patients with adult spinal deformity
    (SPRINGER, 2018-01-01) Mannion, A. F.; Elfering, A.; Bago, J.; Pellise, F.; Vila-Casademunt, A.; Richner-Wunderlin, S.; Domingo-Sabat, M.; Obeid, I.; Acaroglu, E.; Alanay, A.; Perez-Grueso, F. S.; Baldus, C. R.; Carreon, L. Y.; Bridwell, K. H.; Glassman, S. D.; Kleinstuck, F.; European Spine Study Grp, E. S. S. G.
    Designed for patients with adolescent idiopathic scoliosis, the SRS-22 is now widely used as an outcome instrument in patients with adult spinal deformity (ASD). No studies have confirmed the four-factor structure (pain, function, self-image, mental health) of the SRS-22 in ASD and under different contexts. Factorial invariance of an instrument over time and in different languages is essential to allow for precise interpretations of treatment success and comparisons across studies. This study sought to evaluate the invariance of the SRS-22 structure across different languages and sub-groups of ASD patients. Confirmatory factor analysis was performed on the 20 non-management items of the SRS-22 with data from 245 American English-, 428 Spanish-, 229 Turkish-, 95 French-, and 195 German-speaking patients. Item loading invariance was compared across languages, age groups, etiologies, treatment groups, and assessment times. A separate sample of SRS-22 data from 772 American surgical patients with ASD was used for cross-validation. The factor structure fitted significantly better to the proposed four-factor solution than to a unifactorial solution. However, items 14 (personal relationships), 15 (financial difficulties), and 17 (days off work) consistently showed weak item loading within their factors across all language versions and in both baseline and follow-up datasets. A trimmed SRS (16 non-management items) that used the four least problematic items in each of the four domains yielded better-fitting models across all languages, but equivalence was still not reached. With this shorter version there was equivalence of item loading with respect to treatment (surgery vs conservative), time of assessment (baseline vs 12 months follow-up), and etiology (degenerative vs idiopathic), but not age (< vs ae50 years). All findings were confirmed in the cross-validation sample. We recommend removal of the worst-fitting items from each of the four domains of the SRS-instrument (items 3, 14, 15, 17), together with adaptation and standardization of other items across language versions, to provide an improved version of the instrument with just 16 non-management items.
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    Analysis of factors affecting baseline SF-36 Mental Component Summary in Adult Spinal Deformity and its impact on surgical outcomes
    (TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2018-01-01) Mmopelwa, Tiro; Ayhan, Selim; Yuksel, Selcen; Nabiyev, Vugar; Niyazi, Asli; Pellise, Ferran; Alanay, Ahmet; Perez Grueso, Francisco Javier Sanchez; Kleinstuck, Frank; Obeid, Ibrahim; Acaroglu, Emre; Grp, European Spine Study
    Objectives: To identify the factors that affect SF-36 mental component summary (MCS) in patients with adult spinal deformity (ASD) at the time of presentation, and to analyse the effect of SF-36 MCS on clinical outcomes in surgically treated patients. Methods: Prospectively collected data from a multicentric ASD database was analysed for baseline parameters. Then, the same database for surgically treated patients with a minimum of 1-year follow-up was analysed to see the effect of baseline SF-36 MCS on treatment results. A clinically useful SF-36 MCS was determined by ROC Curve analysis. Results: A total of 229 patients with the baseline parameters were analysed. A strong correlation between SF-36 MCS and SRS-22, ODI, gender, and diagnosis were found (p < 0.05). For the second part of the study, a total of 186 surgically treated patients were analysed. Only for SF-36 PCS, the un-improved cohort based on minimum clinically important differences had significantly lower mean baseline SF-36 MCS (p < 0.001). SF-36 MCS was found to have an odds ratio of 0.914 in improving SF-36 PCS score (unit by unit) (p < 0.001). A cut-off point of 43.97 for SF-36 MCS was found to be predictive of SF-36 PCS (AUC = 0.631
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    Persistent extramural vascular invasion positivity on magnetic resonance imaging after neoadjuvant chemoradiotherapy predicts poor outcome in rectal cancer
    (ELSEVIER SINGAPORE PTE LTD, 2021-01-01) Guner, Osman Serhat; Tumay, Latif Volkan
    Background: In rectal cancer, extramural vascular invasion (EMVI) is the presence of tumour cells in blood vessels outside the muscular layer, which is associated with poor prognosis. Regression of EMVI on MRI following neoadjuvant chemoradiotherapy or its persistence may have prognostic implications. Methods: This retrospective study included 52 patients with rectal cancer who underwent total mesorectal excision following long-course neoadjuvant chemoradiotherapy (CRT). EMVI assessments were done on previous pelvic MRIs obtained before neoadjuvant CRT and eight weeks after the completion of neoadjuvant chemoradiotherapy in initially EMVI positive cases. Results: Persistently EMVI positive patients had worse overall survival and disease-free survival compared to initially EMVI negative patients and patients who returned to negative (p < 0.001 for both). Multivariate analysis identified persistent EMVI positivity after neoadjuvant treatment (HR, 102.9