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    Adrenal insufficiency caused by bilateral adrenal macrometastases: a rare case with metastatic colon cancer
    (Kare Publ, 2008) Cicin, Irfan; Uzunoglu, Sernaz; Karagol, Hakan; Usta, Ufuk; Temizoz, Osman; Ermantas, Nilay
    A 42-year-old male with symptoms of weight loss, fatigue, hyponatremia, hypoglycemia, hypotension and fever was referred to our hospital. A computed tomographic scan of the abdomen and pelvis showed multiple solid masses in the liver, thickened wall of sigmoid colon and bilateral solid adrenal masses, 7x5x3 cm on the right side and 6x4.5x3.5 cm on the left side. A colonoscopic examination showed tumoral mass originating from the sigmoid colon. A biopsy was performed and adenocarcinoma was diagnosed. The patient was suspected of having primary adrenal insufficiency due to bilateral adrenal macrometastases. The diagnosis of adrenal insufficiency was confirmed by levels of ACTH serum, cortisol and ACTH stimulation test. Adrenal metastases are well-recognized, but compared with the prevalence of adrenal metastases, adrenocortical insufficiency in patients with cancer seems to be rare. We report the case of a patient with both bilateral surrenal macrometastases, which is rare in colorectal cancer, and subsequent adrenal insufficiency.
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    An ambiguous phenomenon of radiation and drugs: Recall reactions
    (Karger, 2007) Caloglu, Murat; Yurut-Caloglu, Vuslat; Cosar-Alas, Rusen; Saynak, Mert; Karagol, Hakan; Uzal, Cem
    The term 'radiation recall' describes an acute inflammatory reaction in previously irradiated areas after the administration of certain inciting systemic agents. It was first described in 1959 by D'Angio that dermatitis is related to the application of actinomycin D on the skin. Though this reaction occurs frequently on the skin, it may also be seen in the oral mucosa, the larynx, esophagus, small intestine, lungs, muscle tissue, and brain. Most drugs associated with recall reactions are cytotoxics, however, several other drugs may also elicit the phenomenon. Although this phenomenon is well known, its etiology is not understood. Radiation recall reactions are generally associated with megavoltage radiotherapy. The time interval between the completion of radiotherapy and the recall reaction ranges from days to years. The recall reaction occurs on average 8 days (3 days to 2 months) after the application of the promoting agent. Although no standard treatment exists, some authors suggest discontinuation of the inciting drug and the use of corticosteroids or nonsteroidal anti-inflammatory agents.
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    The Better Performance Status, the Better Outcome: Laryngeal Carcinoma Treated with Definitive Radiotherapy
    (B C Decker Inc, 2008) Yurut-Caloglu, Vuslat; Caloglu, Murat; Turan, Fatma Nesrin; Ibis, Kamuran; Karagol, Hakan; Kocak, Zafer; Uzal, Cem
    Purpose: To evaluate the prognostic factors affecting locoregional control (LRC) and overall survival (OS) of patients with laryngeal carcinoma who were not candidates for surgical treatment due to tumour or host factors but were treated with definitive radiotherapy (RT). Patients and Methods: Sixty-three consecutive patients, treated with definitive RT between 1999 and 2005, were retrospectively analyzed. All patients had histologically proven squamous cell carcinomas of the larynx. The median age was 62 years (range 43-83 years). Follow-up ranged from 22 days to 68 months (median 32 months). Results: The LRC rates at 2 and 5 years were 70% and 48%. The 2- and 5-year OS rates were 65% and 40%. No statistically significant relationship was found between World Health Organization performance status score (WHO PS) and age (p = .21), tumour site (p = .42), overall stage (p = .11), T stage (p = .19), and N stage (p = .69). Multivariate analyses showed that a WHO PS score >= 2 (p < .0001) and RT treatment time >= 50 days (p = .0172) significantly decreased LRC. Moreover, a WHO PS score >= 2 (p < .0001), RT treatment time >= 50 days (p = .0138), and RT dose < 66 Gy (p = .04) were significantly negative prognostic factors on OS. Conclusion: Definitive RT, in patients with early- and more advanced-stage squamous cell carcinoma of the larynx, is an important treatment option. It is clear that patients with good pretreatment PS would get better results from definitive RT.
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    A brief look at the evaluation of the development and effectiveness of cytotoxic chemotherapy in advanced non-small-cell lung cancer
    (Kare Publ, 2010) Uzunoglu, Sernaz; Karagol, Hakan; Tanriverdi, Ozgur; Cicin, Irfan; Caloglu, Murat; Kocak, Zafer
    Systemic chemotherapy for patients with advanced-stage non-small-cell lung cancer prolongs survival and palliates symptoms, when compared with the best supportive care alone. However, the results of standard cytotoxic regimens are not yet satisfactory. As the effectiveness in the treatment of refractory disease is low, it still remains critical to better understand and develop new treatment options for refractory disease. Within the second-line therapeutic approaches, there are new chemotherapeutic schemes as well as molecular-targeted treatment options that block the epidermal growth factor receptor or angiogenesis. Future research efforts should focus on identifying prognostic and predictive markers of benefit not only for the standard cytotoxic agents, but also for the new target-driven agents currently.
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    BURNED-OUT TUMOR OF THE TESTIS: CASE REPORT
    (Aves, 2008) Kaplan, Mustafa; Karagol, Hakan; Altaner, Semsi; Aktoz, Tevfik; Caloglu, Murat; Inci, Osman
    Introduction: Burned-out testicular tumor is a rare entity. The term burned-out tumor of the testis describes a spontaneously and completely regressed testicular tumor which presents by its metastases to retroperitoneum, mediastinum, lymph nodes such as supraclavicular, cervical and axillary. This condition is different and less common from the primary extragonadal germ cell tumors. Many pathologists are not familiar with the findings that support a diagnosis of burned-out primary in a patient with metastatic germ cell tumor. We report 2 cases of burned-out testicular tumors to illustrate the clinical, radiological and histopathological features. Burned-out testicular tumor must be considered in a patient with retroperitoneal lymph node involvement and histology of germ-cell tumor in the absence of palpable testicular tumor. Metastases should be treated according to the histology and clinical stage of the tumor. Radical orchiectomy must be performed because of the high rate of persistent testicular tumor.
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    A case of gastric adenocarcinoma with rectal metastasis in the form of linitis plastica presenting as primary rectum carcinoma
    (Aves Yayincilik, Ibrahim Kara, 2008) Uzunoglu, Sernaz; Cicin, Irfan; Karagol, Hakan; Tanriverdi, Oezguer; Genchellac, Hakan; Usta, Ufuk
    It is often reported that metastases in the form of linitis plastica developed in the gastrointestinal system are rare cases and frequently the primary tumor is located in the stomach. We presented a case of gastric adenocarcinoma developing a metastasis in the rectum in the form of linitis plastica, which appeared as a primary local advanced rectum cancer. We discussed the clinical, radiological, and pathological characteristics of the intestinal metastases of gastric adenocarcinomas.
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    A case of non-Hodgkin's lymphoma presenting as a large chest wall mass
    (Kare Publ, 2008) Uzunoglu, Sernaz; Tanriverdi, Ozgur; Karagol, Hakan; Cicin, Irfan; Caloglu, Vuslat; Tokatli, Fusun
    Malignant lymphoma as a solitary chest wall mass is rare. Although surgical resection is the main treatment modality for malignant chest wall tumors, the treatment of primary chest wall lymphomas is controversial. A 65-year-old male patient with an enlarging mass on the left side of his chest wall, which had first appeared four months before, applied to our hospital. The patient was directed to our polyclinic with a diagnosis of large B-cell lymphoma after the biopsy. Following the clinical investigation, stage IIEB extranodal am-Hodgkin's lymphoma was determined, and after a palliative radiotherapy, eight cycles of chemotherapy were planned. However, shortly after the completion of the sixth cycle of chemotherapy, poor performance status developed secondary to chemotherapy and the patient was diagnosed with pulmonary embolus. Following the stop of chemotherapy after six cycles, a complete clinical remission and a nearly complete radiologic remission were achieved. The patient is still under follow-up and was free of disease at four months.
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    The comparison of weekly and 3-weekly cisplatin chemotherapy concurrent with radiotherapy in patients with previously untreated inoperable non-metastatic SCCHN
    (Oxford Univ Press, 2006) Uygun, Kazim; Karagol, Hakan; Caloglu, Murat; Cicin, Irfan; Caloglu, Vuslat Y.; Uzunoglu, Sernaz; Saip, Pinar
    [Abstract Not Available]
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    The comparison of weekly and three-weekly cisplatin chemotherapy concurrent with radiotherapy in patients with previously untreated inoperable non-metastatic squamous cell carcinoma of the head and neck
    (Springer, 2009) Uygun, Kazim; Bilici, Ahmet; Karagol, Hakan; Caloglu, Murat; Cicin, Irfan; Aksu, Gorkem; Fayda, Merdan
    Several studies have shown that the concurrent administration of chemotherapy (CHT) and radiotherapy (RT) is superior to RT alone in patients with inoperable non-metastatic squamous cell carcinoma of the head and neck (InSCCHN). We compared the efficacy and safety profile of RT and concurrent cisplatin CHT given in two different schedules to patients with previously untreated InSCCHN. Fifty patients with previously untreated InSCCHN admitted to our oncology department were included in the study. Thirty of 50 (60%) patients with a younger age or good performance status (PS) (ECOG 0-1) received cisplatin 100 mg/m(2) on a 21-day schedule (group A). Other 20 (40%) patients with older age or poor PS (ECOG 2) received cisplatin 40 mg/m(2) on a 7-day schedule (group B). Each of the 50 patients received concurrent conventional dose RT according to primer tumor location. The median follow-up is 12 months for group A and 12.5 months for group B. Twenty-eight (93.3%) patients in group A and 18 (90%) in group B were evaluable for response. The complete response rate was 50% in group A and 40% in group B (P > 0.05). The objective response rate was 92% in group A and 90% in group B (P > 0.05). All grade 3-4 toxic events were seen in 16 (53.3%) of group A patients and 8 (40%) of group B patients (P > 0.05). Comparison between two treatment modalities appears to result in statistically similar response rates and adverse event profile. A randomized phase III trial is required to confirm the safety and efficacy of weekly cisplatin therapy in patients with poor PS and/or older age at diagnosis.
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    Cutaneous metastasis of epidermoid carcinoma of the larynx: a case report
    (Kare Publ, 2006) Ibis, Kamuran; Ibis, Cem; Yurut-Caloglu, Vuslat; Altaner, Semsi; Caloglu, Murat; Karagol, Hakan; Cosar-Alas, Rusen
    The frequency of distant metastasis of epidermoid carcinoma of the larynx is between 6.5-7.2%. The common sites of metastasis are lung, liver and bone. Cutaneous metastasis is very rare. A 56-year-old male with locally advanced larynx carcinoma who received curative radiochemotheraphy a year ago was presented to our department with subcutaneous nodular lesions, and fatigue. Physical examination revealed 0.5 cm sized, and 1x1cm sized subcutaneous nodular lesions in the right arm, and in the parasternal area, respectively. Histopathologic examination confirmed the skin metastasis of epidermoid carcinoma of the larynx. The patient has profound anemia, hypercalcemia, hypernatremia, and hyperglicemia with complicated diabetic foot. Although the symptomatic treatment began immediately, the patient died on the third day of hospitalisation. Cutaneous metastasis may be the first sign of local failure, of distant metastasis, or even of the undetected laryngeal carcinoma with poor prognosis.
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    A Destroyer Immunologic Cause in Small Cell Lung Carcinoma: Ectopic Cushing's Syndrome
    (Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2010) Cicin, Irfan; Uzunoglu, Sernaz; Ermantas, Nilay; Usta, Ufuk; Temizoz, Osman; Karagol, Hakan
    Ectopic secretion of adrenocorticotropic hormone (ACTH) related Cushing's syndrome (CS) is more frequently observed than many other paraneoplastic syndromes in patients with small cell lung cancer. Suppression of the cellular immune system in these patients is severe problem for both patients and physicians. In addition, the chemotherapy has been caused to severity and higher rate of hematological toxicity. We present a case of small cell lung cancer having a very poor prognosis, with a compressed humoral and cellular immune system due to an ectopic secretion of ACTH related CS. We report a rare case of combined immunosuppression in a case with small cell lung cancer in this paper. In addition, in the light of this special case and literature, we suggest treatment strategies for small cell lung cancer patients with CS.
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    Dural sinus vein thrombosis in a patient with colon cancer treated with FOLFIRI/bevacizumab
    (Wolters Kluwer Medknow Publications, 2009) Ozen, Alaattin; Cicin, Irfan; Sezer, Atakan; Uzunoglu, Sernaz; Saynak, Mert; Genchellac, Hakan; Karagol, Hakan
    The adverse effects of regimes in cancer treatment have forced us to change to new targeted therapy options. Understanding these side effects, which can lead to discontinuation of the new therapy strategies, will allow the clinical management of these side effects and result in continuing therapies with effective medications. Bevacizumab, which is an IgG1 antibody against vascular endothelial growth factor, has side effects such as proteinuria, hypertension, venous and arterial thromboembolic events, and hemorrhage. This is the first reported case of dural sinus vein thrombosis, during the treatment with bevacizumab.
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    The efficacy of tamoxifen in patients with advanced epithelial ovarian cancer
    (Humana Press Inc, 2007) Karagol, Hakan; Saip, Pinar; Uygun, Kazim; Caloglu, Murat; Eralp, Yesim; Tas, Faruk; Aydiner, Adnan
    Background: Activity of tamoxifen as a salvage therapy in patients with advanced epithelial ovarian cancer was evaluated by a number of studies. In this study, we evaluated efficacy of tamoxifen in our patients with platinum-resistant epithelial ovarian carcinoma. Patients and Methods: A retrospective analysis was conducted of patients who received tamoxifen at a dose 20 mg twice daily for the treatment of advanced epithelial ovarian cancer. Results: Twenty-nine eligible patients were included to the study. There were 1 (3%) complete response, 2 (7%) partial response, 6 (21%) stable disease, and 20 (69%) progressive disease. All patients were progressed after initiation of tamoxifen. Median progression-free survival was 4 mo (95% CI: 2.98-5.02). Disease progression of 19 (65%) patients were shown within the first 6 mo after initiation of tamoxifen. Progression-free survival was between 6 and 12 mo for 7 (24%) patients and >= 12 mo for 3 (10%) patients. The median survival after initiation of tamoxifen was 15 mo (95% CI: 7.2-22.8). No toxicity attributable to tamoxifen was seen in any of the patients. The only independent prognostic factor that had a significant predictive value for progression-free survival was the response to tamoxifen treatment (p = 0.043, hazard ratio: 0.12, 95% CI: 0.01-0.94). Conclusion: Considering minimal side effects and ability to cause objective responses, there is a place for tamoxifen in treatment of patients with platinum-resistant ovarian cancer. A phase III trial is required to confirm the value of the drug in patients presenting these clinical settings.
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    The efficacy of tamoxifen in patients with advanced epithelial ovarian cancer [Meeting Abstract]
    (Elsevier, 2006) Karagol, Hakan; Saip, Pinar; Uygun, Kazim; Caloglu, Murat; Eralp, Yesim; Tas, Faruk; Aydiner, Adnan
    [Abstract Not Available]
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    The efficiency of single agent docetaxel in patients with platinum-refractory non-small cell lung carcinoma
    (Humana Press Inc, 2008) Uygun, Kazim; Aksu, Gorkem; Cicin, Irfan; Karagol, Hakan; Kocak, Zafer; Fayda, Merdan; Binici, Ahmet
    Background To evaluate the efficiency of docetaxel as second line chemotherapy in patients with platinum-refractory non-small cell lung carcinoma (NSCLC). Patients and methods Fifty-two patients with locally advanced or metastatic NSCLC who had platinum-refractory disease (progressed through or within 3 months of completion of first line therapy) and an Eastern Cooperative Oncology Group performance (ECOG) status 0-2 were treated with second-line chemotherapy consisting of single agent docetaxel (100 mg/m2, intravenously, on day 1 of a 21-day cycle). The median number of treatment cycles was 4 (2-6). Disease-free (DFS) and overall survival (OS), response rates and toxicity were evaluated. Results The median progression-free survival of patients was 3 months (95% CI: 0.01-5.99) and overall survival was 7.2 months (95% CI: 2.2-9.5). One-year overall survival rate was 29%. Disease control (complete response, partial response, or stable disease) was achieved in 25 patients (48%) and overall response rate was 13% (7 patients). There were no complete responses. Seventeen patients (33%) had stable disease and twenty-seven patients (52%) had progressive disease. Age, gender, stage at diagnosis (IIIB vs. IV), performance status at initiation of second-line therapy (0-1 vs. 2) histopathological type (epidermoid vs. others), grade, LDH, albumin, weight loss were evaluated as prognostic factors; however, none of these had a significant affect on survivals. The protocol was well tolerated and there were no toxic deaths. Grade III-IV anemia was present in 8 patients (15%) and thrombopenia in 12 (23%) patients. The most frequent grade 3-4 toxicities were leucopenia (52%) and neutropenia (48%). Febril neutropenia occurred in 14 patients (26%). No patients experienced grade III-IV mucositis and diarrhea. Totally, the need of a dose reduction was about 25% and treatment delay (4-9 days) occurred in 5 patients (10%) and 7 patients (13%), respectively, because of toxicity. Conclusions Second-line chemotherapy with single-agent docetaxel offers a small but significant survival advantage with acceptable toxicity for patients with advanced NSCLC who have platinum-refractory disease.
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    Efficient and safe application of a FOLFIRI/bevacizumab combination to a patient with locally advanced rectal cancer and severe chronic renal failure
    (Karger, 2007) Cicin, Irfan; Karagol, Hakan; Uzunoglu, Sernaz; Uygun, Kazim
    [Abstract Not Available]
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    Evaluation of prognostic factors and comparison of systemic treatment modalities in patients with recurrent or metastatic endometrial carcinoma
    (Humana Press Inc, 2006) Karagol, Hakan; Saip, Pinar; Uygun, Kazim; Kucucuk, Seden; Aydiner, Adnan; Topuz, Erkan
    Background: Prognostic factors related to survival in patients with inoperable metastatic or recurrent endometrial carcinoma (MREC) have remained unclear due to lack of clinical trials.The management of these patients is also controversial.This study was performed to compare the efficacy and toxicity profiles of two different systemic therapies (chemotherapy vs hormonal therapy) given for the treatment of patients with MREC and to identify the impact of various prognostic factors on the survival. Methods: Between 1992 and 2004, 44 patients with MREC were admitted to our oncology department. Four cases were excluded from this retrospective study because of lack of data in their charts. Age, presence of other systemic diseases (such as diabetes mellitus, hypertension), histological type, tumor grade, staae, disease-free interval, site of recurrence or metastasis, systemic treatment modality, overall response to treatment, and duration of time to progression were evaluated as prognostic factors. Cox regression analysis was per-formed for identification of independent prognostic factors and differences between patients characteristics of two treatment groups were calculated by the chi-square or t test. Results: The median follow-up was 18 mo (range 3-113). The overall response rates for chemotherapy and hormonal therapy group were 42% and 41 %, respectively (p > 0.05). The median time to progression was 4 mo for the chemotherapy group and 5 mo for the hormonal therapy group (p > 0.05). The median survival after metastasis or recurrence was I I mo for the chemotherapy group and 16 mo for the hormonal therapy group (p > 0.05). In the group of chemotherapy, grade 3-4 hematologic and northematologic toxicities were seen in eight and two, patients, respectively. No grade 3-4 toxicities were noted in patients treated with hormonal C therapy. In multivariate analysis, only time to progression (p = 0.001) and grade (p = 0.04) were the independent prognostic factors on survival after metastasis or recurrence. Conclusion: Histological differentiation and duration of time to progression are predictive factors for survival after metastasis or recurrence in the whole group. The efficacy of two different groups of treatment in these patients appears to be similar. But the chemotherapy may have some disadvantageous in terms of toxicity. This study supports a future randomized prospective trial of hormonal therapy vs chemotherapy in patients with MREC.
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    Extrapulmonary small cell carcinoma localized in lymph nodes: Is it a different clinical entity?
    (Taylor & Francis Ltd, 2009) Cicin, Irfan; Usta, Ufuk; Karagol, Hakan; Uzunoglu, Sernaz; Kocak, Zafer
    Background. Extrapulmonary small cell carcinomas (EPSCC) can clinically progress differently depending on the primary site of disease involvement. This review is focused on patients with small cell carcinoma (SmCC) exclusively localized in a lymph node or in multiple lymph nodes without any evidence of a primary tumor in any other organ. Methods. We searched the period 1980 to 2007 in the PubMed database and idendified 11 publications in the English language presenting at least one case of SmCC. In total 28 individual patients were included in the present study. They were scrutinized in terms of epidemiology, clinical presentation, staging, pathology, etiology, treatment and prognosis. Results. Characteristics such as age, gender and smoking were similar to those seen in other EPSCCs. Median survival was not reached (42+, range, 9.1 to 100 months). The survival rate was found to be 79% at 3 years. Seventy-seven percent of the patients had limited stage disease. These patients completely responded to surgical therapy, chemotherapy, radiotherapy or to a combination of these treatments. Seventy-one percent of the patients with limited stage SmCC localized in lymph nodes were recurrence-free during the study periods. Discussion. Our review patient group with SmCC localized in lymph nodes exhibited an excellent clinical behavior and survival results when compared to other patients with pulmonary and non-pulmonary SmCCs. SmCCs localized in lymph nodes may be a separate clinical entity.
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    Extrapulmonary small-cell carcinoma compared with small-cell lung carcinoma - A retrospective single-center study
    (Wiley, 2007) Cicin, Irfan; Karagol, Hakan; Uzunoglu, Sernaz; Uygun, Kazim; Usta, Ufuk; Kocak, Zafer; Caloglu, Murat
    BACKGROUND. The study was conducted with the aim of reviewing the clinical features, therapy, and natural course of patients with extrapulmonary small-cell carcinoma (EPSCC) and small-cell lung carcinoma (SCLC) to better define current concepts regarding EPSCCs. METHODS. The medical records of patients with proven diagnosis of small-cell carcinoma (SmCQ between January 1999 and May 2006 were retrospectively reviewed. A total of 65 SmCC cases were included in the study (11 [17%] cases of EPSCC and 54 [83%] cases of SCLQ. RESULTS. Progression-free survival of all patients with EPSCC and patients with-extensive EPSCC disease was 7 months (95% confidence interval 10], 0.58-13.42) and 7 months (95% Cl, 4.71-13.29), respectively. Overall survival of all patients with EPSCC and patients with extensive EPSSC disease was 32 months (95% CI, 18.74-45.26) and 28 months (95% Cl, 12.24-43.76), respectively. Progression-free survival and overall survival for all patients with SCLC were 5 months (95% Cl, 2.26-7.74) and 10 months (95% Cl, 5.95-14.05), respectively. Progression-free survival and overall survival for patients with extensive disease were 3 months (95% Cl, 4.71-13.29) and 5 months (95% CI, 3.33-6.67), respectively. Overall survival was significantly better in all patients with EPSCC and in patients with extensive EPSCC disease compared with A patients with SCLC and patients with extensive SCLC disease (P =.014, P -.004, respectively). Early death and brain metastasis were observed in a higher number of patients with SCLC compared with EPSCC) however, these results were not statistically significant (P 33 and P =.076, respectively). Smoking history was significantly less in the FPSCC group (P <.0001). CONCLUSIONS. EPSCC is usually treated similarly to SCLC. However, this study suggests some differences such as etiology, clinic course, survival, frequency of brain metastases, and early death between these entities. These possible differences may influence the choice of therapeutic approach. Cancer 2007; 110: 106&76. (c) 200 7 American Cancer Society.
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    Factors affecting local control, distant recurrence and survival in patients with locally advanced bladder cancer treated by definitive radiotherapy or chemoradiotherapy
    (Kare Publ, 2006) Caloglu, Murat; Yurut-Caloglu, Vuslat; Saynak, Mert; Cosar-Alas, Rusen; Karagol, Hakan; Kaplan, Mustafa; Ibis, Kamuran
    OBJECTIVES Treatment results of 34 patients with bladder cancer admitted to Department of Radiation Oncology, Medicine Faculty of Trakya University between October 1997 and June 2005 were retrospectively analyzed. Prognostic factors associated with survival were determined. METHODS Their median age was 69 years (range 44-93). Thirty patients (88%) were male and 4 patients (12%) were female. Histopathological diagnosis was transitional cell carcinoma in 20 (59%) patients. Chemotherapy was administered concomitantly with radiotherapy to the 11 (32.35%) of the patients. The median radiotherapy dose was 62.5 (35-68) Gy. The median follow-up was 22 months (5-76 months). Median survival and median disease-free survival were 14.2 months (3.8-57.5) and 10 months (0-55), respectively. RESULTS Three years loco-regional control, metastasis free survival, disease free survival and overall survival rates were 76.59 , 72.2%, 55% and 41.1%, respectively. Epidermoid carcinoma histopathology (p=0.002), not performing concomitant chemotherapy (p=0.003), applying carboplatin instead of cisplatin with radiotherapy (p=0.004) and not conducting complete TURB (p=0.008) were significant poor prognostic factors on loco-regional control. Undifferentiated cell type (p=0.012) and not performing concomitant chemotherapy (p=0.046) were significant adverse factors on distant metastases. Factors that affect overall survival were tumor in stage T-4 (p=0.05), hemoglobin value below 10 g/dl (p=0.032) and not performing concomitant chemo-radiotherapy (p=0.017) and complete TURB (p=0.049). CONCLUSION Complications of radiotherapy were acceptable. For the treatment of muscle invasive locally advanced bladder cancer, RT combined with cisplatin is an acceptable treatment option. Moreover, complete TURB before RT is important both for local control and for survival.