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Öğe THE ACCESS RATE TO DIAGNOSIS AND TREATMENT MODALITIES IN BREAST CANCER PATIENTS IN TURKEY; MULTICENTER OBSERVATIONAL STUDY(Aves, 2011) Saip, Pinar; Keskin, Serkan; Ozkan, Metin; Kaplan, Mehmet Ali; Aydogan, Fatma; Demirag, Guzin Gonullu; Uzunoglu, SernazPurpose: We aimed to determine the elapsed time between the first notification of the disease and the accession to the diagnosis and treatment modalities and its associated factors in female patients with breast cancer in Turkey. Patients and Methods: The data was acquired by a questionnaire completed by 535 patients who applied to the 14 various oncology clinics between 1st and 28th of February 2010 in Turkey. The centers located in metrople - Istanbul, Izmir, and Ankara- were named Group 1 (n= 161), the centers located in Marmara and Central Anatolia region - Kocaeli, Bursa, Edirne and Kayseri- were named Group 2 (n= 189), and the centers located in Karadeniz and East-Southeast Anatolia region - Zonguldak, Samsun, Trabzon, Elazig and Diyarbakir- were named Group 3 (n= 185). The grouping for the centers were configured according to their socio- economic development of provinces. Results: Median age was 48 +/- 11.2 (24- 89) years, the number of patients of age less than 50 years were 282 (% 56.1). 85% of the patients detected a mass in their breast by themselves. % 27 of the patients over age 50 never had a breast ultrasound and/ or mammography done until the definite diagnosis was established. The median elapsed time between the disease noticed by the patient and the application to a health care center was 10 days, between the application and the biopsy was 19 days, between the biopsy and the surgery was 31 days. The elapsed time between recognition of the disease by the patient and the patient applying to a health care center in Group 1, Group 2, and Group 3 was 15, 10 and 14 days, respectively, and the elapsed time between the biopsy and surgery was 14, 1.5 and 12 days, respectively. The elasped time between the first recognition of the disease and applying of the patient to the health care center and the elapsed time between the biopsy and surgery in Group 2 centers was statistically significantly shorter compared to group 1 and 3 centers (p< 0.05). Conclusions: A high level of awareness of breast cancer in our country has examined through the time that is defined as 10 days between recognition of the disease and medical application. Compared with the developed countries the elapsed time between the application and biopsy, surgery and systemic therapy is longer than the expected and it has been marked differences between regions.Öğe ANTIEMETIC EFFICACY OF DIAZEPAM IN THE PROPHYLAXIS OF ACUTE AND DELAYED EMESIS INDUCED BY CISPLATIN BASED CHEMOTHERAPY TREATED WITH STANDARD ANTI EMETICS(Kare Publ, 2005) Saip, Pinar; Onat, Haluk; Uygun, Kazim; Demir, Cumhur; Salepci, Taflan; Guney, Nese; Basaran, MertThis study was conducted to evaluate the efficacy of diazepam in managing acute and delayed emesis induced by cisplatin-based chemotherapy. A total of 92 cancer patients who were receiving 60-75 mg/m(2) cisplatin based chemotherapy were treated with granisetron 3 mg/IV plus dexamethasone 16 mg/IV on the first day of the chemotherapy Forty three of these patients also treated with diazepam 5 mg/PO 10-12 and 1 hours before the chemotherapy and 42 of these patients did not received any diazepam prophylaxis. Categorical scales were utilised to document the incidence of vomiting, nausea and loss of appetite. Among the 85 evaluable patients there was no statistically significant difference between the treatment arms in terms of acute and delayed emesis. But more patients achieved acute complete control of vomiting (79% vs 64%) and defined their quality of life as very good and good (70% vs 52%) in the diazepam arm. The protection obtained at the first day significantly influenced the protection during the subsequent days irrespective of the treatment arms. Diazepam does not increase the efficacy of antiemetic treatment but the increase in the patients well being and complete control acute vomiting suggest that it could be added to the standard antiemetic protocols.Öğe 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]Öğe 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, AdnanBackground: 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.Öğe 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]Öğe 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, ErkanBackground: 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.Öğe Factors affecting the prognosis of breast cancer patients with brain metastases(Churchill Livingstone, 2008) Saip, Pinar; Cicin, Irfan; Eralp, Yesim; Kucucuk, Seden; Tuzlali, Sitki; Karagol, Hakan; Aslay, IsikThe aim of this retrospective analysis was to investigate the factors affecting the prognosis of brain metastases in breast cancer patients to identify subgroups which might benefit from prophylactic treatments in future. Seventy-three early and 13 advanced stage patients with known Erb-2 status were included. In 14% of the early stage patients, the first recurrence site was isolated brain metastasis. None of the anthracycline resistant patients had brain metastases as their first recurrence site. The median interval between diagnosis and brain metastasis was 41.5 months (95% CI, 35.79-47.20) in early stage patients. The median interval between the first extracerebral metastases to the brain metastases was 15.5 months (95% CI, 12.24-18.76) in all patients. High histologic and nuclear grade, large tumor, anthracycline resistance were the factors which significantly affected the early appearance of brain metastases but only advanced age (>= 55 years, P = .035) correlated with isolated brain metastasis. Progression with isolated brain metastases was significantly higher in responsive ErbB-2 positive population (P = .036) and none of other pathological factors was associated with isolated brain metastasis in advanced stage. The median survival after brain metastasis in patients with brain metastasis as first recurrence was longer than the patients with brain metastasis after other organ metastasis (13 months vs 2 months P = .003). The median survival following brain metastases in complete responsive patients was higher than the others (24 months vs 6 months, P = .002). Therefore, response to systemic treatment was more determinative in the development of isolated brain metastases than clinical and pathologic features. ErbB-2 should be emphasized in prophylactic treatment strategies. Prophylactic cranial radiotherapy may be an effective treatment option for metastatic patients with complete responsive disease and with controlled ErbB-2 positive disease. (C) 2008 Elsevier Ltd. All rights reserved.Öğe Factors related to recurrence after pathological complete response to postoperative chemotherapy in patients with epithelial ovarian cancer(Pensiero Scientifico Editor, 2009) Karagol, Hakan; Saip, Pinar; Eralp, Yesim; Topuz, Samet; Berkman, Sinan; Ilhan, Ridvan; Topuz, ErkanAims and background. It has been appreciated for some time that the lack of detection of ovarian cancer at clinical and pathological (second-look laparotomy) evaluation is not synonymous with cure. The goal of this study was to define clinical risk factors for recurrence after complete pathological response to postoperative chemotherapy in patients with epithelial ovarian cancer. Methods. Fifty-seven patients who met the inclusion criteria of our study were evaluated. The characteristics (age, menopausal status, histological subtype, tumor grade, presence of ascites at diagnosis, type of omentectomy, FIGO stage, and residual tumor volume after primary surgery) of patients with and those Without tumor recurrence were compared. Results. The median follow-up was 52 months (range, 15-142 months). The overall survival rates of the patients were 100%, 96%, and 87% at 1, 3 and 5 years, respectively At the time of the study analysis, 21 of 57 (37%) patients had recurrent disease. The median time to recurrence was 16 months. Recurrences were most frequent in the pelvis and abdominal cavity (38%). Age, menopausal status, stage at diagnosis, and residual tumor volume after initial surgery were significantly related to the risk of recurrence in univariate analysis (P = 0.039, 0.038, 0.004, and 0.000, respectively). Residual tumor volume after initial surgery-was found to be the only significant independent prognostic factor (P = 0.049, HR: 0.16, 95% CI: 0.02-0.99). Conclusion. We believe it is necessary to conduct randomized studies on this issue because insight into predictors of recurrence after pathological complete response to postoperative chemotherapy could be used to select patients for trials of consolidation therapy.Öğe Factors related with recurrence after complete pathologic response to post- operative chemotherapy in patients with epithelial ovarian cancer(Elsevier, 2006) Karagol, Hakan; Saip, Pinar; Uygun, Kazim; Eralp, Yesim; Topuz, Samet; Berkman, Sinan; Ilhan, Ridvan[Abstract Not Available]Öğe Identification of patients who may benefit from the prophylactic cranial radiotherapy among breast cancer patients with brain metastasis(Springer, 2009) Saip, Pinar; Cicin, Irfan; Eralp, Yesim; Karagol, Hakan; Kucucuk, Seden; Alas, Rusen Cosar; Yavuz, EkremBackground To identify the candidates for prophylactic cranial radiotherapy (PCI) among the patients with early and advanced-stage breast cancer. Methods The demographic, pathologic and clinical features and survival results of 182 brain metastatic breast cancer patients treated with cranial radiotherapy were examined. Results Early stage patients who progressed with isolated brain metastasis had longer survival (13 months vs. 4 months P = 0.006). Lobular/mixed type histology (P = 0.033), high nuclear (P = 0.046) and high histological grade (P = 0.034) were the prognostic factors for isolated brain metastases. The most significant factor for the time to brain metastasis was the number of involved of lymph nodes (P = 0.004). In 60% of 148 patients with metastatic breast cancer, a progression with isolated brain metastasis was developed while the systemic disease was under control. Isolated brain metastasis progression was related to the presence of the hepatic metastasis at the first relapse (P = 0.001) and with ErbB-2 overexpression (P = 0.034). The time to the brain metastasis from the first extracerabral metastasis was associated with the high nuclear grade (P = 0.040) and with chemoresistance (P = 0.037). The median survival time after the brain metastases in chemosensitive patients was longer than in chemoresistant patients (8 months vs. 3 months P = 0.044). In chemoresistant patients (P = 0.0028) and/or in triple negative patients (P = 0.05) the development of the brain metastasis was early and the survival after brain metastasis was short. Discussions Since there is a tendency to early brain metastasis in early stage patients with high-grade, lobular/mixed type histology tumors and with a high number of involved lymph nodes, the value of PCI can be explored in these patients by a well designed prospective trial. Advanced stage chemosensitive patients with ErbB-2 over-expression and/or with hepatic metastasis at their first relapse may be candidates for PCI. There is no place for PCI in chemoresistant and triple-negative breast cancer patients.Öğe Malignant Ovarian Germ Cell Tumors A Single-Institution Experience(Lippincott Williams & Wilkins, 2009) Cicin, Irfan; Eralp, Yesim; Saip, Pinar; Ayan, Inci; Kebudi, Rejin; Iyibozkurt, Cem; Tuzlali, SitkiObjective: To evaluate the clinicopathologic prognostic factors in malignant ovarian genii Cell tumors. Methods: We reviewed the medical records of 70 patients treated from 1990 to 2006 at our center. Clinical data including demographics, stage, surgery, chemotherapy, survival, menses status, and fertility were collected from patients' charts. Results: Median age was 22 years (range, 9-68). The histologic Subtypes included 36 dysgerminomas, 11 yolk sac tumors, 3 immature teratomas, 1 embryonal carcinomas, and 19 mixed types. The most striking clinicopathologic finding was a history of concomitant immunosuppressant therapy, which was observed in 2 patients. Two patients had contralateral sex-cord tumors at presentation and follow-up. During a median follow-tip period of 4.6 years, 11 patients had recurrence. The median time to recurrence was 8 months (6-28 months). Recurrences appeared in the abdominopelvic cavity in 9 Out Of 11 patients. Only one could be salvaged with second-line chemotherapy. Cumulative survival rate was 97% and 60% in patients with dysgerminoma and nondysgerminoma, respectively. Nondysgerminoma histology and residual tumor after surgery were unfavorable prognostic factors (P < 0.001 and P = 0.015). Fertility-sparing surgery was as effective as radical surgery among all eligible patients. Of patients with known menstrual status, 96% had regular menses. Of the 8 patients who opted for conception among these patients, 7 delivered healthy infants. Conclusions: Nondysgerminomas have an aggressive clinical course. New treatment strategies are needed for eradication of abdominopelvic disease at initial diagnosis and recurrent setting. Occurrence of malignant ovarian germ cell tumors may be associated with immunosuppression in some patients. Sex-cord stromal tumors may present with bilateral involvement. It is possible to maintain fertility after fertility-sparing surgery followed by chemotherapy.Öğe Ovarian carcinosarcomas: Clinicopathological prognostic factors and evaluation of chemotherapy regimens containing platinum(Academic Press Inc Elsevier Science, 2008) Cicin, Irfan; Saip, Pinar; Eralp, Yesirn; Selam, Meltern; Topuz, Samet; Ozluk, Yasernin; Aydin, YucelObjective. To evaluate the clinicopathological prognostic factors and outcome of chemotherapy in ovarian carcinosarcomas. Methods. We reviewed the records of 26 patients treated from 1990 to 2006 at the Oncology Institute of Istanbul University. Clinical data including demographics, stage, surgery, chemotherapy, and survival were collected from patients' charts. Results. All patients underwent initial debulking surgery. Optimal debulking was achieved in 21 (81%) patients. The most striking clinicopathological finding was the high incidence of hemorrhagic ascites (n: 6) which was observed in 60% of the patients with ascites (n: 10). The overall median survival of the patients was 26 months. Residual disease was associated with a decreased overall survival, P=0.04. Median survival (50 months vs 9.7 months, P=0.042) of the patients with early stage disease were longer than the patients with advanced stage. Twenty-two patients received platinum-based combination chemotherapy. There was a trend for increased median survival in the patients who were treated with carboplatin/paclitaxel combination (P=0.066). Although the numbers were insufficient for statistical evaluation, the patients treated with ifosfamide combinations had improved survival (36 months vs 26 months). However, when the patients treated with ifosfamide and carboplatin/ paclitaxel combinations were combined, survival was statistically improved compared to the other regimens (36 months vs 9.7 months, P=0.04). Chemotherapy regimens containing doxorubicin or cyclophosphamide were not encouraging. Stage (P=0.02) and adjuvant platinum-based chemotherapy containing either paclitaxel or ifosfamide (P=0.024) remained predictive of outcome in the multivariate analysis. Conclusions. Hemorrhagic ascites can be used in the initial differential diagnosis of ovarian carcinosarcomas. Stage, optimal debulking and type of adjuvant therapy were statistically significant prognostic predictors of ovarian carcinosarcomas. We advise that patients with ovarian carcinosarcomas should be treated by optimal cytoreduction followed by adjuvant platinum/taxan or platinum/ifosfamide combinations. C 2007 Elsevier Inc. All rights reserved.Öğe Second line chemotherapy in non-small-cell lung carcinoma: A single-institution experience(Oxford Univ Press, 2006) Uygun, Kazim; Cicin, Irfan; Karagol, Hakan; Uzunoglu, Sernaz; Saip, Pinar[Abstract Not Available]Öğe The treatment results of patients with extrapulmoner and pulmoner small cell cancer(Oxford Univ Press, 2006) Uygun, Kazim; Cicin, Irfan; Karagol, Hakan; Uzunoglu, Sernaz; Kocak, Zafer; Caloglu, Murat; Saip, Pinar[Abstract Not Available]Öğe Yolk sac tumours of the ovary: Evaluation of clinicopathological features and prognostic factors(Elsevier Ireland Ltd, 2009) Cicin, Irfan; Saip, Pinar; Guney, Nese; Eralp, Yesim; Ayan, Inci; Kebudi, Rejin; Topuz, ErkanObjective: To evaluate the clinicopathological prognostic features, factors and outcomes of chemotherapy in ovarian yolk sac tumours (YST). Study design: We reviewed the medical records of 32 women with ovarian YST treated from 1990 to 2006 at two centres. Results: The median follow-up was 36 months. The median age was 22 (range, 9-68). Two patients were postmenopausal. The most common symptoms at diagnosis included abdominal swelling or mass (72%) and abdominopelvic pain (62%). The location of the tumour was bilateral in 2 cases. Eight patients were in stage I, 4 patients in stage II, 17 patients in stage III, and 3 patients in stage IV. Eighteen patients underwent unilateral salpingo-oophorectomy, two bilateral salpingo-oophorectomy and two cystectomy, while 10 patients had total abdominal hysterectomy and two bilateral salpingo-oophorectomy. Of 32 patients who received postoperative chemotherapy, 27 were treated with a bleomycin/etoposide/cisplatin (BEP) regimen. Seventy-two percent of patients were alive at the last follow-up visit. Ten (31%) patients suffered from a recurrence of the disease with a median time to recurrence of 8 months (range, 6-28 months). The most common site of recurrence was the intra-abdominal space, with 8 patients. Only one patient who had recurrence could be salvaged. Fertility-sparing surgery was found at least as effective as radical surgery. While age, histology (mixed vs. pure), stage, tumour size, ascites, and marker levels were not found as prognostic factors, the presence of residual tumour (P = 0.014) and BEP chemotherapy (P = 0.016) were significant prognostic factors in univariate analysis. Conclusions: In patients with ovarian YST, fertility-sparing surgery is as effective as radical surgery. Optimal cytoreductive surgery and standard BEP regimen are the most decisive prognostic factors. In these tumours, adjunctive therapeutic modalities to eradicate intra-abdominal disease and effective salvage therapy strategies are needed. (C) 2009 Elsevier Ireland Ltd. All rights reserved.
