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Öğe Analysis of early and last effects concomittant chemoradiotherapy of 24 patients with locally advanced cervical carcinoma (lacc)(Oxford Univ Press, 2004) Tokatli, Fusun; Uygun, Kazim; Ibis, Kamuran; Bayir, Gulden; Denizli, Bengu; Uzal, Cem[Abstract Not Available]Öğe 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, FusunMalignant 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.Öğe Clinical and prognostic features of plasmacytomas: A multicenter study of Turkish Oncology Group-Sarcoma Working Party(Wiley, 2008) Kilciksiz, Sevil; Celik, Omur Karakoyun; Pak, Yucel; Demiral, Ayse Nur; Pehilvan, Mustafa; Orhan, Okan; Tokatli, FusunTo identify the outcomes of prognostic factors of solitary plasmacytoma mainly treated with local radiotherapy (FIT). The data were collected from 80 patients with solitary plasmacytoma (SP). Forty patients (50.0%) received radiotherapy (FIT) alone while 38 of them (47.5%) were treated with surgery (S) and FIT. The median radiation dose was 46 Gy (range 30-64). The median follow up was 2.41 years (range 0.33-12.33). Ten-year overall survival (OS) and local relapse-free survival (LRFS) were 73% and 94%, respectively. The median progression-free survival (PFS) and multiple myeloma-free survival (MMFS) were 3.5 years and 4.8 years, respectively. On multivariate analyses, the favorable factors were radiotherapy dose of >= 50 Gy and RT + S for PFS and younger age for MMFS. For the patients with medullary plasmacytoma, the favorable factor was younger age for MMFS. RT at >= 50 Gy and RT + S may be favorable prognostic factors on PFS. Younger patients, especially with head-neck lesion and without pre-RT macroscopic tumor, seem to have the best outcome when treated with RT +/- S. Progression to MM remains as the main problem especially for older patients.Öğe Colonic metastasis from carcinoma of the breast that mimicks a primary intestinal cancer(Yonsei Univ Coll Medicine, 2006) Uygun, Kazim; Kocak, Zafer; Altaner, Semsi; Cicin, Irfan; Tokatli, Fusun; Uzal, CemAlthough the lung, liver, or bones are the most common location for distant metastases; in breast cancer patients, metastases to the intestinal tract are very rarely recognized in the clinic. We will present an unusual case of colonic metastasis from a carcinoma of the breast that mimics a primary intestinal cancer, along with a through review of English language medical literature. Despite the fact that isolated gastrointestinal (GI) metastases are very rare and much less common than benign disease processes or second primaries of the intestinal tract in patients with a history of breast cancer, metastatic disease should be given consideration whenever a patient experiences GI symptoms.Öğe The comparisons of prognostic indexes using data mining techniques and Cox regression analysis in the breast cancer data(Pergamon-Elsevier Science Ltd, 2009) Ture, Mevlut; Tokatli, Fusun; Omurlu, Imran KurtThe purpose of this study is to determine new prognostic indexes for the differentiation of subgroups of breast cancer patients with the techniques of decision tree algorithms (C&RT, CHAID, QUEST, ID3, C4.5 and C5.0) and Cox regression analysis for disease-free survival (DFS) in breast cancer patients. A retrospective analysis was performed in 381 breast cancer patients diagnosed. Age, menopausal status, age of menarche, family history of cancer, histologic tumor type, quadrant of tumor, tumor size, estrogen and progesterone receptor status, histologic and nuclear grading, axillary nodal status, pericapsular involvement of lymph nodes, lymphovascular and perineural invasion, adjuvant radiotherapy, chemotherapy and hormonal therapy were assessed. Based on these prognostic factors, new prognostic indexes for C&RT, CHAID, QUEST, ID3, C4.5 and C5.0 and Cox regression were obtained. Prognostic indexes showed a good degree of classification, which demonstrates that an improvement seems possible using standard risk factors. We obtained that C4.5 has a better performance than C&RT, CHAID, QUEST, ID3, C5.0 and Cox regression to determine risk groups using Random Survival Forests (RSF). (C) 2008 Elsevier Ltd. All rights reserved.Öğe The correlation between TTF-1 immunoreactivity and the occurrence of lymph node metastases in patients with lung cancer(Sage Publications Ltd, 2006) Altaner, Semsi; Yoruk, Yener; Tokatli, Fusun; Kocak, Zafer; Tosun, Birsen; Guresci, Servet; Kutlu, KemalAims and background: Thyroid transcription factor (TTF-1) is a tissue-specific transcription factor expressed in the epithelial cells of thyroid and lung. The aim of this study was to evaluate the relationship between the expression of TTF-1 and clinicopathological parameters in pulmonary adenocarcinoma and adenosquamous carcinoma. Methods: Resection material of pneumonectomies and lobectomles of 39 patients was retrospectively examined. Twenty-eight patients were diagnosed with adenocarcinoma and 11 with adenosquamous carcinoma. Tumors were classified into 3 groups: a strongly positive group (++) with double dagger 50% tumor cells positive for TTF-1; a weakly positive group (+) with 1-49% positive tumor cells; and a negative group (-) with less than 1% or no positive tumor cells. Analysis was performed with Kaplan-Meier estimates and log-rank tests. Results: Staining for TTF-1 was negative in 10 cases. There was focal staining in 9 cases, while there was diffuse staining in 20 (51%) cases out of 39, and 15 (75%) of these were adenocarcinomas. There was a statistically significant association between TTF-1 and lymph node metastases (P = 0.029). No relationship was found between TTF-1 positivity and disease-free and overall survival. Conclusions: TTF-1 expression may be a predictor of lymph node metastases. Additional work in a larger group of patients is needed to better assess the utility of this marker.Öğe Expression of Bcl-2 and Ki-67 in tamoxifen-associated endometrial polyps: Comparison with postmenopausal polyps(Karger, 2006) Altaner, Semsi; Gucer, Fatih; Tokatli, Fusun; Guresci, Servet; Ozdemir, Cigdem; Puyan, Fulya Oz; Kutlu, KemalBackground: The aim of this study was to evaluate the expression of Bcl-2 and Ki-67 in tamoxifen (TAM)-associated endometrial polyps and postmenopausal polyps. Material and Methods: For this purpose, a retrospective analysis of paraffin-embedded specimens was carried out. Polyps of 20 postmenopausal and 14 TAM-treated patients, 11 simple endometrial hyperplasia, 10 atypical complex endometrial hyperplasia and 8 endometrial adenocarcinoma specimens were included in the study. Hematoxylin/eosin-stained sections were evaluated. Immunohistochemical staining was performed to investigate the expression of Bcl-2 protein and the Ki-67 proliferation index. Results: There was no statistically significant difference between the 5 groups with regard to Bcl-2 staining (p > 0.05). However, Bcl-2 expression in TAM-associated polyps was higher (86%) than in the postmenopausal control group (80%). Positive Ki-67 was highest in the endometrial adenocarcinoma specimens, followed by the atypical complex endometrial hyperplasia group (p < 0.0001). Compared to these 2 groups, Ki-67 expression was lower in TAM-associated polyps, but Ki-67 indexes were significantly higher in the TAM-associated group than in the control group (p < 0.0001). Conclusion: Since TAM-associated polyps tend to have higher proliferation indexes and Ki-67 ratios than control groups, we suggest that they are likely to have a higher malignant potential.Öğe The Importance of Using PET/CT Investigation in Case of Recurrence in an Ovarian Cancer Case with Lymph Node Metastasis Without any Lesions That can be Scanned via Conventional Methods(Galenos Yayincilik, 2008) Tanriverd, Ozgur; Uzunoglu, Sernaz; Karagol, Hakan; Cicin, Irfan; Cosar Alas, Rusen; Tokatli, Fusun; Altaner, SemsiAlthough lymph node involvement is common in ovarian cancer, axillary and supraclavicular lymph node involvement is quite rare. In the 55-year-old patient without any lesions that are scannable via conventional methods, in which increase of CA-125 level was detected during follow-up, recurrence was detected via combined positron emission tomography and computed tomography investigation. This case recurring with intraabdominal and supraclavicular and axillary lymph node (which are rare regions of involvement) metastasis has been discussed with literature information. In this article, the importance of combined positron emission tomography and computed tomography investigation in patients with suspected recurrence in whom no tumor detectable via conventional methods has been identified was highlighted.Öğe THE INTERACTION OF RADIOTHERAPY AND CHEMOTHERAPY IN BREAST CANCER TREATMENT(Aves, 2008) Tokatli, FusunCytotoxic agents can increase the efficacy of radiation. Radiosensitizing effects (interaction within the radiation field) can be additive or supra-additive. Multiple mechanisms underlie radiosensitizing properties of cytotoxic agents and include increased radiation damage, inhibition of DNA repair, cell-cycle synchronization, increased cytotoxicity against hypoxic cells, inhibition of prosurvival pathways, and abrogation of rapid tumor cell repopulation. The agents, which have the most radiosensitizing effects, are cisplatin and paclitaxel. In addition to the classic cytotoxic agents with radiosensitizing properties several novel agents show promising interactions with radiation (e.g. EGFR inhibitors, antiangiogenic agents). Today, a sequential treatment is the standard treatment in the early stage breast cancer patients. However, concomitant chemotherapy and radiotherapy (RT) could be more appropriate to patients with high risk of recurrence, for example, in those with axillary lymph node metastases, close or positive surgical margins, large tumor size, young age and presence of lymphovascular invasion. Phase III trials are needed to define the benefits and the late effects of concomitant modern RT techniques (with 3 dimensional conformal, intensity modulated or image guided RT) with taxanes, capecitabine and targeted biologic agents in the adjuvant settings.Öğe Palliative radiotherapy for malign melanoma: a case report(Kare Publ, 2006) Yurut-Caloglu, Vuslat; Caloglu, Murat; Tokatli, Fusun; Kocak, Zafer; Cosar-Alas, Rusen; Ibis, Kamuran; Karagol, HakanMalignant melanoma is a skin cancer with poor prognosis. Historically melanoma has been thought of as a relatively radioresistant tumour. Nowadays, radiation delivered according to hypofractionated schedule is the most used, although there are few data confirm that this schedule improves the therapeutic impact. We report a case, with stage IV malignant melanoma, whose tumoral bleeding was palliated successfully giving 20 Gy external radiotherapy in 5 fractionations.Öğe Postmastectomy irradiation in breast in breast cancer patients with T1-2 and 1-3 positive axillary lymph nodes: Is there a role for radiation therapy?(Bmc, 2011) Cosar, Rusen; Uzal, Cem; Tokatli, Fusun; Denizli, Bengu; Saynak, Mert; Turan, Nesrin; Uzunoglu, SernazBackground: We aimed to evaluate retrospectively the correlation of loco-regional relapse (LRR) rate, distant metastasis (DM) rate, disease free survival (DFS) and overall survival (OS) in a group of breast cancer (BC) patients who are at intermediate risk for LRR (T1-2 tumor and 1-3 positive axillary nodes) treated with or without postmastectomy radiotherapy (PMRT) following modified radical mastectomy (MRM). Methods: Ninety patients, with T1-T2 tumor, and 1-3 positive nodes who had undergone MRM received adjuvant systemic therapy with (n = 66) or without (n = 24) PMRT. Patient-related characteristics (age, menopausal status, pathological stage/tumor size, tumor location, histology, estrogen/progesterone receptor status, histological grade, nuclear grade, extracapsular extension, lymphatic, vascular and perineural invasion and ratio of involved nodes/dissected nodes) and treatment-related factors (PMRT, chemotherapy and hormonal therapy) were evaluated in terms of LRR and DM rate. The 5-year Kaplan-Meier DFS and OS rates were analysed. Results: Differences between RT and no-RT groups were statistically significant for all comparisons in favor of RT group except OS: LRR rate (3% vs 17%, p = 0.038), DM rate (12% vs 42%, p = 0.004), 5 year DFS (82.4% vs 52.4%, p = 0.034), 5 year OS (90,2% vs 61,9%, p = 0.087). In multivariate analysis DM and lymphatic invasion were independent poor prognostic factors for OS. Conclusion: PMRT for T1-2, N1-3 positive BC patients has to be reconsidered according to the prognostic factors and the decision has to be made individually with the consideration of long-term morbidity and with the patient approval.Öğe PROGNOSTIC FACTORS AND TREATMENT RESULTS IN LARYGEAL CARCINOMA: DEPARTMENT OF RADIATION ONCOLOGY OF TRAKYA UNIVERSITY MEDICAL SCHOLL EXPERIENCE(Kare Publ, 2005) Caloglu, Murat; Yurut Caloglu, Vuslat; Uzal, Cem; Karagol, Hakan; Tokatli, Fusun; Uygun, KazimPurpose: To review the Department of Radiation Oncology of Trakya University Medical School experience in the treatment of laryngeal carcinoma and to evaluate the different factors affecting locoregional control. Methods and Material: We reviewed the records of 78 consecutive patients were treated for laryngeal carcinoma between July 1999 and November 2004. There were 74 men and 4 women, with a median age of 58 years (range, 34-80 years). Forty-two patients had T4 lesions, and 20 had T3 lesions; 32 had NO, 15 had N1, 27 had N2, and 2 had Nx disease. Surgery was the primary treatment modality in 34 patients. Twenty-six patients had RT alone, or chemotherapy combined with RT. Eighteen patients applied with locoregional or distant recurrent disease and they were given salvage or palliative treatment. x2 statistics were employed to identify significant factors for LRC. Results: The median follow-up was 18 months (range, 4-54 months). Twelve patients relapsed, of which 9 (26.5 %) locoregional failures among 34 patients of postoperative radiotherapy group. Significant prognostic factors for locoregional recurrence on univariate analysis were performance status, and surgical margin. Nine of 26 (34.6 %) patients relapsed and all of them had locoregional failures in primary radiotherapy group. Significant prognostic factors for these patients were primary tumor site, overall stage, T stage, and N stage. Conclusion: Radiotherapy is effective in the treatment of laryngeal carcinoma. The identification of prognostic factors for locoregional recurrence could help to determine more effective treatment strategies.Öğe Prognostic value DCE-MRI parameters in predicting factor disease free survival and overall survival for breast cancer patients(Elsevier Ireland Ltd, 2012) Tuncbilek, Nermin; Tokatli, Fusun; Altaner, Semsi; Sezer, Atakan; Ture, Mevlut; Omurlu, Imran Kurt; Temizoz, OsmanPurpose: The aim of the study is to assess the predictive power of DCE-MRI semi-quantitative parameters during treatment of breast cancer, for disease-free (DFS) and overall survival (OS). Materials and methods: Forty-nine women (age range, 28-84 years; mean, 50.6 years) with breast cancer underwent dynamic contrast enhancement MRI at 1.0 T imaging, using 2D FLASH sequences. Time intensity curves (TICs) were obtained from the regions showing maximal enhancement in subtraction images. Semi-quantitative parameters (TICs; maximal relative enhancement within the first minute, E (max/1); maximal relative enhancement of the entire study, E-max; steepest slope of the contrast enhancement curve; and time to peak enhancement) derived from the DCE-MRI data. These parameters were then compared with presence of recurrence or metastasis, DFS and OS by using Cox regression (proportional hazards model) analysis, linear discriminant analysis. Results: The results from of the 49 patients enrolled into the survival analysis demonstrated that traditional prognostic parameters (tumor size and nodal metastasis) and semi-quantitative parameters (E-max/1, and steepest slope) demonstrated significant differences in survival intervals (p < 0.05). Further Cox regression (proportional hazards model) survival analysis revealed that semi-quantitative parameters contributed the greatest prediction of both DFS, OS in the resulting models (for E-max/1: p = 0.013, hazard ratio 1.022; for stepest slope: p = 0.004, hazard ratio 1.584). Conclusion: This study shows that DCE-MRI has utility predicting survival analysis with breast cancer patients. (C) 2011 Elsevier Ireland Ltd. All rights reserved.Öğe Using Kaplan-Meier analysis together with decision tree methods (C&RT, CHAID, QUEST, C4.5 and ID3) in determining recurrence-free survival of breast cancer patients(Pergamon-Elsevier Science Ltd, 2009) Ture, Mevlut; Tokatli, Fusun; Kurt, ImranCurrent evidence supports a clear association between clinical and pathologic factors and recurrence-free survival (RFS) in breast cancer patients. The Cox regression model is the most common tool for investigating simultaneously the influence of several factors oil the survival time of patients. But it gives no estimate of the degree of separation of the different Subgroups. We propose to analyze different decision tree methods (C&RT, CHAID. QUEST, C4.5 and ID3) and use them additionally to the well-known Kaplan-Meier estimates to investigate the predictive power of these methods. Five hundred patients were included to the study. Two hundred and seventy-nine of them had complete data for prognostic factors and median follow-up is about 40.5 months. First, decision tree methods were analyzed for prognostic factors. Then, according to multidimensional scaling method C4.5 (error rate 0.2258 for training set and 0.3259 for cross-validation) performed slightly better than other methods in predicting risk factors for recurrence. Tumor size, age of menarche, hormonal therapy. histological grade and axillary nodal Status arc found that in important risk factors for the recurrence. Eight terminal nodes were found and stratified by Kaplan-Meier survival curves. Larger tumor size (>= 4.4 cm) and receiving no hormonal therapy in a small subgroup of patients were associated with worse prognosis. The five-year RFS is 71.3% in the whole patient population. The sensitivity, specificity and predictive rates calculated by C4.5 method were found 43.8%, 91% and 77.4% respectively. In this study, C4.5 showed a better degree of separation. As a result, we recommend 10 use decision tree methods together with Kaplan-Meier analysis to determine risk factors and effect of this factors oil survival. (C) 2008 Elsevier Ltd. All rights reserved.Öğe THE VALUE OF MAGNETIC RESONANCE IMAGING IN BILATERAL SYNCHRONOUS BREAST CANCER(Kare Publ, 2005) Tuncbilek, Nermin; Okten, Ozerk Omur; Karakas, Hakki Muammer; Tokatli, FusunThe prevalence of synchronous bilateral breast cancer is approximately 1-3%. It has a greater risk for distant metastasis than unilateral breast cancer. The early determination of the bilaterality and multifocality of the breast cancer could change the therapeutic options, and subsequently reduce the mortality and morbidity rates. Current screening methods for the breast cancer are mammography and clinical examination. In this paper, we evaluated the additional diagnostic value of dynamic contrast-enhancement magnetic resonance mammography to conventional techniques.
