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    Bevacizumab plus irinotecan in recurrent or progressive malign glioma: a multicenter study of the Anatolian Society of Medical Oncology (ASMO)
    (Springer, 2013) Demirci, Umut; Tufan, Gulnihal; Aktas, Bilge; Balakan, Ozan; Alacacioglu, Ahmet; Dane, Faysal; Engin, Huseyin
    The overall prognosis for recurrent malignant glioma (MG) is extremely poor, and treatment options are limited. We evaluated our multicenter retrospective experience for patients with recurrent MG administering bevacizumab and irinotecan in combination therapy. A total of 115 patients with grade IV glial tumor (n = 93) and grade III glial tumor (n = 22) were retrospectively evaluated at 14 centers in Turkey. Primary objectives of the study were to evaluate the efficacy and toxicity of the bevacizumab and irinotecan as salvage treatment based on response to therapy, progression-free survival (PFS), 6 months of PFS, overall survival (OS), and 6 months of OS (OS6). Bevacizumab and irinotecan were performed as second line (79.1 %) and third line treatment (20.9 %). Median chemotherapy cycle was 6 (range 1-37), and median follow-up was 6 months (range 1-36 months). Objective response rate was 39.1 %. Six-month PFS and OS6 were 46.3 % and 67.5 %, respectively. Median PFS was 6 months (95 % CI 2.5-9.5) and 6 months (95 % CI 4.9-7.1) in the grade III and IV groups, respectively (p = 0.773). Median OS was 9 months (95 % CI 7.1-10.9) and 8 months (95 % CI 6.6-9.4) in the grade III and IV groups, respectively (p = 0.450). Serious toxicities were observed in 7.8 % of patients. Treatment-related toxic death was observed in 3 patients. There was no treatment related to central nervous system hemorrhage or other serious hemorrhages. Present study results were consistent with previous studies. In addition, we detected similar outcomes in grade III and IV glial tumors.
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    Efficacy of sorafenib in patients with gastrointestinal stromal tumors in the third- or fourth-line treatment: A retrospective multicenter experience
    (Spandidos Publ Ltd, 2013) Kefeli, Umut; Benekli, Mustafa; Sevinc, Alper; Yildiz, Ramazan; Kaplan, Muhammed Ali; Ciltas, Aydin; Balakan, Ozan
    Sorafenib is a multi-targeted tyrosine kinase receptor inhibitor used to treat patients with advanced gastrointestinal stromal tumors (GISTs). The present study evaluated the efficacy and tolerability of sorafenib therapy for patients with GISTs. Between January 2001 and November 2012, 25 patients, from multiple centers, who had received sorafenib as the third-or fourth-line treatment for GISTs were investigated retrospectively. In total, 17 patients were male and eight were female. The median age was 54.0 years (range, 16-82 years). From the patients, 21 received imatinib for longer than six months and four received it for less than six months. The clinical benefit rate of sorafenib was 40.0%. Treatment-related adverse events were reported in 72% of patients. These adverse events were generally mild to moderate in intensity. The median progression-free survival (PFS) and overall survival (OS) times of the patients who received sorafenib were 7.2 and 15.2 months, respectively. The duration of imatinib usage was an independent prognostic factor for PFS and OS. Sorafenib is an effective treatment in patients with GISTs showing a clinical benefit rate of 40.0% and an acceptable tolerability.
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    Efficiency and Side Effects of Sorafenib Therapy for Advanced Hepatocellular Carcinoma: A Retrospective Study by the Anatolian Society of Medical Oncology
    (Asian Pacific Organization Cancer Prevention, 2013) Berk, Veli; Kaplan, Mehmet Ali; Tonyali, Onder; Buyukberber, Suleyman; Balakan, Ozan; Ozkan, Metin; Demirci, Umut
    Background: Inoperable and metastatic hepatocellular carcinoma (HCC) is associated with a poor prognosis and low chemotherapeutic efficiency. Sorafenib is an oral multi-kinase inhibitor exerting its effects via the RAF/MEK/ERK pathway, vascular endothelial growth factor receptor (VEGFR) and platelet derived growth factor receptor beta (PDGFR-beta) tyrosine kinases. Randomized studies have shown a significant contribution of sorafenib to life expectancy and quality of life of cancer patients. The aim of the present study is to evaluate the efficacy and side effects of sorafenib therapy in Turkey. Materials and Methods: Data for 103 patients (82 males, 21 females) receiving sorafenib therapy in 13 centers from February 2008 to December 2012 were evaluated. Median age was 61 years and median ECOG performance status was 1 (range: 0-2). 60 patients (58%) had hepatitis B, 15 patients (15%) had hepatitis C infection and 12 patients (12%) had a history of alcohol consumption. All of the patients had Child scores meeting the utilization permit of the drug in our country (Child A). Results: A total of 571 cycles of sorafenib therapy were administered with a median of four per patient. Among the evaluable cases, there was partial response in 15 (15%), stable disease in 52 (50%), and progressive disease in 36 (35%). Median progression-free survival was 18 weeks and median overall survival was 48 weeks. The dose was reduced only in 6 patients and discontinued in 2 patients due to grade 3-4 toxicity, 18 patients (17%) suffering hand-foot syndrome, 7 (7%) diarrhea, and 2 (2%) vomiting. Conclusions: This retrospective study demonstrated better efficacy of sorafenib therapy in patients with advanced HCC compared to the literature while progression-free survival and overall survival findings were comparable. The side effect rates indicate that the drug was tolerated well. In conclusion, among the available treatment options, sorafenib is an efficient and tolerable agent in patients with inoperable or metastatic HCC.
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    Helicobacter pylori in primary gastric lymphoma and gastric cancer: A clinicopathologic and prognostic assessment
    (2013) Dal, Mehmet Sinan; Urakçı, Zuhat; Yıldız, Yılmaz; Alabalık, Ulaş; Küçüköner, Mehmet; İnal, Ali; Balakan, Ozan
    Amaç: Helicobacter pylori mide lenfoması ve adenokarsinom için risk faktörüdür. Bu çalışmada H. pylori'nin primer mide lenfoma ve mide kanserinde prognostik faktör olup olmadığı incelendi.Yöntemler: Primer mide lenfoma ve mide kanserli 255 hastanın rezeksiyon veya biyopsi materyalleri H. pylori açısından incelendi. Patoloji spesmenlerinde H. pylori varlığını değerlendirmek için hematoksilen ve eozin boyası kullanıldı.Bulgular: Primer mide lenfomalı 140 hastanın 34'ünde (%24,3) H. pylori saptanırken mide kanserli 115 hastanın 62'sinde (%53,9) H. pylori saptandı. H. pylori varlığı mide kanserli hastalarda, mide lenfomalardan daha sık görüldü (p< 0.001). H. pylori pozitifliği, mide lenfoma içinde mukoza ilişkili lenfoid doku tip lenfomada (MALT) %53,5 oranında, diffüz büyük B hücreli lenfomadan farklı olarak %18,7 oranında görüldü (p< 0,001). Primer mide lenfoma da H. pylori'nin varlığı hastalıksız sağkalım ve genel sağkalım açısından anlamlılık oluşturmuyordu (p=0,833, p= 0,503). Bununla beraber mide kanserli hastalarda da H. pylori varlığı ile hastalıksız sağkalım ve genel sağkalımda da anlamlılık oluşturmuyordu (p=0,392, p= 0,357). Sonuç: Çalışmamızda mide kanserli ve primer mide lenfoma arasında H. pylori varlığı bakımından anlamlı farklılık vardı. Ancak H. pylori varlığı, hem hastalıksız sağkalım hem de genel sağkalım açısından prognostik anlamlılık oluşturmuyordu.
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    Hipokrom mikrositer anemi ile başvuran hastada talassemi minör ve kurşun entoksikasyonu birlikteliği
    (2006) Kara, İsmail H.; Balakan, Ozan; Kıdır, Veysel; Süner, Ali
    Huzursuzluk, halsizlik, yorgunluk ve efor intoleransı şikayetleri ile Dicle üniversitesi Tıp Fakültesi Aile Hekimliği Polikliniği’ne başvuran 39 yaşındaki bayan hastanın muayenesinde obesite [Vücut Kitle İndeksi (VKI) = 32 kg/m2] ve konjunktivalarda solukluk saptandı. Aneminin etyolojik incelemesinde, hipokrom mikrositer anemi tespit edildi. Olgunun, serum demiri, demir bağlama kapasitesi ve ferritin düzeyi normal bulununca diğer nedenler incelendi. Hemoglobin elektroforezinde HbA1, HbA2 ve HbF düzeyleri sırasıyla %93.5, %3.8 ve %2.7 bulundu. Atomik absorpsiyon spektrofotometresi (AAS) ile ölçülen kan kurşun düzeyi de 1.01 ppm bulundu. Hastanın bulguları talassemi minör ve kurşun entoksikasyonu ile uyumluydu. Mesleki veya çevresel kurşun maruziyeti saptanmayan olguda, yüksek kan kurşun düzeyi tek risk faktörü olan sigara içimine bağlandı. Burada sunulan olgu, talassemi minör ve kurşun entoksikasyonu birlikteliği olgusu olarak hipokrom mikrositer anemi ayırıcı tanısında dikkat çekici görünmektedir.
  • Küçük Resim
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    Kronik delta Hepatitli, kronik Hepatit B'li ve iyileşmiş Hepatit B'li hastalarda plazma sitokon ve CD düzeylerinin karşılaştırılması
    (2017) Balakan, Ozan; Yalçın, Kendal
    Çalışmamıza Aralık 2003 ile Mayıs 2005 tarihleri arasında Dicle Üniversitesi Hastanesi Gastroenteroloji polikliniğinde, kronik hepatit B ve delta hepatit tanılarıyla takip edilen 152 hasta ile iyileşmiş hepatit B'li 42 sağlıklı birey dahil edildi. Hastalarda tanı, anamnez, fizik muayene, biyokimyasal parametreler, serum HBV belirleyicileri, HBV-DNA, anti-HDV antikorları, HDV RNA, gerekli görülen ve işlemi kabul edenlere perkütan karaciğer biyopsi incelemesi yapılarak konuldu. Bu çalışmada kronik hepatit B ve kronik delta hepatit tanısı konulan hastalarla daha önceden hepatit B ile karşılaşmış ve virüse karşı antikor geliştirmiş olan iyileşmiş hepatit B'li bireylerde hepatit B enfeksiyonunun kronikleşmesinde rolü olduğu düşünülen CD oranlan (CD3, CD4, CD8, CD56, CD4/CD8) ile plazma inflamatuar sitokinleri (İLİ- p, İL-2 reseptörü, ÎL-6, ÎL-8, İL-10, TNF- a) araştırıldı. Tüm gruplarda (kronik hepatit B, kronik hepatit D, iyileşmiş hepatit B) ortalama CD3, CD4, CD8, CD56 oranlan erişkin yaş normal sınırlan içerisinde bulundu. Gruplar arası karşılaştırmada kronik hepatit B ve D'li hastalar arsında CD4 düzeyleri dışında istatistiksel olarak anlamlı bir fark bulunamadı. Tüm grupların ortalama CD4/CD8 oranlan erişkin yaş normal sınırlan içerisinde bulumdu. İL-1B tüm gruplarda saptanamayacak düzeylerde düşük bulundu. Hastalıklı grupta İL-2 reseptörü, İL-8 ve TNF-a iyileşmiş hepatit B grubuna göre anlamlı düzeyde yüksek bulundu (P<0,05). HDV'li grupta TNF-a ve İL-8 düzeyi HBV'li gruba göre artmış bulundu (P<0,05). Sirozlu hastaların sitokin düzeyleri ile sirozu bulunmayanlar ki arasında anlamlı bir fark saptanmadı (P>0,05). TNF-a ile İL-2 reseptörü, ALT düzeyi ve hepatik aktivite indeksi arasında pozitif koreleasyon bulundu (P<0,05). İL-2 reseptörü ile TNF-a ve ALT düzeyleri arasında pozitif koreleasyon bulundu (P<0,05). Bu sonuçlar bize sitokinlerin vücutun immün yanıtını ve hastalığın aktivite derecesini tesbitte kullanılabileceğini göstermektedir.
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    MICRONUCLEUS SCORE IN THE BUCCAL MUCOSA OF WOMEN WITH BREAST CANCER AND THE RELATIONSHIP TO CHEMOTHERAPY
    (Oxford Univ Press, 2014) Kalender, Mehmet E.; Yildirim, Ibrahim H.; Ulasli, Mustafa; Oztuzcu, Serdar; Kizilyer, Ayse; Suner, Ali; Balakan, Ozan
    [Abstract Not Available]
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    Multipl atriyal trombus gelişen splenektomili talasemi major olgusu
    (2005) Ayyıldız, Orhan; Süner, Ali; Balakan, Ozan; Kıdır, Veysel; Şit, Dede
    Talasemi majorlü (TM) hastaların son yıllarda daha uzun yaşatılabilmeleri daha önce bilinmeyen bazı komplikasyonların ortaya çıkmasına neden olmuştur. Bu komplikasyonlardan biri de hemostatik değişikliklere bağlı gelişen tromboembolik olaylardır. Özellikle splenektomi geçiren talasemililerde kronik hiperkoagülabilitenin varlığı kanıtlanmıştır. Talasemide birçok tromboembolik komplikasyonlar bildirilmiştir. Bunların önemli bir bölümü serebral trombozlardır. İntrakardiyak trombus ise oldukça nadirdir. Bu sunumda 6 yıl önce splenektomi yapılan ve 2 yıldır gittikçe artan efor dispnesi olan ve ekokardiyografisinde sağ atriyumda multiple trombus saptanan TM olgusu sunulmaktadır.
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    NON-SMALL CELL LUNG CANCER IN YOUNG PATIENTS: CLINICOPATHOLOGICAL FEATURES
    (Lippincott Williams & Wilkins, 2013) Coskun, Ugur; Gunaydin, Yusuf; Ulas, Arife; Balakan, Ozan; Inanc, Mevlude; Inal, Ali; Gumus, Mahmut
    [Abstract Not Available]
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    The Evaluation Of Inflammatory Bowel Disease Cases In Dicle University Medical Faculty Hospital Between 1999 And 2005
    (Düzce Üniversitesi, 2007) Balakan, Ozan; Kıdır, Veysel; Süner, Ali; Yalçın, Kendal
    Aim: Inflammatory bowel disease (IBD) is a chronic gas trointestinal illness including ulcerative colitis (UC) and Crohn’s disease (CD). In this study, we aimed to investigate social–demographic and clinical features and management strategies in patients diagnosed as IBD between 1999-2005. Material and Method: We investigated the patients examined in Gastroenterology Clinic of Dicle University Faculty of Medicine in 1999-2005, retrospectively. Mean ages, female/male ratios, smoking, types of the diseases, localizations of the disease were determined. Local or systemic complications, treatment strategies and causes of surgical treatments were evaluated. Result: A total of 42 patients diagnosed as IBD, of which 36 were UC, 6 were CD (p
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    Treatment modalities in primary gastric lymphoma: the effect of rituximab and surgical treatment. A study by the Anatolian Society of Medical Oncology
    (Termedia Publishing House Ltd, 2014) Mehmet, Kucukoner; Sener, Cihan; Uyeturk, Ummugul; Seker, Mesut; Tastekin, Didem; Tonyali, Onder; Balakan, Ozan
    Aim of the study: Gastrointestinal lymphoma is the most common type of extranodal lymphoma and commonly involved site is the stomach. We have compared the superiority between treatment modalities for primary gastric lymphoma and we want to investigate efficacy of rituximab in gastric lymphoma. Material and methods: Between April 2002 and December 2011, 146 patients with a histologically confirmed primary gastric lymphoma, initially diagnosed at eight different Cancer Centers within Turkey were evaluated retrospectively. According to the treatment modality, the patients were divided into chemotherapy (CT) alone, chemotherapy and radiotherapy (CRT), surgery and chemotherapy (SCT), surgery along with chemotherapy and radiotherapy (SCRT), and surgery (S) alone groups. Results: Median follow-up period was 25.5 months. The 5-year EFS (event free survival) and OS (overall survival) rates for the patients were 55% and 62.3% respectively. In Log rank analysis of OS and EFS, we have identified levels of albumin and hemoglobine, IPI score, stage at diagnosis as factors influencing survival. In multivariate analysis of OS and EFS, only albumin and stage at diagnosis were factors independently contributing to survival. There was no statistically significant difference in terms of survival between different treatment modalities (p = 0.707 in EFS and p = = 0.124 in OS). In analysis of patients treated with chemotherapy alone, there was no a statistically significant difference in terms of EFS and OS between chemotherapy regimens with or without rituximab in localized and advanced stage groups (p = 0.264 and p = 0.639). There was no statistical difference in survival rate (EFS and OS) between surgical or non-surgical treatment modalities for localized/ advanced stage gastric lymphoma groups (p = 0.519 / p = 0.165). Conclusions: There are several treatment options due to similar results in different treatment modalities. Also benefit of rituximab treatment in gastric lymphoma is still a controversial subject. Additional prospective trials are definitely required in order to clarify use of rituximab in treatment of extranodal gastric lymphoma.
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    XELOX vs. FOLFOX4 as Second Line Chemotherapy in Advanced Pancreatic Cancer
    (H G E Update Medical Publishing S A, 2012) Berk, Veli; Ozdemir, Nuriye; Ozkan, Metin; Aksoy, Sercan; Turan, Nedim; Inal, Ali; Balakan, Ozan
    Background/Aims: The efficacy and tolerability of oxaliplatin in combination with either folinic acid, fluorouracil (5-FU) (FOLFOX4 regimen) or capecitabine (XELOX regimen) was evaluated in advanced pancreatic cancer. Methodology: In this study, eighty-five patients with advanced pancreatic cancer were enrolled after failing to gemcitabine-based chemotherapy between November 2005 and August 2011. FOLFOX4 was repeated every two weeks and XELOX regimen was repeated every three weeks until either disease progression or unacceptable toxicity occurred. Results: Eighty-five patients were evaluated for tumor response. Seven patients (18%) achieved a partial response with XELOX and stable disease was observed in 16 patients (41%). Eight patients (17%) achieved a partial response with FOLFOX4 and stable disease was observed in 12 patients (26%). Disease control rates were 59% in the XELOX arm and 43% in the FOLFOX4 arm. The median time to progression was 16 weeks in both arms. The median overall survival was 21 weeks with XELOX and 25 weeks with FOLFOX4. Conclusions: Oxaliplatin-based combination therapy showed moderate clinical activity with acceptable toxicity in patients who had progressive disease after receiving gemcitabine-based chemotherapy for advanced and/or metastatic pancreatic cancer. We conclude that XELOX is similar in terms of efficacy and toxicity profile to FOLFOX4 in the second-line treatment of metastatic pancreatic cancer.