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Öğe The clinical and pathologic characteristics of 400 gastrointestinal stroinal tumor patients from Turkey: The final results of the Turkish Anatolian Society of Medical Oncology Multicenter Registery(Lippincott Williams & Wilkins, 2014) Sevinc, Alper; Seker, Mesut; Yildiz, Ramazan; Cihan, Sener; Kaplan, Mehmet Ali; Dane, Faysal; Karaca, Halit[Abstract Not Available]Öğe Efficacy and Toxicity of Cisplatin and Capecitabine Combination in the First-Line Treatment of Patients with Advanced Gastric Cancer: A Multicenter Study by the Anatolian Society of Medical Oncology(Akad Doktorlar Yayinevi, 2016) Ciltas, Aydin; Buyukberber, Suleyman; Topcu, Turkan O.; Kucukoner, Mehmet; Uyeturk, Ummugul; Cihan, Sener; Sendur, Mehmet A.Gastric cancer is an important public health problem which comprises 10% of all cancers and 12% of all cancer related deaths all over the world. Because of the differences in patient populations and treatment schemes in various studies, standard practice for advanced stage gastric cancer has not been fully established. The aim of this study was to assess the use of cisplatin and capecitabine combination regimen in real-world clinical practice. Medical records of 76 male and 37 female metastatic gastric cancer patients treated with first-line cisplatin and capecitabine combination between February 2006 and December 2009 were retrospectively analyzed in 11 centers of the Anatolian Society of Medical Oncology. Patients previously treated with chemotherapy were excluded from the analysis. The median age of the patients was 64 years (range, 28-83). Seventy-six (67.2%) patients were males and 37 (32.7%) females. Most of the patients were metastatic (n= 85, 75.2%) at the time of initial diagnosis. The most common sites for metastasis were liver (65.9%), lung (11.3%), peritoneum (23.8%) and local recurrence (15.9%) with multiple metastases in 9.7% of the patients. The mean follow-up period of all patients was 41 months (range 12-61). Overall response rates was 33.6%, while disease control rate (DCR) was 72.6 %. Median Progression-free survival was 4.7 months (95% CI 3.75-6.49) and median overall survival was 11.1 months (95% CI 5.58-10.98). The most common grade 3-4 adverse events were anemia (8.3%), nausea-vomiting (3.8%) and diarrhea (1.8%). In terms of efficacy, toxicity and convenience, cisplatin and capecitabine combination is effective and well tolerated in Turkish patients with advanced gastric cancer, and could be one of the standard regimens for the first-line treatment in this cohort.Öğe Hypersensitivity and tumor lysis syndrome associated with cetuximab treatment: should we be afraid?(Sage Publications Ltd, 2015) Cihan, Sener; Atasoy, Ajlan; Yildirim, Yasar; Babacan, Nalan Akgul; Kos, Tugba FahriyeThe majority of the chemotherapy agents in use today cause various infusion reactions, from mild flushing to life-threatening events. The frequency of the reported hypersensitivity reactions induced by cetuximab varies between 3% and 22%. It is recommended in the literature to stop the infusion and replace cetuximab with panitumumab in case of hypersensitivity reactions observed during the treatment of colon cancer. Tumor lysis syndrome (TLS) may occur in colorectal cancers with heavy tumor load. Tumor lysis syndrome may be life-threatening. In our patient with widespread bone and liver metastases, treatment continued with cetuximab as a combination therapy with irinotecan in spite of the hypersensitivity and TLS led to a complete treatment response. The complete response observed after 3 months through continued therapy in our patient may present an example supporting treatment with cetuximab in spite of severe reactions.Öğe A Metastatic Parachordoma Case(Gazi Univ, Fac Med, 2014) Cihan, Sener; Cihan, Birsen Songul; Atasoy, Ajlan; kos, Tugba Fahriye; Babacan, Nalan AkgulParachordoma is a soft tissue tumor with a high risk of local recurrence. Despite the fact that parachordomas mostly have an indolent course, distant metastasis can be seen on rare occasion. We hereby report a case of a 28-year-old male who was initially diagnosed with parachordoma five years ago when he presented with a mass on his right shoulder. He suffered from local recurrence twice within the first two years after his surgery. Metastatic disease later presented itself with a mass in his left retro-orbital fossa. The patient underwent a partial surgical resection and the pathologic evaluation was reported as ''myoepithelial tumor metastasis''. The patient's systemic work up showed bilateral pulmonary metastatic nodules and metastasis in the right sacroiliac joint. After radiotherapy for the sacroiliac and left orbital mass, chemotherapy was initiated. The regimen consisted of ifosfamide, mesna and doxorubicin. Follow-up evaluation revealed a minimal decrease in size in the pulmonary nodules and the retro-orbital mass. There was no 18-FDG uptake in the sacroiliac mass on PET-BT. In conclusion, surveillance carries importance due to the risk of metastasis for patients with parachordoma. Systemic chemotherapy consisting of doxorubicin and ifosfamide could be used successfully.Öğe Outcomes of surveillance versus adjuvant chemotherapy for patients with stage IA and IB nonseminomatous testicular germ cell tumors(Springer, 2017) Gumus, Mahmut; Bilici, Ahmet; Odabas, Hatice; Ustaalioglu, Bala Basak Oven; Kandemir, Nurten; Demirci, Umut; Cihan, SenerBackground Currently, it is accepted that risk assessment of clinical stage I (CS I) nonseminomatous germ cell tumors (NSGCT) patient is mainly dependent on the presence of lymphovascular invasion (LVI). Initial active surveillance, adjuvant chemotherapy and retroperitoneal lymph node dissection (RPLND) are acceptable treatment options for these patients, but there is no uniform consensus. The purpose of this study was to compare outcomes of active surveillance with adjuvant chemotherapy. Methods A total of 201 patients with CS I NSGCT after orchiectomy were included. Outcomes of active surveillance and adjuvant chemotherapy were retrospectively analyzed. The prognostic significance of risk factors for survival and relapse was evaluated. Results Of the 201 patients, 110 (54.7%) received adjuvant chemotherapy, while the remaining 91 patients (45.3%) underwent surveillance. Relapses were significantly higher for patients underwent surveillance compared to adjuvant chemotherapy group (18.3 vs. 1.2%, p < 0.001). The 5-year relapse-free survival (RFS) rate for patients who were treated with adjuvant chemotherapy was significantly better than those of patients underwent surveillance (97.6 vs. 80.8%, respectively; p < 0.001). Univariate analysis showed that the presence of LVI (p = 0.01) and treatment option (p < 0.001) were prognostic factors for RFS and pT stage (p = 0.004) and invasion of rete testis (p = 0.004) and the presence of relapse (p < 0.001) were significant prognostic factors for OS. Multivariate analysis revealed that the treatment strategy was an independent prognostic factor for RFS (p < 0.001, HR 0.54). A logistic regression analysis demonstrated that treatment options (p = 0.031), embryonal carcinoma (EC) > 50% (p = 0.013) and tumor diameter (p = 0.016) were found to be independent factors for predicting relapse. Conclusion Our results indicate that adjuvant chemotherapy is associated with improved RFS compared with surveillance for CS I NSGCT patients. Moreover, the treatment strategy is an important prognostic indicator for RFS and a predictive factor for relapse. Although adjuvant chemotherapy seems to be a suitable treatment for patients with risk factors for relapse, surveillance is still preferred management option.Öğe Outcomes of surveillance VS. adjuvant chemotherapy for patients with STAGE IA and IB NON-seminomatous testicular germ-cell tumors.(Amer Soc Clinical Oncology, 2016) Bilici, Ahmet; Gumus, Mahmut; Odabas, Hatice; Kandemir, Nurten; Demirci, Umut; Cihan, Sener; Bayoglu, Ibrahim Vedat[Abstract Not Available]Öğe Prognostic Factors in Gastrointestinal Stromal Tumors: Multicenter Experience of 333 Cases from Turkey(H G E Update Medical Publishing S A, 2013) Seker, Mesut; Sevinc, Alper; Yildiz, Ramazan; Cihan, Sener; Kaplan, Mehmet Ali; Gokdurnali, Ayse; Dane, FaysalBackground/Aims: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal tract. In an attempt to survey the approximate incidence, clinicopathological characteristics, and immunophenotypic features of GISTs in Turkey, we conducted a clinicopathological and immunohistochemical analysis of GISTs. Methodology: Three hundred and thirty-three patients with GIST from nine institutions in Turkey were retrospectively evaluated. Results: Between January 2001 and March 2011, a total of 333 patients with GISTs were included; of these, 204 (61.2%) were male and 129 (38.8%) were female. The median age was 55 years (range; 22402 years). At the median follow-up of 26 months (range; 4-166 months), the 1-, 3- and 5-year OS rates of the 333 patients were 96.9%, 85.8% and 78.5%, respectively. The 5-year DFS rate was 40%. The 5-year OS rate and median OS time for the patients with R-0 resection were significantly higher than for patients with metastatic diseases (79.7 vs. 75.7% and not reached vs. 115 months, respectively, p=0.04). Conclusion: Although our results should be confirmed by prospective studies, we believe that they contribute to the literature because the study included both resectable and metastatic or unresectable GIST patients and multicenter findings from Turkey.Öğe Recurrence Risk and Prognostic Parameters in Stage I Rectal Cancers(Asian Pacific Organization Cancer Prevention, 2014) Cihan, Sener; Kucukoner, Mehmet; Ozdemir, Nuriye; Dane, Faysal; Sendur, Mehmet Ali Nahit; Yazilitas, Dogan; Urakci, ZuhatBackground: The standard therapy for stage I rectum cancer is surgical resection. Currently, there is no strong evidence to suggest that any type of adjuvant therapy is beneficial. The risks of local relapse and distant metastasis are higher in rectal tumors. Therefore, while there is no clearly defined absolute indication for adjuvant therapy in lymph node negative colon cancers, rectum tumors that are T3N0 and higher require adjuvant treatment. Due to the more aggressive nature of rectal cancers, we explored the clinical and pathologic factors that could predict the risk of relapse in Stage I (T1-T2) disease and whether there was any progression-free survival benefit to adjuvant therapy. Materials and Methods: This multicenter study was carried out by the Anatolian Society of Medical Oncology. A total of 178 patients with rectal cancers who underwent curative surgery between January 1994 and August 2012 in 13 centers were included in the study. Patient demographics, including survival data and tumor characteristics were obtained from medical charts. Results: The median age was 58 years (range 26-85 years). Most tumors were well or moderately differentiated. For adjuvant treatment, 13 patients (7.3%) received radiotherapy alone, 12 patients (6.7%) received chemotherapy alone and 15 patients (8.4%) were given chemoradiotherapy. Median follow up was 29 months (3-225 months). Some 42 patients (23.6%) had relapse during follow up; 30 with local recurrence (71.4%) whereas 12 (28.6%) were distant metastases. Among the patients, 5-year DFS was 64% and OS was 82%. Mucinous histology and receiving adjuvant therapy were found to have statistically insignificant correlations with relapse and survival. Conclusions: In our retrospective analysis, approximately one quarter of patients exhibited either local or systemic relapse. The rates of relapse were slightly higher in the patients who had no adjuvant therapy. There may thus be a role for adjuvant therapy in high-risk stage I rectal tumors.Öğe Retrospective analysis of 178 patients with stage I rectum cancer.(Lippincott Williams & Wilkins, 2013) Cihan, Sener; Ozdemir, Nuriye; Urakci, Zuhat; Kucukoner, Mehmet; Dane, Faysal; Yazilitas, Dogan; Durnali, Ayse[Abstract Not Available]Öğe Treatment preferences in stage IA and IB testicular seminoma: multicenter study of Anatolian Society of Medical Oncology(Springer, 2015) Bilici, Ahmet; Ozturk, Turkan; Turkmen, Esma; Odabas, Hatice; Cihan, Sener; Selcukbiricik, Fatih; Erdogan, BulentApproximately 75 % of patients with testicular seminoma present with stage I disease, and the probability of long-term survival approaches 100 %. However, the standard adjuvant treatment for stage I seminoma patients remains controversial, and there is no uniform consensus in the literature. The present study was performed to evaluate treatment preference and outcomes for men with stage I testicular seminoma. From 1997 to 2013, 282 patients with histologically confirmed stage IA and IB testicular seminoma who underwent orchiectomy were included. The outcomes of three management options and survivals were retrospectively analyzed. The prognostic significance of risk factors for relapse on survival was evaluated by univariate and multivariate analysis; in addition, the factors predicting relapse were also evaluated by logistic regression analysis. Of the 282 patients with stage I seminoma, 130 (46.1) received adjuvant radiotherapy (RT), 80 (28.4 %) were treated with adjuvant carboplatin, while the remaining 72 patients (25.5 %) underwent surveillance. At the time of analysis, the median follow-up period of 38.5 months; relapses were observed in 16 patients (22.3 %) on surveillance, in one patient (1.2 %) treated with adjuvant carboplatin and in ten patients (%7.7) who received adjuvant RT. The 5-year disease-free survival (DFS) rate for patients who underwent surveillance was worse than those of patients treated with adjuvant carboplatin and RT (64.2 vs. 97.7 vs. 91.9 %, respectively; p < 0.001). However, the 5-year overall survival (OS) rate for patients on surveillance was similar compared with the adjuvant treatment groups (100 vs. 92.3 vs. 97.4 %, respectively; p = 0.44). Univariate analysis showed that only the treatment approach (surveillance vs. adjuvant carboplatin vs. adjuvant RT) for DFS (p < 0.001), invasion of the rete testis (p = 0.041) and the presence of relapse (p < 0.001) for OS were important prognostic indicators. Multivariate analysis indicated that the treatment strategy for DFS (p < 0.001, HR 0.34) was an independent prognostic factor. Furthermore, a logistic regression analysis showed that adjuvant treatment was found to be an independent factor for predicting relapse (p = 0.004, odds ratio: 0.39). Our results indicate that adjuvant treatment with carboplatin or RT is associated with improved DFS compared with surveillance for men with stage I testicular seminoma after orchiectomy. Moreover, the treatment strategy is an important prognostic indicator for DFS and a predictive factor for relapse. Although adjuvant treatment, especially carboplatin, seems to be a suitable treatment for patients with risk factors for relapse, surveillance is still feasible and the preferred management option after radical orchiectomy in men with stage I seminoma. More reliable predictive factors are needed to make treatment decisions.
