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Öğe Comparison of the role of 18F-fluorodeoxyglucose PET/computed tomography and 68Ga-labeled FAP inhibitor-04 PET/CT in patients with malignant mesothelioma(Lippincott Williams & Wilkins, 2023) Guezel, Yunus; Koemek, Halil; Can, Canan; Kaplan, Ihsan; Kepenek, Ferat; Ebinc, Senar; Bueyuekdeniz, Mehmet PerverObjectiveIn this study, we aimed to compare the role of Ga-68-labeled FAP inhibitor (Ga-68-FAPI)-04 PET/computed tomography (CT) and F-18-fluorodeoxyglucose (F-18-FDG) PET/CT in the evaluation of primary tumor and metastases in patients diagnosed with malignant mesothelioma. Materials and methodsOur prospective study included 21 patients with histopathological diagnosis of malignant mesothelioma who underwent both Ga-68-FAPI-04 PET/CT and F-18-FDG PET/CT imaging between April 2022 and September 2022. Maximum standardized uptake value (SUVmax), metabolic tumor volume, total lesion glycolysis, tumor-to-background ratio (TBR) and highest SUVpeak (HPeak) values and lesion numbers were calculated from primary and metastatic lesions on FDG and FAPI PET/CT images. Findings obtained from FAPI and FDG PET/CT were compared. ResultsMore lesions were detected in Ga-68-FAPI-04 PET/CT compared to F-18-FDG PET/CT in primary tumor and lymph node metastases. Statistically significantly higher SUVmax and TBR values were found with FAPI PET/CT (primary lesion SUVmax and TBR, P = 0.001 and P < 0.001, respectively; lymph node SUVmax and TBR, P = 0.016 and P = 0.005, respectively). With FAPI PET/CT, upstage was observed according to tumor-node-metastasis staging in a total of seven patients including three patients with pleural origin, three patients with peritoneal origin and one patient with pericardial origin. ConclusionIn addition to the stage change with Ga-68-FAPI-04 PET/CT in malignant mesothelioma patients, a statistically significant superiority was observed in SUVmax, TBR and volumetric parameters in primary tumors and metastases.Öğe Comparison of Two Chemotherapy Regimens After First-Line Treatment for HER2-Negative Metastatic Gastric Cancer(Springernature, 2023) Urakci, Zuhat; Ebinc, Senar; Tunc, Sezai; Kalkan, Ziya; Oruc, Zeynep; Kucukoner, Mehmet; Kaplan, Muhammet AliAim: Metastatic stage gastric cancer is a disease with a poor prognosis and the likelihood of achieving a cure in these patients is low. Treatment response to subsequent-line treatments is poor. We aimed to investigate the effectiveness of the folinic acid, fluorouracil and irinotecan (FOLFIRI) and paclitaxel+carboplatin regimens, which are used in subsequent lines of therapy in advanced-stage gastric cancer.Materials and methods: This study included 40 patients who have metastatic stage gastric cancer and received FOLFIRI or paclitaxel+carboplatin therapy in subsequent lines of therapy between 2017 and 2022. The data of the patients were analyzed retrospectively.Results: At diagnosis median age was 51 (23-88) years. The tumor was localized in the gastroesophageal junction in eight (20%) patients and in other gastric locations in 32 (80%) patients. At diagnosis, 75% (n=30) of the patients presented with the disease in the metastatic stage, while 25% (n=10) presented with stage II -III disease. Regarding the treatments received in the second and further lines of therapy, 18 (45%) patients received paclitaxel+carboplatin and 22 (55%) patients received a FOLFIRI regimen. Of these treatments, 67.5% (n=27) were given as the second line and 32.5% (n=13) were given as third-line therapy. The objective response rate (ORR) was 45.5% in the FOLFIRI arm compared to 16.7% in the paclitaxel+carboplatin arm (p=0.05). Both treatment arms had a median progression-free survival (PFS) of three months (p=0.82). The median overall survival (OS) time was seven months in the FOLFIRI arm compared to eight months in the paclitaxel+carboplatin arm (p=0.71). Side effects were similar between both treatment arms.Conclusion: This study determined that FOLFIRI and paclitaxel+carboplatin treatments have similar OS, PFS, and side effect profiles in subsequent line treatment of gastric cancer. The FOLFIRI treatment regimen yielded a higher ORR.Öğe Effects of the changes between pre- and post-treatment 18F-FDG PET-CT volumetric parameters on overall survival in pleural mesothelioma(Via Medica, 2023) Tuzun, Faris; Ebinc, Senar; Kaplan, Muhammet Ali; Kaplan, Ihsan; Komek, Halil; Oruc, Zeynep; Tuzcu, Sadiye KemalIntroduction. This study aimed to examine the efficacy of positron emission tomography in fusion with computed tomography (PET-CT) parameters in predicting survival outcomes for patients with malignant pleural mesothelioma.Material and methods. This study retrospectively evaluated the data of 250 patients who were followed up after a diagnosis of malignant pleural mesothelioma. The relationship of pre-treatment [maximum standardized uptake value (SUVmax1), metabolic tumor volume (MTV1), total lesion glycolysis (TLG1), tumor/background (TBR1), pleural thickness1), post-treatment (SUVmax2, MTV2, TLG2, TBR2, pleural thickness2], and APET-CT parameters with survival was retrospectively evaluated in 36 patients whose pre-and post-treatment CT scan examinations were complete.Results. The median age of the patients was 57.5 years, ranging from 35 to 76. Median follow-up time was 16 months, with a range of 7 to 42 months. Median survival was calculated as 18.8 months for all patients. Based on the determined cut-off values, overall survival was determined as 29.9 months in patients with TLG2 <= 158 compared to 16 months in patients with TLG2 > 158 (p = 0.009) and as 30.9 months in patients with ATLG <= -62.58 compared to 16 months in patients with ATLG > -62.58 (p = 0.001). In addition, median overall survival (OS) was determined as 29.9 months in patients with MTV2 <= 63.9 compared to 16 months in patients with MTV2 > 63.9 (p = 0.007) and as 29.9 months in patients with AMTV <=-54.03 compared to 16 months in patients with AMTV > -54.03 (p = 0.002). When evaluated with respect to TBR2; median OS was 29.9 months in patients with TBR2 <= 1.84 compared to 16 months in patients with TBR2 > 1.84 (p = 0.039).Conclusions. Our research findings indicate a correlation between OS and volumetric PET-CT measures, specifically TLG and MTV.Öğe Evaluation of Factors Influencing Survival in Metastatic Renal Cell Cancer(2021) Kaplan, Muhammet Ali; Oruc, Zeynep; Isikdogan, Abdurrahman; Ileri, Serdar; Ebinc, Senar; Urakci, Zuhat; Kucukoner, MehmetObjectives: The use of prognostic factors that can correctly predict the clinical outcomes of patients with mRCC has particular importance for individualized risk assessment. In this study, we aimed to address the prognostic factors in mRCC patients. Methods: Eighty-six patients who were diagnosed with de-novo metastatic renal cell cancer or developed metastasis during follow-up between January 2007-January 2020 were included and their files were retrospectively evaluated. From patient files; demographic characteristics [age, gender, EGOC PS (Eastern Cooperative Oncology Group perfor- mance status), tumor localization, tumor size, metastasis status, metastatic sites], histopathological characteristics and laboratory tests (hemoglobin, serum albumin, lactate dehydrogenase), treatments they received were recorded. Results: Factors determined to be significant in univariate analysis were assessed using multivariate analysis and the results identified a tumor size larger than 6 cm (p= 0.032), ECOG PS ?2 (p< 0.001), a hemoglobin level below 13 gr/dl (p= 0.016) and a serum albumin level below 3.6 gr/dl (p= 0.006) as independent unfavorable prognostic factors associ- ated with overall survival. Conclusion: Our study determined tumor size>6cm, hemoglobin ?13gr/dL, serum albumin ?3,6 gr/dL and ECOG PS ?2 as factors influencing the prognosis unfavorably in mRCC patients.Öğe Evaluation of the effectiveness and tolerability of sunitinib and pazopanib in the first line treatment of metastatic renal cell carcinoma(Via Medica, 2022) Ebinc, Senar; Kalkan, Ziya; Oruc, Zeynep; Urakci, Zuhat; Kucukoner, Mehmet; Kaplan, Muhammet Ali; Isikdogan, AbdurrahmanIntroduction. It is known that sunitinib and pazopanib are effective in the first-line and subsequent treatment of metastatic renal cell carcinoma (mRCC). This study aims to investigate the effectiveness and tolerability of sunitinib and pazopanib in the first-line treatment of mRCC. Material and metbods. This study included 78 patients followed up in our clinic due to a diagnosis of mRCC, who received pazopanib or sunitinib treatment between 2006 and 2020. Along with clinical and laboratory findings, survival times obtained with each treatment and medication side effects were assessed. Sunitinib and pazopanib were compared in terms of effectiveness (ORR, PFS and OS) and tolerability. Results. The patients' median age at diagnosis was 55 years (25-81). In the first-line treatment, 54 patients (69.2%) received sunitinib and 24 (30.8%) received pazopanib. The comparison of sunitinib and pazopanib yielded an ORR of 66.7% vs. 45.8% (p = 0.08), PFS of 24 months vs. 19 months (p = 0.66) and OS of 27 months vs. 30 months (p = 0.73), respectively. The most common side effect was hypothyroidism in those on sunitinib (25.9%) and nausea-vomiting in those on pazopanib (41.7%). In our study, hemoglobin >= 13 g/dL, an ECOG PS of 0-1 and the occurrence of hypothyroidism as a medication side effect were found to be predictive factors of PFS for both agents. An International Metastatic RCC Database Consortium score corresponding to the poor risk group was associated with a poor PFS. Conclusions. This study, which provides current real-world data, confirms that sunitinib and pazopanib have similar effectiveness and side-effect profiles in the first-line treatment of mRCC.Öğe Factors influencing HER2 discordance in nonmetastatic breast cancer and the role of neoadjuvant therapy(Future Medicine Ltd, 2022) Ebinc, Senar; Oruc, Zeynep; Sezgin, Yasin; Karhan, Ogur; Bilen, Erkan; Yerlikaya, Halis; Kalkan, ZiyaPlain language summary HER2 is an important and targetable molecule in breast cancer. In the early stages of breast cancer, a treatment modality called neoadjuvant therapy, which now includes anti-HER2 therapies, is administered before surgery in order to achieve disease regression and make the patient suitable for a more minor operation. In breast cancer, HER2 status may be positive in the initial biopsy specimen and negative in the surgical specimen. HER2 status plays an important role in treatment decisions. In this study, we investigated the factors causing HER2 status to change in early-stage breast cancer. This study has a retrospective design and includes 400 female patients with early-stage breast cancer. The results of the study identified the factors causing HER2 status to change to negative as receipt of neoadjuvant therapy, small tumor size and younger age. Objective: The rates of and the factors influencing HER2 discordance in patients receiving neoadjuvant therapy for breast cancer are investigated. Methods: This study retrospectively examines the rates of HER2 and hormone receptor discordance between the biopsy and postoperative resection specimens of 400 female early-stage breast cancer patients. Results: One hundred and thirty-three (33.3%) patients had received neoadjuvant therapy. The rate of HER2 discordance between biopsy and resection specimens was 1.7% in the control group and 5.3% in the neoadjuvant therapy group (p = 0.018). The rate of HER2 discordance was higher in younger patients and in patients with T1 tumors in the neoadjuvant therapy group. Conclusion: Neoadjuvant therapy, age <40 years and smaller tumor size were independent risk factors for HER2 discordance.Öğe Factors influencing the prognosis in Braf wild-type metastatic malignant melanoma and the role of novel inflammation indices(Galenos Publ House, 2023) Ebinc, Senar; Kalkan, Ziya; Oruc, Zeynep; Sezgin, Yasin; Urakci, Zuhat; Kucukoner, Mehmet; Kaplan, Muhammet AliBackground and Design: This study aims to investigate the prognostic factors in BRAF wild-type metastatic cutaneous melanoma and the prognostic role of inflammation indices.Materials and Methods: Metastatic BRAF wild-type cutaneous melanoma patients who presented to our clinic between 2011 and 2021 were enrolled. To investigate their prognostic roles, age, gender, performance status, first immunotherapy regimen received by the patient, metastatic sites, and seven inflammation indices [C-reactive protein (CRP)/albumin ratio (CAR), neutrophil lymphocyte ratio (NLR), prognostic nutritional index (PNI), platelet lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and advanced lung cancer inflammation index (ALI) and hemoglobin, albumin levels, lymphocyte and platelet counts (HALP)] were studied.Results: Fourty-seven patients, consisting of 22 (46.8%) females and 25 (53.2%) males, were included in this study. Mean patient age was 54 (18-88) years. In our study, there were 16 (34%) patients with liver metastasis, 17 (36.2%) patients with lung metastasis, and 9 (19.1%) patients with brain metastasis. As immunotherapy, 34 (72.3%) patients had received Nivolumab, while 13 (27.7%) patients had received Ipilimumab therapy. When the relationships of the prognostic variables with overall survival were inspected in univariate and multivariate analyses, brain metastasis was found to be an independent prognostic factor (p=0.02). Lung metastasis approached the threshold of statistical significance in univariate analysis (p=0.09) and liver metastasis in multivariate analysis (p=0.07). The seven inflammation indices examined in the analyses [CAR, NLR, PNI, PLR, SII ALI and HALP] were found to have no prognostic role in both univariate and multivariate analyses.Conclusion: Our study determined that brain metastasis is an independent poor prognostic factor in BRAF wild-type metastatic melanoma. Prognostic roles of the CAR, NLR, PNI, PLR, SII ALI and HALP indices could not be demonstrated.Öğe Investigation of Factors Influencing the Prognosis in Prostate Cancer Patients with Isolated Bone Metastasis(Galenos Publ House, 2022) Ebinc, Senar; Oruc, Zeynep; Urakci, Zuhat; Kaplan, Muhammet Ali; Kucukoner, Mehmet; Isikdogan, AbdurrahmanObjective: Bone metastases, which show a milder course compared with visceral disease, are among the most common metastatic sites in prostate cancer. In the present study, we aimed to investigate the prognostic factors that influence the survival time in the castration-sensitive phase in patients diagnosed with prostate adenocarcinoma with isolated bone metastasis.Materials and Methods: The prognostic effects of the clinical (performance status, number of bone metastases) and laboratory parameters of a total of 217 patients, of whom the data could be accessed, on survival in the castration-sensitive phase were evaluated.Results: Of the 217 patients included in our study, 144 (66.4%) were metastatic at presentation. The mean age of the patients was 68.4 (42-88) years. The mean follow-up duration was 44 months. Of our 217 patients, 125 (57.6%) were included in the castration-sensitive group and 92 (42.4%) in the castration-resistant group. In multivariate analyses; lactate dehydrogenase, alkaline phosphatase (ALP) levels and the number of bone metastases were independent prognostic factors with a strong correlation with time to castration-resistant prostate cancer. The evaluation of these three parameters within the framework of a prognostic index and subsequent risk stratification revealed median progression-free survival times of 91, 36, 20 and 12 months for the very low-risk, low-risk, intermediate-risk and high-risk groups, respectively.Conclusion: Lactate dehydrogenase, ALP levels and the number of bone metastases were determined as strong and useful prognostic factors in predicting time to inÖğe Neoadjuvant Therapy and Factors Influencing Survival in Locally Advanced Non-Small Cell Lung Cancer(Springernature, 2023) Ebinc, Senar; Oruc, Zeynep; Kalkan, Ziya; Teke, Fatma; Onat, Serdar; Urakci, Zuhat; Kaplan, Muhammet AliAim: We aimed to investigate the effectiveness of neoadjuvant therapy (NAT) and clinicopathological characteristics in locally advanced non-small cell lung cancer (NSCLC) (IIIA-IIIB), as well as the influence of the post-NAT treatment modalities on survival. Materials and methods: This study included patients who presented to the Dicle University Medical Oncology Clinic and received NAT for a diagnosis of locally advanced NSCLC between 2004 and 2020. Clinicopathological and radiological data of the 57 patients whose data could be retrieved from the hospital archive system were retrospectively reviewed. Patients' overall survival (OS) and failure-free survival (FFS) times and the factors influencing these times were evaluated. Results: This study included a total of 57 patients consisting of five (8.8%) females and 52 (91.2%) males. The median patient age at diagnosis was 58 (30-75) years. All patients had received four courses of chemotherapy during the neoadjuvant period. When the factors influencing OS were evaluated, the post-NAT modality was found to have a statistically significant effect on survival. FFS times were 12, 13, and 16 months in the chemotherapy, chemoradiotherapy, and surgery arms, respectively (log-rank p=0.035). FFS was longer in those who underwent surgery (Hazard ratio (HR): 0.33, 95 % CI: 0.14-0.77, (p=0.01)). OS times were 20, 21, and 55 months in the chemotherapy, chemoradiotherapy, and surgery arms, respectively (log-rank p=0.05). OS was longer in the arm undergoing surgery compared to the other arms (HR: 0.36, 95% CI: 0.14-0.87, (p=0.02)). Five-year survival rates for the chemotherapy, chemoradiotherapy, and surgery arms were 14.3%, 21.4%, and 40%, respectively. Conclusions: This study shows that achieving an operable status is the most important indicator of survival and that patients undergoing surgery have a marked advantage in OS and FFS compared with patients receiving chemoradiotherapy or palliative chemotherapy.Öğe The role of basal metabolic and volumetric 18F-FDG PET/CT 18 parameters and their changes in predicting pathological complete response in breast cancer patients receiving neoadjuvant chemotherapy(Hellenic Soc Nuclear Medicine, 2022) Kepenek, Ferat; Karaoglan, Huseyin; Can, Canan; Komek, Halil; Kaplan, Ihsan; Etem, Hulya; Ebinc, SenarObjective: The aim of this study is to investigate the roles of pre-and post treatment quantitative fluorine-18-fluorodeoxyglucose ( F-FDG) positron emission tomography/computed tomography (PET/CT) para-18 meters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) and their rate of change in predicting pathological complete response (pCR) in patients with local and locally advanced invasive breast cancer receiving neoadjuvant chemotherapy (NAC). Subjects and Methods: Ninety-eight patients who received NAC after being diagnosed with local and locally advanced invasive breast cancer between January 2017 and September 2021 were retrospectively included in our study. Molecular subtypes of all patients were determined. Maximum SUV, MTV, TLG, percent change in SUVmax (ASUVmax), AMTV, and ATLG obtained from PET/CT scans performed before and after NAC were calculated. The cut-off, area under curve (AUC), sensitivity, and specificity values of these parameters in predicting pCR were calculated using receiver operating characteristic (ROC) curves. Results: ATMTV (cut-off 94.01%, AUC: 0.846), ATTLG (cut-off 97.36%, AUC: 0.870), B2MTV (cut-off < 1.75, AUC: 0.764), B2TLG (cut-off < 2.11, AUC: 0.764), B2SUVmax (cut-off < 1.58, AUC: 0.767), ABMTV (cut-off 93.67%, AUC: 0.851), ABTLG (cut-off 97.22%, AUC: 0.870), ABSUVmax (cut-off 84.99%, AUC: 0.846) calculated using ROC curves were found to significantly predict pCR with high sensitivity and specificity. Conclusion: We concluded that meta-bolic and volumetric PET/CT parameters, the rates of their change, and metabolic res-ponse during NAC may be important variables in predicting pCR in patients with breast cancer.Öğe Survival outcomes of patients diagnosed with muscle-invasive bladder cancer who showed a response after neoadjuvant chemotherapy and refused radical cystectomy, and patients who had radical cystectomy or received chemoradiotherapy(Via Medica, 2023) Tunc, Sezai; Urakci, Zuhat; Ebinc, Senar; Ileri, Serdar; Kalkan, Ziya; Oruc, Zeynep; Kucukoner, MehmetIntroduction. We aimed to compare the survival results of patients with muscle-invasive bladder cancer who responded after neoadjuvant chemotherapy (NAC) and did not accept further treatment and those who underwent radical cystectomy or received chemoradiotherapy (CRT).Material and methods. The study included 53 patients with non-metastatic muscle-invasive bladder cancer who received NAC between 2009 and 2020. Clinical findings and post-NAC survival analysis were evaluated. Survival analyses of patients who underwent radical cystectomy (RC) after NAC, received CRT, and refused treatment were compared.Results. The median age at diagnosis was 61 (33-80) years. After NAC, 18 patients (34%) received CRT, 9 patients (17%) underwent RC, and 18 patients (34%) refused further treatment. Complete response (CR) was present in 10 (18.4%) patients, partial response (PR) in 35 (66%) patients, stable disease (SD) in 1 (1.9%) patient, and progression in 7 (13.2%) patients. Median overall survival (OS) was 78 months. Median OS was not reached in the RC arm; it was 97 months in the CRT arm and 78 months in the declined-treatment arm. There was no statistical difference between the arms (p = 0.94). Median disease-free survival (DFS) was 32 months. Median DFS in the RC arm was 30 months, in the CRT arm - 34 months, and 28 months in the declined-treatment arm after NAC. There was no statistically significant difference between the arms (p = 0.74).Conclusions. We did not find any difference in terms of OS and DFS between patients who after NAC underwent RC, CRT, or refused treatment.
