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Öğe Adjuvant Chemoradiation for Gastric Cancer: Multicentric Study of the Anatolian Society of Medical Oncology(H G E Update Medical Publishing S A, 2012) Kucukoner, Mehmet; Isikdogan, Abdurrahman; Arpaci, Erkan; Bilici, Mehmet; Uncu, Dogan; Cetin, Bulent; Dane, FaysalBackground/Aims: The aims of this study were to report the clinical outcomes of adjuvant chemo-radiotherapy after curative resection in 637 patients with gastric cancer. Methodology: The retrospective analysis included 637 patients with resectable gastric cancer and stage IB-IV (MO) from 8 medical centers between 2003 and 2010. The patients were treated with 5FU-leucovorin and radiotherapy according to Schema for INT-0116. Results: Of the 637 patients, the median of overall survival (OS) was 43.7 months and relapse free survival (RFS) was 36.6 months. OS rates were 84%, 45%, 40% while RFS rates were 81%, 45% and 35% at 1, 3 and 5-years, respectively. Hematological and gastro-intestinal toxicities (grade 1-4) were observed in 35% and 36.5% of patients, respectively. In univariate analysis, according to the Lauren classification, tumor grade, T stage, N stage, type of operation (total gastrectomy or subtotal) and surgery resection margin (R0 or R1) were found as prognostic factors on RFS and OS (p<0.05). In multivariate analysis, T stage, N stage and surgical margins were found as effective factors on OS. T stage, N stage and Lauren classification were factors affecting RFS. Conclusions: Adjuvant chemo-radiotherapy after curative resection of gastric cancer was feasible, with acceptable toxicities in the Turkish population.Öğe ARE ABDOMINAL PAIN AND DISTENTION SYMPTOMS OF BREAST CANCER?(Aves, 2012) Girgin, Sadullah; Onder, Akin; Kapan, Murat; Firat, Ugur; Arikanoglu, Zulfu; Kucukoner, MehmetBreast cancer usually metastasizes to bone, lungs, liver and central nervous system. Rarely, atypical metastases may occur. Isolated peritoneal metastasis of breast cancer is very uncommon. On systemic examination of a 50-yearold woman who presented to our outpatients' clinic with the complaints of abdominal pain and distention, abdominal ascites and a breast mass were found. Biopsy from the breast mass revealed invasive ductal carcinoma and laparoscopic peritoneal biopsy showed peritoneal metastasis of the breast cancer. Palliative chemotherapy was planned. The patient rejected the treatment and has been under follow-up for 6 months does not have any other metastasis now.Öğe Biased view against biopsy among cancer patients and its reasons(Drunpp-Sarajevo, 2012) Kucukoner, Mehmet; Inal, Ali; Kaplan, Muhammed Ali; Urakci, Zuhat; Isikdogan, AbdurrahmanObjective: Because the belief that biopsy causes spread of the disease, is a widely accepted opinion among the people in our region. The aim of this study is to assess the view of patients diagnosed with cancer about biopsies and evaluate the factors influencing this. Material and Methods: Three hundred and twenty four patients who presented themselves to the Department of Medical Oncology between October 2009 and March 2010, were included in the study. Data were obtained from patient charts and evaluations of questionnaires. Results: Among those patients with low level of education, the number of people who are thinking that biopsy is harmful, was significantly high (p=0.001). The gender of patients thinking that biopsy was harmful was more female (p=0.065). However, significantly elderly patients (76.8%, n=99) aged over 40 years, considered biopsy as harmful compared to those aged less than 40 years (p=0.078). Significant differences were found in biopsy perception of patients based on their economic status (p=0.023). Conclusions: The education level of the patient should be taken into consideration in diagnosing cancer with biopsy and subsequent transition to treatment steps the consciousness level of the patient should be certainly increased as well.Öğe Biological Subtypes and Survival Outcomes in Breast Cancer Patients with Brain Metastases (Study of the Anatolian Society of Medical Oncology)(Karger, 2012) Kaplan, Muhammet Ali; Isikdogan, Abdurrahman; Koca, Dogan; Kucukoner, Mehmet; Gumusay, Ozge; Yildiz, Ramazan; Dayan, AdemBackground: The aim of this study is to determine the relationship between the survival outcomes and biological subtype in breast cancer patients with brain metastases. Methods: We retrospectively evaluated clinical data from 422 breast cancer patients with brain metastases between 2001 and 2011 from referral centers in Turkey. The study population was divided into four biological subtypes according to their hormone receptor status and HER2 expression. Results: Systemic treatment prolonged median overall survival (OS) after brain metastases in the entire group (14 vs. 3.2 months, p < 0.001). It also prolonged median OS after brain metastases in the triple negative (7.5 vs. 1.6 months, p = 0.010) and luminal A (14.3 vs. 7.1 months, p = 0.003) subgroups. The median OS for untreated patients, chemotherapy and/or hormonal therapy receiving patients, and chemotherapy and/or hormonal therapy plus targeted therapy receivers was 2, 5.8, and 17.7 months, respectively (p < 0.001), in the HER2-overexpressing subgroup. In the luminal B subgroup, it was 3.7, 5.3, and 15.4 months, respectively (p = 0.003). Conclusions: The use of systemic therapy improves OS after brain metastases in all biological subgroups. Targeted therapies also improve OS after brain metastases in HER2-positive patients. The combined use of targeted therapies and lapatinib are superior to single use and trastuzumab, respectively, in these patients. Copyright (C) 2012 S. Karger AG, BaselÖğe Brain metastases in HER2-positive metastatic breast cancer patients who received chemotherapy with or without trastuzumab(Springer Japan Kk, 2015) Kaplan, Muhammet Ali; Ertugrul, Hamza; Firat, Ugur; Kucukoner, Mehmet; Inal, Ali; Urakci, Zuhat; Pekkolay, ZaferObjective The aim of this study was to assess whether trastuzumab usage is a risk factor for the development of brain metastasis (BM) in human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) and factors affecting survival after development of BM. Materials and methods One hundred thirty-two patients treated with (treatment group) or without trastuzumab (control group) with brain metastasis were retrospectively analyzed. Results Ninety of the 132 HER2-positive MBC patients were in the treatment group and 42 were in the control group. BM was significantly increased in patients who were treated with trastuzumab in two or more lines (58.5 vs 24.1 %, p < 0.001). Trastuzumab and lapatinib usage after BM and age were independent prognostic factors for overall survival in univariate and multivariate analysis. Conclusion The risk for BM was increased in patients who were treated with trastuzumab in two or more lines. Using trastuzumab and lapatinib after BM and age were independent prognostic factors for time to death from BM.Öğe Can LMWH improve the outcome of patients with inoperable stage III non-small cell lung cancer?(Termedia Publishing House Ltd, 2012) Kucukoner, Mehmet; Isikdogan, Abdurrahman; Kaplan, Muhammed Ali; Inal, Ali; Zinciroglu, S.; Cit, Murtaza; Cil, TimucinAim of the study: Lung cancer is the most common malignancy, accounting for one-third of all deaths from cancer. Some studies have shown that low molecular weight heparin (LMWH) significantly prolongs the survival of patients with non-small cell lung cancer (NSCLC). The aim of this study was to determine the effects of treating inoperable stage III NSCLC with LMWH in addition to concurrent chemoradiotherapy. Material and methods: Eighty-two patients with inoperable stage III NSCLC were evaluated at Dicle University's Medical Oncology Department between 2005 and 2010. All patients were treated with concurrent chemoradiotherapy (CRT) with or without LMWH (enoxaparin 4000 IU/day) depending on the patient's risk of thrombosis. The primary objectives were to determine disease-free survival (DES) and overall survival (OS) for patients treated with LMWH. Results: A total of 38 patients in the LMWH negative group and 44 patients in the LMWH positive group were included in the study. The median OS was 11.2 months for the enoxaparin recipients and 12.7 months for the non-enoxaparin group (p = 0.4). The median DES was 9.3 months with CRT alone and 10.0 months with CRT plus enoxaparin (p = 0.9). The one-year OS rates were 47% and 34% for groups treated with CRT and enoxaparin plus CRT, respectively, while the two-year OS rates were 23% and 21%, respectively. No significant difference was noted between the two groups in terms of grade 3-4 hematologic toxicity and mucositis (p = 0.3). Conclusions: This study did not demonstrate improvements in survival for patients with NSCLC treated with enoxaparin. LMWH's positive contribution is still controversial.Öğe The case of gastric adenocarcinoma applying with malign Acanthosis Nigricans(Kare Publ, 2015) Oruc, Zeynep; Kaplan, Mehmet Ali; Urakci, Zuhat; Kucukoner, Mehmet; Avci, Yahya; Isikdogan, AbdurrahmanAchantosis Nigricans (AN) is a skin disorder characterised with hyperpigmented hyperkeratotic lesions. It occurs mostly in association with insulin resistance while it may also arise as a symptom of visceral malignancies. In the occurrence of AN considered as associated with malignancy, a detailed examination may be necessary to identify underlying malignancy. 85% of malign AN cases abdominal adenocarcinomas, and especially 60% of those are gastric adenocarcinomas. A 44-year-old male patient applied to our clinic with hyperpigmentation and hyperkeratosis, widespread body pain and weight loss within 3-4 months. Skin symptoms were reviewed as acanthosis nigricans. He had no endocrinological diseases such as DM or obesity. Due to ocurrence of many skin symptoms in accordance with acanthosis nigricans in a rapid growth on our patient, no findings of other AN causes, systemic symptoms such as the age of patient and weight loss, it is considered as malign AN.Öğe Cisplatin-Based Therapy for the Treatment of Elderly Patients with Non-Small-Cell Lung Cancer: a Retrospective Analysis of a Single Institution(Asian Pacific Organization Cancer Prevention, 2012) Inal, Ali; Kaplan, M. Ali; Kucukoner, Mehmet; Urakci, Zuhat; Karakus, Abdullah; Isikdogan, AbdurrahmanBackground: In spite of the fact that platinum-based doublets are considered the standard therapy for patients with advanced non-small-cell lung cancer (NSCLC), no elderly-specific platinum based prospective phase III regimen has been explored. The aim of this retrospective singlecenter study was to evaluate the efficacy and side effects of cisplatin-based therapy specifically for the elderly. Methods: Patients receiving platinum-based treatment were divided into three groups. In the first group (GC), Gemcitabine was administrated at 1000 mg/m(2) on days 1, 8 and cisplatin was added at 75 mg/m(2) on day 1. In the second group (DC), 75 mg/m(2) docetaxel and cisplatin were administered on day 1. The third group (PC) received 175 mg of paclitaxel and 75 mg of cisplatin on day 1. These treatments were repeated every three weeks. Result: GC arm had 36, the DC arm 42 and the PC arm 29 patients. Grade III-IV thrombocytopenia was higher in the GC arm (21.2% received GC, 2.8% received DC, and 3.8% received PC), while sensory neuropathy was lower in patients with GC arm (3.0%, 22.2%, and 23.1% received GC, DC and PC, respectively). There were no statistically significant difference in the response rates among the three groups (p>0.05). The median Progression-free survival (PFS) was 5.0 months and the median Overall survival (OS) in each group was 7.1, 7.4 and 7.1 months, respectively (p>0.05). Conclusion: The response rate, median PFS and OS were similar among the three treatment arms. Grade III-IV thrombocytopenia was higher in the GC arm, while the GC regimen was more favorable than the other cisplatin-based treatmetns with regard to sensory neuropathy.Öğe The Clinical and Demographic Characteristics of Our Cases with Primary Bone Tumors and Soft Tissue Tumors(Akad Doktorlar Yayinevi, 2016) Oruc, Zeynep; Kaplan, Muhammet A.; Yerlikaya, Halis; Celik, M. Ali; Oruc, Idris; Urakci, Zuhat; Kucukoner, MehmetThe current study aimed to investigate the clinical and demographic characteristics of the patients with sarcoma who were treated and followed-up in Dicle University Medical Oncology Department. We retrospectively investigated the medical records of 547 patients who were diagnosed with sarcoma in the Dicle University School of Medicine, Department of Medical Oncology, between 2007 and 2015. When we considered the total number of patients (total 23,264) admitted to our center between 2007 and 2015, the rate of our patients with sarcoma was found to be 2.3% of this total number. Primary bone tumor and soft tissue sarcoma were determined in 32% (n=172) and 68% (n=375) of the patients, respectively. The most frequent histological type was osteosarcoma. The age, location of the primary tumor, adjuvant chemotherapy, location of relapse (local, metastatic), history of smoking, and comorbid diseases showed statistically significant differences between two groups. The overall survival and progression-free survival also did not differ significantly between the primary bone tumors and soft tissue tumors (p=0.65). The rate of our patients with sarcoma was 2.3% of the total number of patients (total 23,264) admitted to our center. This rate is higher than that in the literature. It is hard to interpret the results of the study, however it has been confirmed that the soft tissue sarcomas and primary bone tumors differ with regard to the age at diagnosis, location of tumor, location of relapse, prevalence of adjuvant chemotherapy and risk factors.Öğe Clinical characteristics and treatment outcomes in 132 patients with malignant mesothelioma(Medknow Publications & Media Pvt Ltd, 2011) Abakay, Abdurrahman; Tanrikulu, Abdullah C.; Kaplan, Muhammet Ali; Kucukoner, Mehmet; Abakay, Ozlem; Sen, Hadice; Isikdogan, AbdurrahmanPurpose: Our objective is to scrutinize clinical, laboratory, radiological characteristics, treatment regimens, and treatment outcomes of malignant mesothelioma (MM) cases in our hospital. Materials and Methods: We investigated, retrospectively, the clinical characteristics and treatment outcomes of all 132 MM patients at Dicle University Hospital between January 2006 and April 2010. Results: A total of 82 (62.1%) patients were male, and 50 (37.9%) female. Median age was 56.0 years. Mean survival time was 9.66.9 months. Mean survival time of patients who had received best supportive care was 7.5 months, chemotherapy 10.4 months, and multimodality treatment regimen 12.6 months. Patients in the multimodality treatment group survived longer than did those in the other two groups (P=0.042). A total of 76 patients received chemotherapy, of whom 17 (22.3%) were administered Cisplatin/Carboplatin and Gemcitabine, 58 (76.4%) Cisplatin/Carboplatin and Pemetrexed, and one (1.3%) Cisplatin Docetaxel. Complete and partial response to treatment in patients receiving Cisplatin/Carboplatin and Gemcitabine was found 47.1% and Cisplatin/Carboplatin and Pemetrexed was found 50.0% (P>0.05). Conclusions: MM related to asbestos exposure is seen frequently in Turkey. Patients present with the typical clinical features of dyspnea, weight loss, and chest pain. Survival analysis shows that patients receiving multimodality treatment may be better.Öğe Clinical characteristics, treatment and survival outcomes in malignant pleural mesothelioma: An institutional experience in Turkey(Imprimatur Publications, 2014) Kucukoner, Mehmet; Kaplan, Mehmet Ali; Inal, Ali; Urakci, Zuhat; Abakay, Ozlem; Tanrikulu, Abdullah Cetin; Abakay, AbdurrahmanPurpose: To compare treatment modalities and investigate potential prognostic factors for survival in patients with malignant pleural mesothelioma (MPM). Methods: The present study has investigated the data of 150 patients with MPM who were examined and treated in our center from 2005 to 2012. Results: The study included 87 male (58%) and 63 female (42%) patients. Surgical resection (pleurectomy/decortications (P/D), and extrapleural pneumonectomy (EPP)) was performed in 32 (36.7%) patients; 87 patients (58%) received chemotherapy alone and 16 (10.7%) had surgery, chemotherapy and radiotherapy (trimodal treatment). The median progression free and overall survival (PFS and OS) for all patients were 10.6 and 14.8 months, respectively. No statistically significant difference was observed between the patients who received pemetrexed/cisplatin (N=54) and gemcitabine/cisplatin (N=28) in terms of PFS and OS (p=0.145, p=0.244, respectively). Also, no statistically significant difference was registered between operated and non operated patients (PFS and OS, p=0.416, p=0.095, respectively). There was no difference in both PFS and OS rates between patients who had P/D or EPP (p=0.87, p=0.652, respectively). Log rank analysis: Eastern Cooperative Oncology Group performance status (ECOG PS)(p=0.018), histology (p < 0.001), stage (p < 0.001) and leukocytosis (p=0.005) were found to be significant prognostic factors of OS. At multivariate analysis, ECOG PS (p=0.016) and stage (p < 0.001) were independent prognostic factors for OS. Conclusion: Median OS was approximately 1 year. ECOG PS, histological type, stage and presence of leukocytosis were prognostic factors that affected both PFS and OS. EPP or P/D surgical options did not provide difference in terms of survival. Survival rates in patients who received a combination of platinum analogues with pemetrexed or gemcitabine as front-line chemotherapy were similar.Öğe Clinical characteristics, treatment, and survival outcomes in malignant pleural mesothelioma: A institution experience in Turkey(Lippincott Williams & Wilkins, 2013) Kucukoner, Mehmet; Kaplan, Muhammed Ali; Inal, Ali; Urakci, Zuhat; Abakay, Ozlem; Tanrikulu, Abdullah; Abakay, Abdurrahman[Abstract Not Available]Öğe Clinical outcomes in patients who received lapatinib plus capecitabine combination therapy for HER2-positive breast cancer with brain metastasis and a comparison of survival with those who received trastuzumab-based therapy: a study by the Anatolian Society of Medical Oncology(Springer Japan Kk, 2014) Kaplan, Muhammet Ali; Isikdogan, Abdurrahman; Koca, Dogan; Kucukoner, Mehmet; Gumusay, Ozge; Yildiz, Ramazan; Dayan, AdemIn this study, we investigated the effect of lapatinib plus capecitabine treatment in HER2-positive breast cancer patients with brain metastasis. Of 405 metastatic breast cancer patients with brain metastases at referral centers in Turkey, 46 were treated with lapatinib plus capecitabine only after the development of brain metastasis. Patients who only received trastuzumab-based therapy after the development of brain metastases were accepted as the historic control group for survival analyses (n = 65). Patients who received both drugs consecutively or sequentially were excluded from the analyses (n = 34). Median age among 46 patients who received lapatinib plus capecitabine therapy was 45 years (27-76), and median time for development of brain metastases was 11.9 months (0-69 months). Twenty-six out of 38 patients who received lapatinib plus capecitabine and had extracranial metastasis showed partial response or stable diseases (68.4 %). Grade 3-4 toxicity was observed in eight patients (17.3 %). Median overall survival (OS) in patients treated with lapatinib plus capecitabine was significantly increased compared to that in patients treated with trastuzumab-based therapy (19.1 vs. 12 months, respectively, p = 0.039). The incidence of cerebral death was slightly decreased in patients who received lapatinib plus capecitabine compared to those who received trastuzumab-based therapy (32 vs. 43.4 %, p = 0.332). In the multivariate analysis, lapatinib plus capecitabine therapy remained an independent positive predictor for survival [odds ratio (OR), 0.57; p = 0.02]. Although this retrospective multicenter study had several limitations, the results suggest that undergoing lapatinib plus capecitabine therapy after the diagnosis of brain metastasis may further improve survival compared to undergoing only trastuzumab-based therapy.Öğe A Clinical, Radiographic and Laboratory Evaluation of Prognostic Factors in 363 Patients with Malignant Pleural Mesothelioma(Karger, 2010) Tanrikulu, Abdullah Cetin; Abakay, Abdurrahman; Kaplan, Mehmet Ali; Kucukoner, Mehmet; Palanci, Yilmaz; Evliyaoglu, Osman; Sezgi, CengizhanBackground: Malignant pleural mesothelioma (MPM) has a poor prognosis. Objectives: Only few studies in literature investigated the presence of pleural fluid and radiographic findings for the prognosis of MPM. Methods: We retrospectively investigated the hospital charts of 363 MPM patients who were diagnosed from January 1989 to March 2010. Survival time was calculated by the Kaplan-Meier method. Pretreatment clinical, laboratory and radiographic features of each patient at the time of diagnosis were obtained from patients' charts. Results: The mean age of 363 patients (217 men, 146 women) was 50.6 +/- 11.2 years (range 19-85) and the mean survival time was 11.7 +/- 8.6 months (range 1-53). Histological types of MPM were epithelial (71.2%), mixed (15.9%) and sarcomatous type (4.9%). The frequency of disease stages were 31.4% for stage 1, 24.2% for stage 2, 28.6% for stage 3 and 15.8% for stage 4. The most frequent symptoms were dyspnea (82.1%), chest pain (68.3%) and weight loss (58.9%). Results of univariate and multivariate analyses revealed that a Karnofsky performance score <= 60, a pleural fluid glucose level <= 40 mg/dl, a C-reactive protein level > 50 mg/l, a serum lactate dehydrogenase level > 500 U/l, the presence of pleural fluid, pleural thickening > 1 cm and a platelet count of > 420 x 10(3)/mu l were found to be associated with poor prognosis in MPM. Conclusions: Our data suggest that low pleural fluid glucose and high C-reactive protein, the presence of pleural fluid and pleural thickening were associated with poor MPM prognosis. Further prospective studies are needed to highlight prognostic factors more clearly. Copyright (C) 2010 S. Karger AG, BaselÖğe COMPARISON OF SKIP EXPRESSION IN MALIGNANT PLEURAL MESOTHELIOMAS WITH KI-67 PROLIFERATION INDEX AND PROGNOSTIC PARAMETERS(Vesalius Univ Medical Publ, 2016) Turkcu, Gul; Alabalik, Ulas; Keles, Ayse Nur; Ibiloglu, Ibrahim; Kucukoner, Mehmet; Sen, Hatice Selimoglu; Buyukbayram, HuseyinWe aimed to determine the presence of SKI-interacting protein (SKIP) expression in malignant pleural mesothelioma (MPM) and its effect on prognosis by investigating SKIP correlation with the Ki-67 proliferation index and prognostic parameters. Pathological preparations of the patients diagnosed with MPM between 2006 and 2012 were evaluated. Immunohistochemical analyses were performed to evaluate the expression of SKIP and the Ki-67 proliferation index. Correlations between SKIP expression, clinicopathological factors and survival were investigated. Survival data were calculated using the Kaplan-Meier method, and Cox regression analysis was used to evaluate the prognostic value of the variables. In total, 52 patients were evaluated in the study; 36 of them were male and 16 were female. The mean age of the patients was 62.3 +/- 12.2 years. The median overall survival period was 8.5 months. Factors negatively affecting general survival in the univariate analysis included high SKIP expression, Ki-67 proliferative index over 30%, presence of non-epithelioid type MPM and stage III-IV disease (p < 0.05). Cox regression analysis revealed that high SKIP expression, high Ki-67 proliferative index and presence of non-epithelioid type MPM are independent factors that affect the survival rate. Higher SKIP expression is associated with poor prognosis in MPM.Öğe Comparison of three different chemotherapy regimens for concomitant chemoradiotherapy in locally advanced non-small cell lung cancer(Springer Japan Kk, 2020) Akdeniz, Nadiye; Kucukoner, Mehmet; Kaplan, Muhammet Ali; Urakci, Zuhat; Karhan, Ogur; Sezgin, Yasin; Bilen, ErkanPurpose The optimal chemotherapy regimen for concurrent chemoradiation in locally advanced non-small cell lung cancer (NSCLC) remains unclear. Cisplatin-etoposide regimen related toxicity is high, weekly regimens have been investigating. We aimed to compare the efficacy and safety of different concurrent chemotherapy regimens in the context. Methods A total of 225 patients with locally advanced, unresectable stage III NSCLC were included. Patients who were treated with weekly docetaxel-platin (DP), paclitaxel-platin (PP) and standard dose etoposide-platin (EP) chemotherapy regimens were selected and divided into groups for the comparison of toxicity, response rate, progression free survival (PFS), and overall survival (OS) times. Results There was a statistically significant difference between overall response rate of each treatment groups (DP: 96.1%, PP: 94% and EP: 76.7%,p < 0.001). The median PFS time of patients who were treated with DP, PP and EP was 16, 15 and 13.3 months, respectively (p = 0.435). The median OS time of patients treated with DP, PP and EP was 19.2, 29.7 and 28.3 months, respectively (p < 0.001). The rates of adverse events such as nausea, vomiting, neuropathy and anaphylaxis was similar. Grade 1-2 mucositis or esophagitis, anemia, pneumonitis were significantly higher in PP group than other groups. However, hematologic toxicities were higher in the EP group than other groups. Conclusions Compared to the weekly chemotherapy regimens with the standard dose, our study demonstrated similar PFS, but a prolonged OS with the EP regimen. The clinical response rate of weekly regimens was better than the full-dose regimen. Adverse events and toxicity rates were different and depended on the type of chemotherapy regimen used.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 COMPLEMENTARY AND ALTERNATIVE MEDICINE USAGE IN CANCER PATIENTS IN SOUTHEAST OF TURKEY(African Networks Ethnomedicines, 2013) Kucukoner, Mehmet; Bilge, Zulfikar; Isikdogan, Abdurrahman; Kaplan, M. Ali; Inal, Ali; Urakci, ZuhatThe aim of this study was to investigate the frequency of complementary and alternative medicine (CAM) methods and clinical characteristics in cancer patients in southeast of Turkey. A total of 324 patients (173 female) were enrolled to this study. Questionnaire was applied to all patients individually for approximately 15 minutes by a doctor. At least one CAM method was used by 62% (n=201) of the patients. 82.5% (n=166) of patients treated with CAM were using at least one herbal species. Likewise, 40.9% (68/166) of these patients were using herbal mixtures and 39.8% (66/166) of them were using single herbal as nettle (Urtica dioica) or its seed, 19.3 % (32/166) of them were using other herbals. CAM methods were preferred more frequently by the patients with metastatic stage (p=0.005), receiving palliative treatment (p<0.001), chemotherapy (p=0.020), in between 40-60 ages patient groups (p=0.002), and when duration of disease was lengthened (p=0.002). CAM use among cancer patients is quite common. Presence of metastatic cancer at diagnosis, receiving chemotherapy and palliative treatment and long disease duration were found as main associated factors for CAM usage.Öğe Cranial Magnetic Resonance Imaging in the Staging of HER2-positive Breast Cancer Patients(Karger, 2013) Kaplan, Muhammet A.; Inal, Ali; Kucukoner, Mehmet; Urakci, Zuhat; Ekici, Faysal; Firat, Ugur; Zincircioglu, Seyit B.Aim: The aim of the current study was to evaluate whether early detection of brain metastases (BMs) could improve survival outcomes in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients. Material and Methods: HER2-positive breast cancer patients without BMs who had no neurological symptoms within 12 months from diagnosis or relapse time of the disease were included in the study. The patients were distributed into 2 groups: Group 1 comprised patients without metastases; group 2 comprised patients with metastases. The symptomatic historic control group with BMs was defined retrospectively for survival comparisons. Results: 55 (57.3%) and 41(42.7%) patients were in groups 1 and 2, respectively. 11 of the 96 patients (11.5%) had occult BMs, and 9 of them were in group 2 whereas only 2 patients were in group 1 (22% vs. 3.6%, respectively; p = 0.008). While the median survival times from the first metastasis (28.7 vs. 22.5 months, respectively; p = 0.561) and BM (6.8 vs. 6.1 months, respectively; p = 0.511) were similar, cerebral death was numerically different (16.7% vs. 46.3%; p = 0.221) between asymptomatic (n = 9) and symptomatic patients (n = 53). Conclusions: BMs were detected very rarely in asymptomatic, non-metastatic HER2-positive breast cancer patients compared with asymptomatic, metastatic patients. Furthermore, although early detection of BMs decreases the cerebral death rate, it does not prolong the survival rate in metastatic patients.Öğe The effect of exercise on disease-free survival and overall survival in patients with breast cancer(Springer London Ltd, 2022) Akdeniz, Nadiye; Kaplan, Muhammet Ali; Kucukoner, Mehmet; Urakci, Zuhat; Lacin, Sahin; Ceylan, Emre Husnu; Isikdogan, AbdurrahmanBackground Positive effects of exercise in cancer patients have been reported. Aim To investigate whether intensity, duration, and timing of exercise affect disease relapse and mortality risk in patients with breast cancer (BC). Methods Patients with local or locally advanced stages of BC between January 2018 and January 2020 were recruited in the study. Sociodemographic and clinicopathological characteristics of patients were recorded. Exercise evaluation was performed by preparing a questionnaire and asking the patients face-to-face questions in the outpatient clinic. Results Risk of relapse was 58% lower in patients who exercised than inactive patients (p = 0.004). Patients who exercised for 2 to 5 days per week had a 63% lower relapse risk than inactive patients (p = 0.010). Risk of relapse was 66% lower in the patients who exercised for less than 1 h or 3 metabolic equivalent of task (MET)-hours per week when compared to inactive patients (p = 0.037). Similarly, relapse risk was 62% lower in patients who exercised between 1 to 3 h or 3 to 8.9 MET-hours per week than inactive patients (p = 0.026). Mortality risk was lower in patients who exercised than patients who did not (p = 0.027). A significantly decreased mortality risk was found in both groups that included patients who exercised for 1 to 5 days per week and patients who exercised for less than 3 h or 9 MET-hours per week when compared to inactive patients. Conclusion Exercise was associated with decreased relapse and mortality rates in patients with BC. Therefore, exercise should be recommended to BC patients as a significant component of the treatment.
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