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Öğe 18F-FDG PET/CT parameters for prediction of response to neoadjuvant therapy and prognosis in rectal cancer(Wolters Kluwer Health, 2023) Ebinç, Senar; Güzel, Yunus; Oruç, Zeynep; Kömek, Halil; Kalkan, Ziya; Can, Canan; Taşdemir, Bekir; Urakçı, Zuhat; Kaplan, Muhammet Ali; Küçüköner, Mehmet; Işıkdoğan, AbdurrahmanObjective This study aims to investigate the role of F-18 fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) parameters in the prediction of treatment response and the prognosis in locally advanced rectal cancer. Methods We investigated the relationship of 18F-FDG PET/CT parameters [rectal metabolic tumor volume (MTV), rectal total lesion glycolysis (TLG), rectal standard uptake value (SUV) max, rectal highest peak SUV, lymph node MTV, lymph node TLG, lymph node highest peak SUV] with the pathological response and disease-free survival (DFS) in 60 patients who received neoadjuvant therapy for a diagnosis of locally advanced rectal cancer. Patients with a total score of 0 were assigned to the low-risk group, patients with a score of 1 were assigned to the intermediate-risk group and patients with a score of 2 were assigned to the high-risk group. Results The multivariate analysis revealed that, from baseline PET CT parameters, lymph node highest peak SUV strongly predicted the pathological response at a cutoff value of 2.23. DFS was predicted by the lymph node highest peak SUV at a cutoff value of 3.13 and by the MTV value at a cutoff value of 27 cm3. The risk scoring performed with regard to rectal MTV and lymph node highest peak SUV values determined a median DFS of 19 months in patients with a risk score of 2, whereas the median DFS was not reached in patients with risk scores of 0 and 1 (P < 0.001). Conclusion This study determined that rectal MTV and lymph node highest peak SUV predicted the response to neoadjuvant therapy and DFS.Öğe A case of primary pancreatic lymphoma followed in remision in the 9th year(Harran Üniversitesi, 2018) Oruç, İdris; Oruç, Zeynep; Küçüköner, Mehmet; Soylu, Berat Evran; Kaplan, Muhammet AliPrimary pancreatic lymphoma (PPL) is a rare form of ekstranodal, lymphomas, comprising 0.2-4.9% of pancreatic masses and <1% of all malignant lymphomas. Due to the rarity of PPL and nonspecific clinical symptoms and imaging, differentiation of PPL from adenocarcinoma is difficult without histopathologic diagnosis. Many patients with primary pancreatic lymphoma are diagnosed after radical surgery due to difficulties in diagnosis. Many patients with primary pancreatic lymphoma can be diagnosed after radical surgical treatments due to diagnostic difficulties. A 70-year-old patient presenting with abdominal pain was detected to have pancreatic mass. The post-operative pathologic outcome was reported as T-rich B-cell lymphoma. The patient was followed with complete remission after receiving six cycles of chemotherapy. This case report emphasizes the importance of distinguishing between pancreatic lymphoma and adenocarcinoma because of the different treatment strategies and prognoses.Öğe Assessing the clinical impact of Lutetium-177 DOTATATE Peptide Receptor Radionuclide Therapy (PRRT) on metastatic neuroendocrine tumors: A multicenter real-world data from Türkiye(Kare Publishing, 2023) Ünal, Çağlar; Selçuk, Nalan Alan; Biricik, Fatih Selçuk; Alan, Özkan; Ordu, Çetin; Selvi, Oğuzhan; Kalkan, Ziya; Oruç, ZeynepObjectives: This study aimed to evaluate the clinical outcomes, including progression-free survival (PFS), overall survival (OS), Objective Response Rate (ORR), and Disease Control Rate (DCR), in patients received Lutetium-177 (Lu-177) DOTATATE Peptide Receptor Radionuclide Therapy (PRRT) for metastatic neuroendocrine tumors. This study further stratified outcomes based on tumor grade, Ki-67 status, primary tumor localization, number of treatment cycles, and associated adverse effects. Methods: We conducted a multicenter retrospective study analyzing the data of 73 patients with metastatic NETs across 17 different hospitals in various regions of Türkiye. A total of 73 metastatic NET patients underwent Lu-177 DOT-ATATE PRRT between December 2013 and March 2023. Results: Over a median follow-up of 52.7 months, patients showed a median PFS of 13.7 months and OS of 51.2 months. The ORR was 29.6%, and the DCR was 66.2%. Grade 1 and 2 tumor patients had superior outcomes (PFS: 16.9 months, OS: 55.5 months) compared to grade 3 tumor patients (PFS: 8.5 months, OS: 29.5 months). Based on their Ki-67 status, those ≤ 20% had prolonged PFS (16.9 months) and OS (55.5 months) than those between 21 and 55% (PFS: 5.9 months, OS: 41.3 months). Regarding primary tumor localization, the PFS values were 13.1, 15.3, 13.7, and 8.6 months for pancreatic, GIS, lung, and unknown origin tumors, respectively. The OS across tumor types fluctuated between 41.1 and 54.1 months. Patients who received more than four cycles demonstrated significantly improved median PFS (22.4 months) and OS (90.3 months) compared to those who received ≤ 4 cycles (median PFS: 9.3 months; median OS: 41.8 months). Grade 3-4 adverse effects were observed in 21.9% of patients. Conclusion: Our findings affirm that PRRT is a potent and well-tolerated treatment for metastatic NETs. Notably, patients who received more than 4 cycles of PRRT experienced a markedly improved median PFS and OS compared to their counterparts who received ≤4 cycles.Öğe Causes of liver test abnormalities in newly diagnosed cancer patients and the investigation of etiological factors(Taylor & Francis Ltd, 2024) Urakçı, Zuhat; Ebinç, Senar; Oruç, Zeynep; Kalkan, Ziya; Kaplan, Muhammet Ali; Küçükköner, Mehmet; Işıkdoğan, AbdurrahmanObjectives: In this study, we aimed to investigate the causes of liver test abnormalities in newly diagnosed patients naive to anti-tumoral therapy. Method: This study included a total of 490 patients with ALT levels > 5X ULN on liver function tests at the initial presentation to our clinic. Data from 247 (50.4%) patients diagnosed with cancer (cohort A) and 243 (49.6%) patients without cancer (cohort B) were compared with regard to the etiology of liver test abnormalities and the risk factors. Results: The most common etiological factor in cohort A was presence of liver metastasis (31.2%, n = 77). In the comparison of the two groups with regard to etiological factors; the rates of liver metastasis [31.2% vs 0%, (p < 0.001)], drug-induced liver toxicity [30/4% vs 19.8%, (p = 0.007)], pancreaticobiliary pathology [21.5% vs 14%, (p = 0.03)] and chronic viral hepatitis [14.2% vs 7.4%, (p = 0.02)] were higher in the cohort A. The rate of NAFLD was higher in the cohort B [6.9% vs 42.2% (p < 0.001). Conclusion: In our study, the most common cause of liver test abnormalities was the presence of liver metastasis in cohort A and NAFLD in cohort B.Öğe Changes in medical oncology practice due to the COVID-19 pandemic in Turkey, and the risk of neglect of cancer patients(Dicle Üniversitesi Tıp Fakültesi, 2021) Oruç, Zeynep; Kaplan, Muhammet Ali; Işıkdoğan, AbdurrahmanCancer patients are among patient groups most affected by the COVID-19 outbreak. During the COVID-19 pandemic, rearrangement of oncological services and adaptation to the pandemic process has become mandatory. In this review, we mentioned the changes in medical oncology practice and adaptive treatment modifications. COVID-19 infection will continue to affect and change the practice of oncology unless the COVID-19 outbreak ends.Öğe Cisplatin plus paclitaxel and bevacizumab versus carboplatin plus paclitaxel and bevacizumab for the first-line treatment of metastatic or recurrent cervical cancer(BMJ Publishing Group, 2022) İlhan, Yusuf; Tatlı, Ali Murat; Teker, Fatih; Önder, Arif Hakan; Köse, Fatih; Geredeli, Çağlayan; Kaplan, Muhammet Ali; Oruç, ZeynepObjective Cisplatin-paclitaxel and bevacizumab is a frequently used treatment regimen for metastatic or recurrent cervical cancer, and carboplatin-paclitaxel and bevacizumab are also among the recommended regimens. In this study we aimed to evaluate the efficacy of these two regimens for the treatment of metastatic or recurrent cervical cancer. Methods Patients with metastatic or recurrent cervical cancer treated with cisplatin-paclitaxel and bevacizumab or carboplatin-paclitaxel and bevacizumab were retrospectively evaluated in this study. The clinical and demographic characteristics of patients in each group were evaluated. Median overall survival, progression-free survival, and response rates between the two groups were compared. Results A total of 250 patients were included. Overall, the numbers of patients with recurrent disease and metastatic disease were 159 and 91, respectively. The most common histologic subtype was squamous cell carcinoma (83.2%). The median duration of follow-up was 13.6 (range 0.5-86) months. The median progression-free survival was 10.5 (95% CI 9.0 to 11.8) months in the cisplatin-paclitaxel and bevacizumab group (group 1), and 10.8 (95% CI 8.6 to 13.0) months in the carboplatin-paclitaxel and bevacizumab group (group 2) (HR 1.20; 95% CI 0.88 to 1.63; p=0.25). The median overall survival was 19.1 (95% CI 13.0 to 25.1) months in group 1 and 18.3 (95% CI 15.3 to 21.3) months in group 2 (HR 1.28; 95% CI 0.91 to 1.80; p=0.15). Conclusions There is no survival difference between cisplatin or carboplatin combined with paclitaxel and bevacizumab in metastatic or recurrent cervical cancerÖğe Comparison of F-18-FDG PET/CT and Ga-68-FAPI-04 PET/CT in the staging and restaging of gastric adenocarcinoma(Lippincott William & Wilkins, 2022) Gündoğan, Cihan; Kömek, Halil; Can, Canan; Yıldırım, Özgen Ahmet; Kaplan, İhsan; Erdur, Erkan; Poyraz, Kerem; Güzel, Yunus; Oruç, Zeynep; Çakabay, BahriObjective In this study, we aimed to evaluate the diagnostic sensitivities of Ga-68-FAPI-04 PET/CT and F-18-FDG PET/CT in the primary tumor, and nodal, peritoneal and distant organ metastases of primary and recurrent gastric adenocarcinoma (GAc) with patient and lesion-based comparison. Materials and method Twenty-one patients with histopathologically proven newly diagnosed or recurrent GAc who underwent F-18-FDG and Ga-68-FAPI-04 imaging were included in the study. Both imaging techniques were evaluated visually according to the intensity of organ-based uptake. SUVmax and tumor-to-background ratio (TBR) values obtained from primary tumor/relapse and metastatic organs were compared statistically. Results Ga-68-FAPI-04 uptake was positive in all 15 newly diagnosed patients, while two patients among them who had mucinous and signet ring cell carcinoma did not exhibit F-18-FDG uptake. The sensitivity and specificity of Ga-68-FAPI-04 PET/CT in detecting primary gastric were 100%, while the sensitivity and specificity of F-18-FDG were 86.6 and 100%, respectively. Ga-68-FAPI-04 imaging revealed diffuse stomach uptake in seven patients, while F-18-FDG could only show two of them. The sensitivity and specificity of in-patient-based detection of lymph node metastases were 100 and 95.2%, respectively, while these values were 71.4 and 93.7%, respectively, for F-18-FDG. For peritoneal involvement Ga-68-FAPI-04 had a sensitivity and specificity of 100%, whereas F-18-FDG had a sensitivity of 40% and a specificity of 100%. Conclusion Ga-68-FAPI-04 PET/CT is an imaging modality with the potential of yielding more sensitive and specific findings F-18-FDG PET/CT. This modality may help avoid invasive diagnostic procedures that may be frequently required in GAc.Öğe Effect of exercise on colorectal cancer prevention and treatment(Baishideng Publishing Group Co, 2019) Oruç, Zeynep; Kaplan, Muhammet AliIn recent years, because of improved cancer screening, detection and treatment modalities, a rapid increase in the population of colorectal and other cancer survivors has been observed. The increasing population has justified the requirement of preventive strategies such as lifestyle modifications with regard to obesity, physical activity, diet and smoking. Physical activity may prevent approximately 15% of the colon cancers. Furthermore, several observational studies have demonstrated the efficacy and dose-dependent and anti-cancer effects of exercise on decreasing the mortality and risk of recurrence before and after the colorectal cancer (CRC) diagnosis. However, the required exercise dose, type and intensity are yet unclear. The results of randomised prospective studies are expected to determine the optimal amount, type and intensity of exercise and formulate the most appropriate exercise plan and guidelines, according to the requirements and comorbidities of the patients. In addition, recent studies have focused on the molecular and genetic mechanisms underlying the effect of physical activity on disease outcomes and recurrence rates. This review aimed to investigate the effects of physical activity and the biological basis of these effects in preventing the risk and recurrence of CRC and decreasing the hazards of cancer and cancer treatment.Öğe The effect of tumor sideness and mutational status on first line treatment response and survival in the patients with metastatic colorectal cancer(Akademi Doktorlar Yayınevi, 2020) Eser, Kadir; Sezer, Emel Yaman; Öztürk, Banu; Onder, Arif Hakan; Erçolak, Vehbi; Oruç, ZeynepRAS and BRAF mutation and primary tumour sideness are prognostic and predictive factors in metastatic colorectal cancer (mCRC). We aimed to investigate RAS-BRAF mutation rates and responses to biologic agents the effects of tumour sideness on survival. This was a retrospective study conducted at three Turkish institutes. 303 patients with mCRC who were examined for tumour RAS and 172 examined for tumour BRAF mutations between 2006-2018. A total of 303 (M/F= 186/117) patients were included to study. Median age was 63 (range: 23-86) years. Median follow-up was 22.8 (range: 19.1-26.4) months. In the RAS wild type population; ad-dition to anti-EGFR agents to standard chemotherapy (CT) had better outcomes than Bevacizumab+CT. Median PFS was improved with anti-EGFR agents (Respectively PFS; 14.5 months, 8.7 months) (log rank p= 0.007 HR= 0.59). Median OS was similar between CT+anti-EGFR and CT+Bevacizumab arms (Respectively OS; 29.3 months, 21.7 months) (log rank p= 0.418; HR= 0.75). RAS mutation rates were similar between right colon cancer (RCC) and left colon cancer (LCC), BRAF mutation rates were significantly increased in RCC (22.2 vs 2.7%, p< 0.0001). RCC (24.1%) had worse prognosis than LCC (75.9%). However, this difference was not significant (PFS: 10.4 vs 10.0 months (log rank p= 0.136), OS: 21.5 vs 23.1 months (log rank p= 0.436). We concluded that in the patients with RAS wild type tumours, CT and anti-EGFR combination was reasonable approach for first line treatment. BRAF mutation, irrespective of CT regimen, was associated with poor survival and more common in RCC patients.Öğe Effectiveness of current first-line treatments and evaluation of prognostic factors related to survival in castration-resistant prostate cancer with isolated bone metastasis(Türkiye Klinikleri Yayınevi, 2023) Urakçı, Zuhat; Ebinç, Senar; Oruç, Zeynep; Kaplan, Muhammet Ali; Küçüköner, Mehmet; Işıkdoğan, AbdurrahmanObjective: This study aimed to investigate the effectiveness of first-line treatments and survival-related prognostic factors in castration- resistant prostate cancer (CRPC) with isolated bone metastasis. Material and Methods: Clinicopathological characteristics of patients diagnosed with CRPC and isolated bone metastasis presenting to the Medical Oncology Clinic of Dicle University between January 2010 and December 2020, as well as the treatments received by them, were retrospectively evaluated. Results: Our study included 91 prostate cancer patients that were in the castration-resistant stage and had isolated bone metastases. As the first-line treatment, 43 (47.2%) of our patients received docetaxel (DOC), 27 (29.6%) received abiraterone acetate (AA), and 21 (23.2%) received enzalutamide (ENZA). The median progression- free survival (PFS) periods for the DOC, AA, and ENZA groups were 9 months [95% confidence interval (CI): 6.52-11.47], 8 months (95% CI: 3.54-12.45), and 13 months (95% CI: 8.09-17.90), respectively (p=0.047). The median overall survival (OS) periods among patients receiving DOC, AA, and ENZA during the hormone-refractory period were 13 months (95% CI: 8.48-17.51), 12 months (95% CI: 8.58- 15.41), and 20 months (95% CI: 2.90-37.09), respectively (p=0.13). Multivariate analyses indicated that the choice of first-line treatment received by the patients was an independent prognostic factor for PFS, whereas lymph node metastasis was an important prognostic variable for OS. Conclusion: Our study involving CRPC patients with isolated bone metastases demonstrates similar OS among patients receiving DOC, ENZA, or AA as the first-line treatment for prostate cancer, although ENZA is associated with a better PFS.Öğe Efficacy and tolerability of current treatments for hormone-refractory prostate cancer patients with visceral metastases(Future Medicine LTD., 2021) Oruç, Zeynep; Kaplan, M. Ali; Karaağac, Mustafa; Özyurt, Neslihan; Tatlı, Ali Murat; Kaya, Ali Osman; Menekşe, Serkan; Kut, Engin; Koca, Sinan; Sever, Özlem Nuray; Yasin, İrem; Ebinç, Senar; Zeynelgil, Esra; Sakin, Abdullah; Turhal, Nazım Serdar; Işıkdoğan, AbdurrahmanAim: To assess the efficacy and tolerability of the first-line treatment options for hormone-refractory prostate cancer patients with visceral metastases. Materials and methods: The records of 191 patients diagnosed with hormone-refractory prostate cancer with visceral metastases were analyzed retrospectively. Results: Docetaxel was administered to 61.2% (n = 117), abiraterone to 14.2% (n = 27) and enzalutamide to 9.4% (n = 18) as the first-line treatment. The median survival of the patients receiving docetaxel, abiraterone and enzalutamide as the first-line treatment during the hormone-refractory period was 15 (95% Cl: 12.9-17) months, 6 (95% Cl: 1.8-10.1) months and 11 (95% Cl: 0.9-23.1) months (p = 0.038), respectively. Conclusion: The present study established a statistically significant difference in favor of docetaxel in terms of overall survival and progression-free survival. Lay abstract The optimal therapeutic option for castration-resistant prostate cancer (CRPC) patients with visceral metastases is unknown. We assessed the efficacy and tolerability of the first-line treatment options for CRPC patients with visceral metastasis. One hundred ninety-one patients diagnosed with CRPC with visceral metastases were included in the study. The present study established a statistically significant difference in favor of docetaxel in terms of overall survival and progression-free survival between first-line docetaxel, abiraterone and enzalutamide treatments in CRPC patients with visceral metastases. For patients who cannot undergo chemotherapy, enzalutamide, among novel androgen pathway inhibitors, may be the most appropriate option, given its numerical, although statistically insignificant, difference in overall survival and its fewer side effects compared with abiraterone.Öğe Efficacy of capecitabine and temozolomide regimen in neuroendocrine tumors: Data from the Turkish Oncology Group(NLM (Medline), 2023) Ünal, Çağlar; Azizy, Abdulmunir; Karabulut, Senem; Taştekin, Didem; Akyıldız, Arif; Yaşar, Serkan; Kalkan, Ziya; Oruç, ZeynepINTRODUCTION: This study aims to report the efficacy and safety of capecitabine plus temozolomide (CAPTEM) across different lines of treatment in patients with metastatic neuroendocrine tumors (NETs). METHODS: We conducted a multicenter retrospective study analyzing the data of 308 patients with metastatic NETs treated with CAPTEM between 2010 and 2022 in 34 different hospitals across various regions of Turkey. RESULTS: The median follow-up time was 41.0 months (range: 1.7-212.1), and the median age was 53 years (range: 22-79). Our results across the entire patient cohort showed a median progression-free survival (PFS) of 10.6 months and a median overall survival (OS) of 60.4 months. First-line CAPTEM treatment appeared more effective, with a median PFS of 16.1 months and a median OS of 105.8 months (median PFS 16.1, 7.9, and 9.6 months in first-, second- and ≥third-line respectively, P = .01; with median OS values of 105.8, 47.2, and 24.1 months, respectively, P = .003) In terms of ORR, the first-line treatment again performed better, resulting in an ORR of 54.7% compared to 33.3% and 30.0% in the second and third or higher lines, respectively (P < .001). Grade 3-4 side effects occurred only in 22.5% of the patients, leading to a discontinuation rate of 9.5%. Despite the differences in outcomes based on treatment line, we did not observe a significant difference in terms of side effects between the first and subsequent lines of treatment. CONCLUSIONS AND RELEVANCE: The substantial superior outcomes in patients receiving first-line CAPTEM treatment highlight its potential as an effective treatment strategy for patients with metastatic NET.Öğe Efficacy of Ga-68-PSMA PET/CT-derived whole-body volumetric parameters in predicting response to second-generation androgen receptor axis-targeted therapy, and the prognosis in metastatic hormone-refractory prostate cancer patients(Lippincott William & Wilkins, 2021) Oruç, Zeynep; Güzel, Yunus; Ebinç, Senar; Kömek, Halil; Küçüköner, Mehmet; Kaplan, Muhammet Ali; Oruç, İdris; Urakçı, Zuhat; Işıkdoğan, AbdurrahmanIntroduction The present study investigates the role of Ga-68-PSMA PET/CT-derived whole-body metabolic and volumetric parameters in the prediction of treatment response and prognosis among metastatic hormone-refractory prostate cancer patients undergoing second-generation androgen receptor axis-targeted therapy (abiraterone or enzalutamide). Materials and methods This retrospective study included 44 metastatic hormone-refractory prostate cancer patients undergoing Ga-68-PSMA PET/CT, including 29 enzalutamide-treated and 15 abiraterone-treated patients. Results Of the 44 patients included in the study, 29 received enzalutamide and 15 received abiraterone. During treatment, the changes in PET parameters were correlated with the PSA (biochemical) response. More specifically, a positive correlation was noted between PSA response and percent change in TLP (Delta TLP) response, and there was concordance between the results (r = 0.652, k = 0.42, P < 0.001). Baseline PSA (P =0.05), high MTVw (P = 0.005), the increase in Delta PSA (P = 0.036), Delta TLP (P = 0.039) and percent change in MTV (Delta MTV) (P = 0.049) values were identified as factors associated with mortality risk.Multivariate analysis showed that PSA1 [odds ratio (OR): 1.005, 95% confidence interval (CI) 1.002-1.008, P = 0.004], Delta PSA (OR: 14.7, 95% CI 1.50-143.7, P = 0.02) and MTVw1 (OR: 11.4, 95% CI 1.11-116, 6, P = 0.04) were independent prognostic factors associated with mortality risk. Conclusion A statistically significant concordance and correlation was noted between Ga-68-PSMA PET/CT-derived whole-body metabolic parameters (Delta TLP and Delta MTV) and Delta PSA. In addition, the baseline PSA, Delta PSA, Delta TLP, Delta MTV and TMTV were identified as predictive factors for mortality risk.Öğe Efficacy of pemetrexed plus a platinum rechallenge in the treatment of pleural mesothelioma(Via Medica, 2023) Urakçı, Zuhat; Ebinç, Senar; Oruç, Zeynep; Kalkan, Ziya; Kaplan, Muhammet Ali; Küçüköner, Mehmet; Işıkdoğan, AbdurrahmanIntroduction. Pemetrexed-based rechallenge therapies can be used as an option in the treatment of pleural mesothelioma. We aimed to investigate the efficacy of pemetrexed-based rechallenge in mesothelioma. Material and methods. A total of 132 patients who received chemotherapy for unresectable or metastatic pleural mesothelioma in the Medical Oncology Clinic of Dicle University Medical Faculty between 2005 and 2020 were included in our study. Pemetrexed plus platinum rechallenge treatments were compared with other chemotherapy regimens in terms of survival. Results. In our study, 31 (23.4%) of a total of 132 patients received rechallenge pemetrexed plus platinum treatment. There was no statistically significant difference between median progression-free survival of patients who received pemetrexed plus cisplatin or gemcitabine plus cisplatin in the first-line therapy [5 months vs. 8 months (HR = 1.43; 95% CI 0.59–3.45; p = 0.376)]. In the second-line treatment, patients who received rechallenge pemetrexed plus platinum therapy had statistically significantly higher median PFS than those who received gemcitabine plus platinum [6 months vs. 4 months (HR = 0.46; 95% CI 0.22–0.94; p = 0.011)] due to a previous good response. In the second-line treatment, median overall survival was 15 months with gemcitabine plus platinum and 29 months with pemetrexed plus platinum rechallenge (p = 0.007). Conclusions. This study demonstrated that the pemetrexed plus platinum regimen was more effective than gemcitabine plus platinum in the second-line treatment in terms of both progression-free and overall survival in patients who had previously benefited from pemetrexed-based chemotherapy and had not progressed up to 6 months after first-line treatment.Öğe Evaluation Of Cancer And Non-Cancer Patients Receiving Palliative Care Service İn Terms Of Hospitalization Times And Overall Survival During Hospitalization: A Single-Center Experience(Veysi AKPOLAT, 2021) Kalkan, Ziya; Ebinç, Senar; Kalkan, Tuğba Tezer; Urakçı, Zuhat; Oruç, ZeynepObjective: In the last 20 years, palliative care has gained a place within the health system worldwide. Our aim is to review the demographic characteristics of patients hospitalized in palliative care centers, to investigate the factors influencing hospitalization times of patients with cancer and non-cancer diagnoses and the median in-hospital survival. Results: A total of 428 patients, comprising 237 (55.4%) males and 191 (44.6%) females were included in the study. Median patient age was 75 (18-105) years. In terms of hospitalization times, there were no significant differences between genders (p=0.79) and diagnoses (malignant/non-malignant); however, there was a statistically significant difference between survival statuses (died/discharged) and patients who died had longer hospitalization times (16 days versus 12 days) (p=0.008). When age, gender, hospitalization type and diagnosis were compared with regard to median in-hospital survival in multivariate analysis, the diagnosis (non-malignant/malignant) was an independent factor indicating median in-hospital survival (HR:2.08, 95% CI:(1.47-2.94), pÖğe Evaluation of factors predicting the effectiveness of regorafenib in the treatment of metastatic colorectal cancer(Aves Yayıncılık, 2022) Ebinç, Senar; Oruç, Zeynep; Urakçı, Zuhat; Kalkan, Ziya; Kaplan, Muhammet Ali; Küçüköner, Mehmet; Işıkdoğan, AbdurrahmanObjective: Regorafenib is a multikinase inhibitor, the effectiveness of which was demonstrated in metastatic colorectal cancer. This study aimed to investigate the factors that could predict the effectiveness of regorafenib. Materials and Methods: This study retrospectively reviewed the clinical characteristics, tumor characteristics, and previous therapies in 62 patients who presented to our center between 2016 and 2020 and used regorafenib for metastatic colorectal cancer. The effects of the investigated variables on the response obtained with regorafenib use were evaluated. Results: This study included a total of 62 patients diagnosed with metastatic colorectal cancer, of whom 30 (48.4%) were males and 32 (51.6%) were females. Patients' median age at diagnosis was 49 years (1868). Regorafenib therapy yielded a disease control rate of 64% [complete response = 0, partial response= 14 (28%), and stable disease = 18 (36%)]. Objective response was obtained in 28% of patients [complete response = 0 and partial response = 14 (28%)]. Progression-free survival was 4 months. The evaluation of the effects of patients' age, sex, performance status, previous treatments, metastatic sites, and RAS mutation status on the disease control rate and progression-free survival did not determine any positive or negative effects on progression-free survival. However, left-sided tumors had a positive effect on disease control rate (69.8% vs. 28.6%, P =.029). and previous use of cetuximab had a negative effect on disease control rate [76.5% vs. 37.5% (P =.007)]. Conclusion: In our study, tumor localization and previous cetuximab use were found to be correlated with the disease control rate in patients on regorafenib. However, the need for novel biomarkers that will predict the effectiveness of regorafenib in metastatic colorectal cancer treatment persists.Öğe Evaluation of Immunotherapy and Targeted Therapies in the Treatment of Metastatic Malignant Melanoma(2022) Kaplan, Muhammet Ali; Kalkan, Ziya; Tunç, Sezai; İleri, Serdar; Oruç, Zeynep; Ebınc, Senar; Urakçı, ZuhatObjectives: The prognosis of metastatic malignant melanoma is poor. In this study, we aim to evaluate the response rates, PFS and OS times obtained with Nivolumab, Ipilimumab and Dabrafenib plus Trametinib in the treatment of advanced malignant melanoma, as well as the side effect profiles of these three agents. Methods: This study included 58 patients diagnosed with advanced malignant melanoma who received Nivolumab, Ipilimumab or Dabrafenib plus Trametinib therapy between January 2010 - March 2021 and had follow-up at our clinic. Response rates, survival times and side effects associated with each of the three treatment arms were evaluated. Nivolumab, Ipilimumab and Dabrafenib plus Trametinib were compared with regard to effectiveness and tolerability. Results: The Nivolumab, Ipilimumab and Dabrafenib plus Trametinib treatment arms, included 34 (58.6%), 13 (22.4%) and 11 (19%) patients, respectively. The comparison of Nivolumab, Ipilimumab and Dabrafenib plus Trametinib yielded, respectively; ORR (53%, 38.5%, 72.8%), mPFS (7 months, 3 months, 9 months) (p=0.57), mOS (12 months, 16 months, 15 months) (p=0.85). Conclusion: In this study that we conducted with real life data, we confirmed that Nivolumab, Ipilimumab and Dab rafenib plus Trametinib have different effectiveness adn manageable side effect profiles in the treatment of advanced malignant melanoma.Öğe Factors predicting pathological complete response to neoadjuvant chemotherapy in patients diagnosed with non- metastatic muscle invasive urothelial bladder cancer(2023) Urakçı, Zuhat; Ebinç, Senar; Tunç, Sezai; Oruç, Zeynep; Küçüköner, Mehmet; Kaplan, Muhammet Ali; Işıkdoğan, AbdurrahmanAim: In this study, we aimed to investigate the factors that may have the potential to predict pathological complete response (pCR) with platinum-based neoadjuvant chemotherapy (NAC) in non-metastatic muscle-invasive bladder cancer (MIBC). Methods: Our study included 46 patients diagnosed with non-metastatic MIBC, who applied to Dicle University Medical Oncology Clinic between 2016-2019 years and received NAC. Age, gender, ECOG performance score, tumor grade, pathological tumor (pT) stage, clinical lymph node (cN) status, localization of the primary tumor in the bladder, presence of comorbid diseases, renal failure status, hydronephrosis, and NAC regimens were analyzed. Results: Of the total 46 patients included in the study, 42 (81.3%) were male and 4 (8.7%) were female. The median age at diagnosis was 61.5 (34-77) years. In the group of patients aged <65 years, pCR was achieved in 9 patients (33.3%) and pCR was not achieved in 18 patients. The rate of pCR after NAC in the patient group aged <65 years was higher than in the age ≥65 group, which was statistically significant (p: 0.03). While the median disease-free survival (DFS) was not reached in the pCR arm, the median DFS was calculated as 26 months (95% CI: 4.6-47.3) in the non-pCR arm (Log Rank p=0.23). The mean overall survival (OS) value in the pCR arm was 126 months (95% CI: 106.5- 145.4) and the mean OS value in the non-pCR arm was 53.5 months (95% CI: 44.2-62.9) (Log Rank p=0.05). Conclusion: In our study, age <65 years was found to be an independent prognostic factor for pCR in the neoadjuvant treatment of non-metastatic MIBC. Mean OS was better in patients who achieved pCR.Öğe Ga-68-FAPI-04 PET/CT, a new step in breast cancer imaging: a comparative pilot study with the F-18-FDG PET/CT(Springer, 2021) Kömek, Halil; Can, Canan; Güzel, Yunus; Oruç, Zeynep; Gündoğan, Cihan; Yıldırım, Özgen Ahmet; Kaplan, İhsan; Erdur, Erkan; Yıldırım, Mehmet Serdar; Cakabay, BahriAbstract Aim We aimed to compare the roles of Ga-68-FAPI-04 PET/CT and F-18-FDG PET/CT in the evaluation of primary tumor and metastases in primary and recurrent breast cancer. Materials and method Twenty female patients with histopathologically confirmed primary and recurrent breast cancer were included in the prospective study. All patients underwent FDG and FAPI PET/CT imaging in the same week. The number of primary and metastatic lesions, SUVmax values, and tumor-to-background ratios (TBR) were recorded from both scans. Data obtained were statistically compared. Results FAPI PET/CT was superior to FDG in detecting breast lesions, as well as hepatic, bone, lymph node, and cerebral metastases in terms of patient- and lesion-based assessments. The sensitivity and specificity of FAPI in detecting primary breast lesions were 100% and 95.6%, respectively, while the sensitivity and specificity of FDG were 78.2% and 100%, respectively. The SUVmax values of primary breast tumors, lymph nodes, lung metastases, and bone metastases were significantly higher on FAPI imaging than FDG imaging (p < 0.05). However, SUVmax values of hepatic metastases did not exhibit a statistically significant difference between two imaging techniques (p > 0.05). Also, FAPI imaging yielded significantly higher TBR in breast lesions as well as hepatic, bone, brain and lung metastases compared to FDG (p < 0.05). Conclusion (68) Ga-FAPI-04 PET/CT is superior to F-18-FDG PET/CT in detecting the primary tumor in patients with breast cancer with its high sensitivity, high SUVmax, and high TBR. (68) Ga-FAPI-04 PET/CT is also superior to F-18-FDG PET/CT in detecting lymph node, hepatic, bone, and cerebral metastases because it has lower background activity and higher uptake in subcentimetric lesions.Öğe The importance of serum and pleural fluid level of vascular endothelial growth factor (VEGF) and VEGF fluid/serum ratio in the differential diagnosis of malignant mesothelioma-related pleural effusion(Termedia Publishing House Ltd., 2017) Düzköprü, Yakup; Oruç, Zeynep; Kaplan, Muhammet Ali; Ülkü, Refik; Tanrıkulu, Çetin; Esmer, Derya; Bırak, Ali; Küçüköner, Mehmet; Urakçı, Zuhat; Işıkdoğan, AbdurrahmanAim of the study: Vascular endothelial growth factor (VEGF) is one of the parameters that has been studied in differential diagnosis of malignant fluids. This study is aimed at evaluate applicability of serum, fluid VEGF level and fluid to serum VEGF ratio in the diagnosis of malignant pleural mesothelioma (MPM). Material and methods: The patients with pleural effusion over age of 18, between 2011 and 2015 were included in the study. They were divided into three groups: Group 1 - mesothelioma patients; group 2 - other malignancies; and group 3 - benign aetiologies. Group 1 and 2 were termed as the malignant group. Fluid, serum VEGF levels, and the ratio of fluid/serum VEGF level were studied to evaluate the fluid/ serum VEGF ratio in all groups. Results: Twenty cases with mesothelioma, 44 cases with other malignancies, and 20 cases with benign aetiologies were included in this study. No statistically significant difference was found according to serum VEGF levels for all groups, (group 1: 437 ±324 pg/ ml, group 2: 354 ±223 pg/ml, group 3: 373 ±217 pg/ml, p = 0.836), while fluid VEGF levels showed a statistically significant difference (group 1: 3359 ±700 pg/ml, group 2: 2175 ±435 pg/ml, group 3: 1092 ±435 pg/ml, p = 0.041). The ratio of fluid to serum VEGF levels showed a difference, at the significance limit, between the malignant (group 1 and group 2) and benign (group 3) groups (8.83 ±1.29 vs. 4.57 ±1.07, p = 0.059) but showed a statistically significant difference between the mesothelioma and benign groups (12.11 ±1.68 vs. 4.57 ±1.07, p = 0.044). Conclusions: The VEGF fluid/serum ratio may be an applicable parameter in the differential diagnosis of malignant fluids, especially MPM.
