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Öğe Adjuvant radiotherapy for uterine carcinosarcoma: A retrospective assessment of treatment outcomes(Wolters Kluwer Medknow Publications, 2019) Yilmaz, Ugur; Alanyali, Senem; Aras, Arif Bulent; Ozsaran, ZeynepObjectives: The objective of the study is to understand the impact of adjuvant radiotherapy (RT) and prognostic factors for patients diagnosed with uterine carcinosarcoma.Materials and Methods: The records of 31 patients receiving adjuvant RT between the dates of September 2003-January 2013 in our clinic were evaluated retrospectively. Surgery was performed in 27 (87%) patients as staging laparotomy, for 4 patients as total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pelvic external beam radiotherapy (EBRT) was 4500-5040 cGy in 25-28 fractions. In addition, 23 patients received brachytherapy following EBRT, 12 patients received adjuvant, and 1 patient received neoadjuvant chemotherapy (CT).Results: The median age was 63 (between 30 and 78). The stage distribution of the patients was as follows: Stage I, 20 (64%); Stage II, 7 (23%), and Stage III, 4 (13%) patients. Five-year locoregional control (LRC) rate was 100%, disease-free survival (DFS) and overall survival (OS) rates were 65.5% and 66.2%, respectively. Stage I or II patients have a tendency for better 5-year OS and DFS rates than Stage III patients (73.1% vs. 42.9% and 72.7% vs. 42.9%; P = 0.065 and 0.051). Regarding lymph node dissection was performed or not, 5-year OS (64.7% vs. 75.0%) was not statistically different between groups (P = 0.77). Five-year OS and DFS rates were 69.2% and 61.5% for patients receiving CT (adjuvant or neoadjuvant) versus 63.7% and 68.8% for patients not receiving CT; P = 0.63 and P = 0.89, respectively. Based on the analysis of peritoneal washings, 5-year OS was 0% for patients with malignant or suspicious cytology whereas 89% for patients with benign cytology (P = 0.000). A negative correlation was observed between mitotic count of sarcomatous component and DFS time (rs = -0.812 and P = 0.05).Conclusions: Surgery and adjuvant RT seem beneficial for excellent LRC rate. However, survival rates are low due to distant metastases. Thus, there is a great need for better systemic therapies.Öğe Estimating changes in the rate of synchronous and metachronous metastases over time: Analysis of SEER data(Elsevier Inc, 2018) Yilmaz, Ugur; Marks, Lawrence B.[Abstract Not Available]Öğe Prognostic value of 68Ga PSMA I&T PET/CT SUV parameters on survival outcome in advanced prostat cancer(Springer, 2018) Komek, Halil; Can, Canan; Yilmaz, Ugur; Altindag, SerdarObjectiveTo determine the association of 68Ga-PSMA-I&T PET/CT SUV parameters with survival outcome in advanced prostate cancer patients.MethodsA total of 148 consecutive patients mean age: 69.37.8years with advanced prostate cancer who underwent 68Ga-PSMA-I&T PET/CT were included in this retrospective study. Data on previous treatments, serum PSA levels (ng/mL), 68Ga-PSMA-I&T PET/CT findings metastases as well as survival data were recorded.ResultsMultivariate regression analysis revealed that Level 1 LN SUV/Liver SUV ratios>2.17 (OR 4.262; 95% CI 1.104-16.453, p=0.035), bone SUV>10.7(OR 23.650; 95% CI 4.056-137.888, p<0.001), bone SUV/spleen SUV ratio>1.842 (OR 25.324; 95% CI 4.204-152.552, p<0.001), highest SUVmax/liver SUV ratio>2.32 (OR 19.309; 95% CI 1.730-209.552, p=0.016) and highest SUVmax/spleen SUV ratio>1.842 (OR 22.354; 95% CI 2.637-189.493, p=0.004) were significant in the determination of increased mortality risk in advanced prostate cancer patients.Conclusion p id=Par4 Our findings, for the first time in literature, provided evidence on potential utility of tracer uptake (SUV) cut-off values on 68Ga-PSMA PET/CT in identification of the survival outcome of patients with metastatic disease and thereby in assisting in the selection of individualized therapeutic strategies tailored to the expected prognosis.Öğe The role of (68Ga)PSMA I&T in biochemical recurrence after radical prostatectomy: detection rate and the correlation between the level of PSA, Gleason score, and the SUVmax(Springer, 2019) Yilmaz, Ugur; Komek, Halil; Can, Canan; Altindag, SerdarObjectiveThe aim of the study was to retrospectively evaluate the recurrence detection rate of Gallium-68-prostate-specific membrane antigen [(Ga-68)PSMA] imaging and therapy (I&T) positron emission tomography/computed tomography (PET/CT) at different PSA levels, which enables early detection of patients with radical prostatectomy. We also aimed to compare Gleason scores, used drugs (LHRH analogs and antiandrogens), PSA levels with SUVmax values, and detection rates.MethodThis retrospective study included 107 patients who underwent radical prostatectomy and who underwent (Ga-68)PSMA I&T PET/CT imaging between January 2015 and December 2018 for the early detection of recurrence. The PSA values, Gleason scores, treatments, lesions detected on (Ga-68)PSMA I&T, and SUVmax values were recorded for all patients.ResultsPatients with a median PSA level of 1.22ng/mL were divided into seven groups according to the PSA values. The lowest lesion detection rate was found to be 7/16 patients (43.8%) when the PSA was<0.2 ng/ml, and the highest lesion detection rate was found to be 33/33 patients (100%) when the PSA was>3.5ng/ml. There was a positive correlation between PSA level and ppSUV(max) (per patient SUVmax) value of the patients with lesions (p<0.001 and r=0.49). As the Gleason score increased, the lesion detection rates also increased and there was a significant correlation between these values (p<0.001 and r=0.360). A positive correlation was determined between the Gleason scores and ppSUV(max) values in patients with lesions (p=0.007 and r=0.302). A statistically significant correlation was found between bicalutamide use and lesion detection on (Ga-68)PSMA I&T (p<0.001). A similar relationship was also determined in patients undergoing maximal androgen blockade (MAB) (p=0.003). Patients determined with lesions on (Ga-68)PSMA I&T and who were administered luteinizing hormone-releasing hormone (LHRH) agonists were found to have statistically significantly higher ppSUV(max) values than those who were not administered LHRH agonists (p<0.001). In binary logistic regression test, when PSA levels and Gleason scores were selected as continuous variables, both PSA levels and Gleason scores were demonstrated as significant covariates (p=0.006 and p=0.022) for lesion detection; by contrast, bicalutamide and MAB were not found as significant factors.ConclusionIn the present study, (Ga-68)PSMA I&T was found to be quite successful in determining lesions in the biochemical recurrence, which is consistent with the findings of other I&T studies and studies conducted with different PSMA ligands. Thus, it can be considered that the use of (Ga-68)PSMA I&T will become increasingly common.
