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Amaç: Over kanseri jinekolojik kanserler arasında en yüksek ölüm oranına sahip olan kanserdir.İnflamasyon temelli skorlar olan nötrofil lenfosit oranı (NLR), trombosit lenfosit oranı (PLR), CRP albümin oranı (CRP/Alb) çoğu kanserde prognoz üzerine etkisi gösterilmiştir. Biz de bu çalışmada NLR, PLR, CRP/Albümin oranlarının over kanserinin prognozu üzerine olan etkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmamıza Eylül 2014 - Aralık 2020 tarihleri arasında Pamukkale Üniversitesi Tıp Fakültesi Tıbbi Onkoloji Bilim Dalı polikliniğine başvuran over karsinom tanılı 124 hasta çalışmaya alındı. Evre 1-4 arasında değişen toplam 124 hasta hasta çalışmaya dahil edildi. NLR, PLR, CRP/Albumin kesme noktaları ROC analizi ile yapıldı. Bulgular: Hastalarımızın medyan yaşı 56 (sınırlar 24-84 ) idi. NLR oranı 63 hastada (%50), PLR oranı 56 hastada (%45), CRP/Alb oranı 61 hastada (%49) kesme değerine göre yüksek saptandı. PLR değeri ile progresyon sağkalım arasında istatistiksel olarak anlamlı ilişki yokken, genel sağkalımla istatistiksel olarak anlamlı ilişki bulunmaktaydı (p=0.01). PLR değeri yüksek olanlarda medyan genel sağkalım 23 ay iken PLR değeri düşük olanlarda 45 aydır olarak saptandı. CRP/Alb oranının ise hem progresyonsuz sağkalım hem de genel sağkalım ile istatistiksel olarak anlamlı ilişkisi mevcuttu (p=0.011; p=0.008). CRP/Alb değeri düşük olanlarda daha uzun progresyonsuz sağkalım ve genel sağkalım olduğu saptandı. Sonuç: Diğer kanser tiplerinde olduğu gibi over kanserinde de inflamasyon belirteçlerinin kanser progresyonu üzerine dolayısıyla prognoza olan etkisi dikkat çekmektedir. PLR oranının genel sağkalımla, CRP/alb oranının ise hem genel sağkalım hemde progresyonsuz sağkalımla istatistiksel olarak anlamlı bir ilişkisi olduğunu gösterdik. Bu oranların gelecekte farklı tedavi gruplarını oluştururken hastaların seçiminde yardımcı olabileceği kanısındayız.

Objectives: Denosumab reduces skeletal related events in castration-resistant metastatic prostate cancer (CRMPC)with bone metastases.It is recommended to give calcium and vitamin D to prevent hypocalcemia after denosumab.There is no recommendation to check vitamin D and the specific level of vitamin D that should not be given beforedenosumab. We aimed to show that the rate of hypocalcemia is high even in vitamin D deficiency alone in the absenceof other risk factors for hypocalcemia and can be reduced by checking vitamin D before the administration or by adjust ing the dose of denosumab according to the vitamin D, which are not included in denosumab product information (PI). Methods: We retrospectively analyzed 40 CRMPC patients who received subcutaneous injections of 120 mg denosumab. Results: 28 patients had vitamin D deficiency before treatment. Patients with vitamin D deficiency had a higher rate ofhypocalcemia (87.5% vs 16.6%). Hypocalcemia was significantly higher in patients with vitamin D deficiency (p:0.001).In patients with vitamin D deficiency, 87.5% grade1, 8.3% grade 2 and 4.1% grade 3 hypocalcemia developed. Conclusion: Vitamin D should be checked before treatment to prevent denosumab-related hypocalcemia. New studiesshould be planned for this recommendation to be in the denosumab PI.

PubMedID: 30377778 Purpose: In this study, we aimed to describe the real-life practice outcomes of pertuzumab–trastuzumab–taxane (PTT) combination in visceral organ metastatic, trastuzumab-naive breast cancer (BC) patients. Methods: This study was conducted by Turkish Oncology Group and included 317 patients’ data from 36 centers. Results: Median age was 51 (22–82). Median PFS was 28.5 months, while median OS was 40.3 months. Patients with brain metastases (n: 13, 4.1%) had worse PFS (16.8 m vs. 28.5 m; p = 0.002) and OS (26.7 m vs. 40.3 m; p = 0.009). Patients older than 65 years of age (n: 42, 13.2%) had significantly lower OS results (19.8 m vs. 40.3 m; p = 0.01). Two hundred sixty-eight patients (86.7%) received docetaxel while 37 patients (11.7%) received paclitaxel. PFS and OS were similar between taxane groups. In eight patients (2.5%), 5–40% ejection fraction decrement from baseline was detected without any clinical sign of heart failure. Conclusions: Our RLP trial included only visceral metastatic, trastuzumab-naïve BC patients including cases with brain involvement who received PTT combination in the first-line treatment. Regardless of negative prognostic characteristics, our results are in parallel with pivotal trial. Further strategies for brain metastasis should be developed to improve outcomes despite encouraging results with PTT treatment. Taxane selection can be personalized and endocrine maintenance may further improve outcomes after taxanes were discontinued. To our knowledge, this is the largest scale real-life clinical practice study of pertuzumab–trastuzumab–taxane therapy to date. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Bangladesh University of Health Sciences and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the committee of University of Health Sciences, Ankara Oncology Education and Research Hospital (TUEK meeting number: 40-15.5.2018).

Amaç: Mide kanseri, kanser kaynaklı ölümlerin önemlibir kısmını oluşturmaktadır. Tüm midekanseri olgularının yarısından fazlası 70 yaş üzerinde olmasına rağmen yaşlıkanser hastalar kemoterapi etkinliğinin değerlendirildiği prospektifçalışmalarda kendilerine yer bulamamaktadırlar. Bizbu çalışmada iki onkoloji merkezindeki geriyatrik gastrik kanserli hastalardakapesitabin bazlı kemoterapilerin etkinliğini ve uygulanabilirliğiniaraştırmayı amaçladık.Materyal-metod: Çalışmaya iki merkezden metastatik midekanseri tanısı ile 2012- 2017 yılları arasında kemoterapi alan 65 yaş üzerihastalar alındı. Hasta dosyaları retrospektif olarak değerlendirildi. HastalarAmerikan Kanser Komitesi evrelendirme sistemi ve performans statusu DünyaSağlık Örgütü skalasına göre değerlendirildi. Bulgular: Çalışmaya alınan 81 hastadaortalama yaş 74 idi. Erkek cinsiyet ve adenokarsinom histolojik tip daha yüksekorandaydı. Hastaların çoğunluğuna kapesitabin-sisplatin kemoterapisiverilmişti. Hastaların ortalama takip süresi 42 aydır. Kapesitabin-sisplatin,kapesitabin-okzaliplatin, kapesitabin kemoterapisi alan grupların median tüm sağ kalım sırasıyla 8 ay, 10,7 ayve 8,9 ay olarak saptandı, arada istatistiksel fark bulunmadı (p=0,467). Tümhastaların median tüm sağ kalım 8,7 bulundu.Kemoterapi alt grupları aralarındaki progresyonsuz sağ kalım farkıistatistiksel olarak anlamlı değildir (p=0,59). En sık yan etki anemi olaraksaptandı. Grad 3-4 yan etkiler kollar arası benzerdi (p=0,725). Çok değişkenlianalizde metastatik bölge sayısı ile mortalite riski istatistiksel anlamlıartış göstermiştir (p=0,001). Kemoterapi protokolleri ile mortalite riski arasıilişki yoktur (p=0,472). Kemoterapiden bağımsız olarak stomatit, bulantı-kusma,nöropati, nötropenik ateş ve nefrotoksisite yan etkileri mortalite riski ileistatistiksel anlamlı ilişki içindedir (sırasıyla p=0,045, p=0,047, p=0,036,p=0,02 ve p=0,049).Sonuç: Çalışmamızda evre IV mide kanserli olgularda 8,7 aytüm sağ kalıma ulaşılmıştır. Kemoterapi alt gruplarında ise hem yan etki hem de sağkalımlar açısından anlamlı farkyoktur. Stomatit, bulantı-kusma, nötropenik ateş, nefrotoksisiteve nöropati yan etkilerinin mortalite riskini arttırması, geriyatrik olgulardaözellikle ağız bakımı, uygun antiemetik tedavi uygulanması, böbrek fonksiyontestlerininin sıkı takibi ve yeterli hidrasyon, enfeksiyon açısından koruyucubariyer tedbirler ve nöropati ilişkili kronik hastalıkların etkin tedavisininen az kemoterapi uygulanması kadar önem taşıdığını göstermiştir., Background: Gastric cancer is responsible for a considerableproportion of all cancer-related deaths. Elderly cancer patients are oftenignored in prospective studies in which the efficacy of chemotherapy isevaluated, although more than half of all gastric cancer cases are over the ageof 70 years. The present study aims to evaluate the efficacy and feasibility ofcapecitabine-based chemotherapies in geriatric patients with gastric cancer. Methods: A total of 81 patients overthe age of 65 years who received chemotherapy for metastatic gastric cancer attwo oncology centers between 2012 and 2017 were included in the study. Themedical records of the patients were evaluated retrospectively, and thepatients and their performance status were evaluated using the American JointCommittee on Cancer staging system and the World Health Organisation scale,respectively. Results: The mean age was 74 years. Themale gender and the adenocarcinoma histological type were seen in higher rates.Most of the patients underwent capecitabine-cisplatin chemotherapy, and themean follow-up was 42 months. The median overall survival of the groups ofpatients receiving capecitabine-cisplatin, capecitabine-oxaliplatin andcapecitabine was 8 months, 10.7 months and 8.9 months, respectively, indicatingno statistically significant differences between the groups (p=0.467). Themedian overall survival of all patients was found to be 8.7. Theprogression-free survival between the different chemotherapy subgroups was notstatistically significant (p=0.59). The most common side effect was found to beanemia. Grade 3–4 adverse effects were similar between the arms of the study(p=0.725). A statistically significant increase was found in the mortality riskwith an increased number of metastatic sites in a multivariate analysis(p=0.001). No correlation was found between the chemotherapy protocols andmortality risk (p=0.472). Adverse effects such as stomatitis, nausea/vomiting,neuropathy, neutropenic fever and nephrotoxicity, independent of chemotherapy,were statistically and significantly associated with the mortality risk(p=0.045, p=0.047, p=0.036, p=0.02 and p=0.049, respectively).Conclusions: Our study resultsshow that adverse effects such as stomatitis, nausea/vomiting, neutropenicfever, nephrotoxicity and neuropathy increase the mortality risk which suggestthat particularly oral health care, the application of appropriate antiemetictreatments, the close follow-up of kidney function tests and adequatehydration, protective infection barrier measures and effective treatment ofneuropathy associated with chronic diseases are as important as chemotherapy ingeriatric cases.

INTRODUCTION: Due to new systemic treatment modalities, overall survival in lung cancer is increasing.Incidence of brain metastases in lung cancer are more common for this reason. The utilisation of stereotacticradiosurgery for one and oligo (two-four) brain metastases, has provided this treatment strategy as a promttreatment alternative. In this study we aimed to investigate the efficiency of stereotactic radiosurgery in lungcancer patients with brain metastasis, the effectiveness of adding diffusion magnetic resonance imaging (MRI) toconventional MRI for treatment evaluation and the relationship between clinical parameters retrospectively.METHODS: Seventy-nine lung cancer patients treated between January 2016 and December 2017 in our clinicwith stereotactic radiosurgery whose eastern cooperative oncology group (ECOG) performance status were 0-1and had less than 5 brain metastases, has retrsopectively analysed.RESULTS: The median age of patients was 59 years (43-78). Diffusion MRI has provided no more benefit forevaluation of treatment. There was no statistically significant mortality difference between subgroups of smallcell and non small cell lung carcinoma. The presence of extracranial metastases has shortened the overallsurvival time significantly (p=0,042).DISCUSSION AND CONCLUSION: The lung cancer patients with brain metastases have histopathologicaland genetic heterogenity. Multivariate analysis showed the presence of extracranial metastases had onlyunfavorable impact on overall survival in our study.

Objective: This study aimed to evaluate the clinical features, radiological findings, risk factors, and management of liver abscesses following transcatheter arterial chemoembolization (TACE) therapy in patients with primary and metastatic liver cancer. Methods: The medical records of 163 patients who were treated with TACE in our hospital for a total of 313 times between January 2012 and January 2018 were reviewed. The incidence rate of patients who developed liver abscesses after undergoing treatment, the computed tomography findings of the abscesses, predisposing risk factors, and the method of treatment were evaluated. Results: Formation of liver abscesses was observed after treatment in four of the 163 (2.4%) patients and in four (1.3%) of the 313 chemoembolization procedures. Additionally, bilioenteric anastomosis was found in two patients and diabetes mellitus in two patients. Conclusion: Formation of liver abscesses after TACE is a rare, but serious, complication. Physicians should be aware of the predisposing risk factors of TACE because of the possibility of death. © The Author(s) 2019.

Purpose: The aim of this study was to examine the effects of tumor localization in early and advanced stage colon cancer patients. Materials and Methods: This retrospective study enrolled 249 primary colorectal cancer (CRC) patients at medical oncology department of Adnan Menderes University between 2013-2017. Results: In early stage, left sided tumors were significantly more common in males (p=0.027). In right sided tumours recurrence developed earlier in female patients (p=0.043) and female sex young age were unfavorable prognostic factors for the relapse time. Positive and unknown RAS mutation status were found to be unfavorable prognostic factors for both side. In metastatic stage, patients with RAS mutant left sided tumors lived longer than RAS negative patients (49.0 vs 25.5 months respectively, p

Purpose: In this study, we aimed to describe the real-life practice outcomes of pertuzumab–trastuzumab–taxane (PTT) combination in visceral organ metastatic, trastuzumab-naive breast cancer (BC) patients. Methods: This study was conducted by Turkish Oncology Group and included 317 patients’ data from 36 centers. Results: Median age was 51 (22–82). Median PFS was 28.5 months, while median OS was 40.3 months. Patients with brain metastases (n: 13, 4.1%) had worse PFS (16.8 m vs. 28.5 m; p = 0.002) and OS (26.7 m vs. 40.3 m; p = 0.009). Patients older than 65 years of age (n: 42, 13.2%) had significantly lower OS results (19.8 m vs. 40.3 m; p = 0.01). Two hundred sixty-eight patients (86.7%) received docetaxel while 37 patients (11.7%) received paclitaxel. PFS and OS were similar between taxane groups. In eight patients (2.5%), 5–40% ejection fraction decrement from baseline was detected without any clinical sign of heart failure. Conclusions: Our RLP trial included only visceral metastatic, trastuzumab-naïve BC patients including cases with brain involvement who received PTT combination in the first-line treatment. Regardless of negative prognostic characteristics, our results are in parallel with pivotal trial. Further strategies for brain metastasis should be developed to improve outcomes despite encouraging results with PTT treatment. Taxane selection can be personalized and endocrine maintenance may further improve outcomes after taxanes were discontinued. To our knowledge, this is the largest scale real-life clinical practice study of pertuzumab–trastuzumab–taxane therapy to date. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

Purpose: Theraising incidence of breast cancer and development of treatment modalitiescause prolongation of survival and new markers are needed for follow up. Serummatrix metalloproteinase 2, 7, 9 (MMP2, MMP7, MMP9), tissue matrixmetalloproteinase inhibitor 1 (TIMP1), interleukin 6, interleukin 8 andvasculer endotelial growth factor (VEGF) take different parts oncancerogenesis. The aim of study is to evaluate the relationship between thesemarkers and clinical stage, histopathologic features and laboratuary parameters.Materialsand methods: Seventyeight pathologically proven,chemotherapy naive breast cancer patients were enrolled. The analyses werecarried out using SPSS v15 and p, Amaç:Meme kanseri insidansının artması vegelişen tedaviler ile sağkalımın uzaması izlemde yeni belirteçlere gereksinimortaya çıkarmaktadır. Serum matriks metalloproteinaz 2, 7, 9 (MMP2, MMP7, MMP9),doku matriks metalloproteinaz inhibitörü1 (TIMP1), interlökin 6, interlökin 8ve vasküler endoteliyal büyüme faktörü (VEGF) kanserogenezin farklı basamaklarındarol almaktadırlar. Çalışmamızın amacı meme kanseri hastalarında buparametrelerin klinik evre, histopatolojik özellikler ve laboratuar değerleriüzerine etkilerini değerlendirmektir. Gereçve Yöntem: Meme kanseri patolojiktanısı konmuş kemoterapi naif yetmiş sekiz kadın hasta çalışmaya alındı. İstatistik,Statistical Package for Social Sciences version15 ile hesaplandı. Sonuçlar %95güven aralığında değerlendirildi. p

Amaç: Postmenopozal hormon pozitif meme kanserli hastalarda ilk sıra hormonoterapi sonrası fulvestrant tedavisinin etkinliği ve tolerabilitesi değerlendirilmiştir. Yöntem: Çalışmaya katılan iki ünitede 2014-2017 yılları arasında tedavi edilen metastatik meme kanserli hastalar retrospektif olarak incelendi. 28 günde bir fulvestrant 500 mg intramuskuler tedavi uygulanan hastaların dahil edildiği çalışmada progresyona kadar her 2 ayda bir olmak üzere yanıt değerlendirmesi yapıldı. Bulgular: Çalışmaya toplam 48 hasta dahil edildi. İlk sıra tedavide hastaların çoğunluğu aromataz inhibitörü (%77) kullanmıştı. Hastaların %25’inde viseral metastaz bulundu. Ortanca progresyonsuz sağkalım ve ortanca sağkalım sırasıyla 6 ay (95% CI, 4,5-7,5) ve 26,6 ay (95%Journal of Human Rhythm 2019;5(1):13-22. Değirmencioğlu ve ark. Metastatik hormon pozitif meme kanserinde fulvestrant tedavisinin etkinliği ve tolerabilitesi14CI, 19,5-33,6) idi. Hastaların %12,5’inde parsiyel cevap, %41,7'sinde stabil hastalık gözlendi. En sık bildirilen yan etkiler hafif-orta dereceli, enjeksiyon bölgesi ağrısı (%20,8), dispepsi (%16,6) ve myalji (% 16,6) idi. Sonuç: Fulvestrant postmenopozal hormon pozitif meme kanserli hastalarda ilk sıra hormonoterapi progresyonu sonrası oldukça etkin ve tolerabl görülmüştür.&nbsp

Introduction: Extraosseous osteosarcomas are rare mesenchymal tumors. Primary osteosarcomas may arise from parenchymal organs like bladder, liver and heart. The number of cases with osteosarcoma primarily arising from the bladder found to be less than 35 in a literature review. We describe the second patient reported in the English literature with primary bladder osteosarcoma and colon adenocarcinoma. Case report: An 83-year-old male patient presented with complaints of abdominal pain, hematuria, constipation, and weight loss. Computed tomography of the abdomen and pelvis demonstrated a heterogeneous giant mass with lobulated contour measuring 5x3.5 cm at the level of the right ureter orifice in the bladder lumen. The transurethral bladder biopsy showed pleomorphic tumor cells with hyperchromatic nuclei, localized between eosinophilic homogeneous osteoids and fibroblastic malignant cells producing lace-like osteoid matrix. A polyp measuring 2 cm in diameter detected in the colon in the colonoscopy performed for preoperative evaluation. Adenocarcinoma reported as the result of biopsy. Cystectomy and left hemicholectomy in the same session decided. However, the patient refused all surgical and medical interventions. The patient died due to uropsepsis 8 months after initial diagnosis. Conclusion: Osteosarcoma of the bladder is a rare tumor with a very poor prognosis. The differential diagnosis gains a significant degree of importance. It would be beneficial to investigate cases like this with regard to synchronous colon and bladder tumors.

Akciğer adeno karsinomları tüm akciğer kanserleri arasında en sıktır ve histolojik açıdan kompleks hücre tipleri içerir. Eski sınıflamada yer alan bronkoalveolar karsinom ve mikst tip adenokarsinom terimleri 2011'de, European Respiratory Society, the International Association for he Study of Lung Cancer ve American Thoracic Society tarafından oluşturulan yeni sınıflama ile ortadan kalkmıştır. Burada, eski sınıflamayla bronkoalveolar karsinom olan, yeni sınıflamaya göre invaziv müsinöz adenokarsinom (taşlı yüzük komponenti içeren) olarak adlandırılan ve organize pnömoniyi taklit eden bir vakayı sunmayı amaçladık

Bleomycin is an antibiotic agent that has anti-tumor efficiency. Dose limiting toxicity depends on pulmonary complications which can be diagnosed by clinical and radiological findings. Positron emission tomography/computed tomography screening is also useful for this purpose. We report an interstitial eosinophilic pneumonia case, diagnosed with Positron emission tomography/computed tomography and surgery, developing after bleomycin combination chemotherapy. © 2015, Anatolian Journal of Clinical Investigation. All rights reserved.

İleri evre küçük hücreli dışı akciğer kanserinde (KHDAK) parlak olmayan prognoz nedeniyle hastalığın izleminde yeni belirteçlere ve daha etkili tedavi yollarına ihtiyaç vardır. Serum vasküler endoteliyal büyüme faktörü (VEGF) günümüzde tanımlanmış en potent anjiyogenetik faktördür. Serum endotelin-1 (ET-1) ve alfa kalsitonin gen ilişkili peptid (CGRP) de tümör damarlanmasında umut vaad etmektedirler. Çalışmamızın amacı ileri evre KHDAK hastalarında serum VEGF, ET-1, CGRP ve diğer laboratuar parametrelerinin serum seviyelerinin anjiyogenez ve prognoz üzerine etkilerini değerlendirmektir.Altmış yedi hasta (62 erkek ve 5 kadın) ile 20 sağlıklı gönüllü (16 erkek ve 4 kadın) çalışmaya dahil edildi. İki grubun demografik, laboratuar verileri ve serum VEGF, ET-1, CGRP düzeyleri karşılaştırıldı.Hastaların kontrol grubuna göre istatistiksel olarak anlamlı yüksek serum VEGF (p=0.000), düşük serum tiroid stimüle edici hormon (TSH), düşük albumin ve hemoglobin düzeyleri vardı (sırasıyla p=0.000, p=0.014 ve p=0.001). Hasta grubunda lökositoz, trombositoz, yüksek C reaktif peptid (CRP) ve laktat dehidrogenaz seviyeleri kontrol grubuna göre istatistiksel olarak anlamlı bulundu (sırasıyla p=0.000, p=0.000, p=0.000, p=0.015). İki grubun serum ET-1 ve CGRP seviyeleri arasında fark yoktu (sırasıyla p=0.96 ve p=0.54). Serum ET-1 ve klinikopatolojik parametreler arasında ilişki yoktu. Serum CGRP seviyesi ve lökositoz arasında istatistiksel anlamlı ilişki bulundu (p= 0.009). Serum VEGF seviyesi ile CRP arasında da istatistiksel anlamlı ilişki vardı (p=0.045). Yüksek serum VEGF seviyesi kısa hastalıksız sağkalım süresi ile istatistiksel anlamlı ilişkiye sahipti (p=0.05). Yüksek serum VEGF, düşük serum TSH ve albumin seviyeleri kötü tüm sağkalım süresi ile istatistiksel anlamlı ilişkili saptandı (sırasıyla p=0.001, p=0.03 ve p=0.033).Sonuç olarak çalışmamız literatürde CGRP ve lökositoz arasındaki istatistiksel anlamlı ilişkiyi gösteren ilk çalışmadır. Çalışmamızda VEGF ve TSH'ın ileri evre KHDAK için prognostik rolleri gösterildi. VEGF, KHDAK tanısında potansiyel bir belirteç olarak kullanılabilir. Fakat VEGF ve TSH seviyelerinin KHDAK tanısındaki ve prognozundaki potansiyel değerlerini ortaya koymak için daha fazla hastayı içeren birçok çalışmaya ihtiyaç vardır. Due to a dismal prognosis of advanced non- small cell lung cancer (NSCLC), novel screening tools and more effective treatments are clearly needed. Vascular endothelial growth factor (VEGF) is the most important angiogenic factor. Endothelin-1 (ET-1) and alpha calcitonin gene related peptides (CGRP) are promising biomarkers for tumor angiogenesis. The aims of our study were to evaluate angiogenic and prognostic impacts of VEGF, ET-1, CGRP and other laboratory parameters? serum levels in advanced NSCLC patients.Sixty seven patiens (62 male, 5 female) and twenty healhty (16 male, 4 female) volunteers were included in this study. Demographical, laboratory data and serum levels of VEGF, ET-1 and CGRP were compared for two groups.Patients presented significantly higher serum VEGF (p=0.000), lower serum thyroid stimulating hormone (TSH), albumin and hemoglobin levels than controls (p=0.000, p=0.014 and p=0.001 respectively). Leukocytosis, thrombocytosis, high levels of C reactive peptide (CRP) and lactate dehydrogenase were significant in patients (p=0.000, p=0.000, p=0.000, p=0.015 respectively). Serum levels of ET-1 and CGRP showed no differences between two groups (p=0.96 and p=0.54 respectively). There was no significant relationship between the serum levels of ET-1 and clinicopathological findings. A significant correlation was found between CGRP and leukocytosis (p= 0.009). Serum VEGF levels were significantly associated with CRP levels (p=0.045). Disease free survival was significantly low in patients with high serum VEGF levels (p=0.05). High serum levels of VEGF, low serum levels of TSH and albumin were associated with poor overall survival (p=0.001, p=0.03 and p=0.033 respectively).In conclusion, our study is the first in the literature that shows statistically significant correlation between CGRP and leukocytosis. In our study we also showed the role of VEGF and TSH in advanced NSCLC prognosis. VEGF may be used as a potential new marker for the diagnosis of NSCLC. Further studies with larger number of patients are recommended to establish the value of VEGF and TSH as potential diagnostic and prognostic markers for advanced NSCLC. 89

Pulmonary sarcomas constitute only 0.1-0.5% of all primary lung malignancies. These tumors may derive from the lung parenchyma, bronchial tree or pulmonary arteries. The most important entity in the differential diagnosis is metastatic synovial sarcoma. A 76-years-old woman was admitted for investigation of a fever, productive cough, dyspnea, weight loss and left-sided chest pain which had been present for one month. A chest computerised tomography showed enlarged mediastinal lymph nodes were observed, as well as a left-sided pleural effusion. Thoracentesis revealed hemorrhagic pleural effusion which was exudate and lymphocyte predominant, closed pleural biopsy showed chronic inflammation. Left sided thoracoscopy was performed under local anesthesia, total collapse of left lung and multiple pleural nodules were observed on the visceral pleura multiple biopsies were obtained from those nodules. Pathologic examinations revealed "synovial sarcoma". As skeleton single photon emission tomography was unremarkable, primary pleuropulmonary synovial sarcoma was decided as diagnosis and chemotheraphy was planned for the patient. Primary pleuropulmonary synovial sarcoma is a rare neoplasm of lung and pleura but it is rare entity.

Bu çalışmanın amacı; ileri evre küçük hücreli dışı akciğer kanserli hastalarda (KHDAK) beyinmetastazı için risk faktörlerini belirlemektir. Yüz altmış üç ileri evre KHDAK’li hastaların dosya kayıtlarıretrospektif olarak incelendi. İzlemleri sırasında beyin metastazı gelişen ve gelişmeyen olmak üzere 2gruba ayrıldı. Yaş, cinsiyet, performans durumu, kilo kaybı, histopatolojik tip, primer tümörünlokalizasyonu, sigara içme öyküsü, tedavi yanıtı ve tanı anındaki laboratuvar tetkiklerinden laktatdehidrogenaz (LDH), albumin, hemoglobin düzeyleri univaryant ve multivaryant analize alındı. Coxproportional hazard modeli ve Kaplan-Meier sağ kalım analizleri SPSS 11.0 kullanılarak yapıldı.İzlemleri sırasında hastaların 40’ında (%24.5) beyin metastazı gelişti. Beyin metastazını etkileyenfaktörler kilo kaybı, ekstrakraniyal metastaz varlığı, tedaviye yanıtın olmaması, primer tümörün üst lobyerleşimli olması, mediastinal lenf nodu tutulumu ve LDH yüksekliği olarak tespit edildi. Tüm gruptaortanca sağ kalım süresi 44 hafta, 1 yıllık sağ kalım oranı %38, beyin metastazı gelişinceye kadargeçen süre 32 hafta, beyin metastazı tanısından sonra ortanca sağ kalım süresi 28 hafta idi. Kilokaybı, ekstrakraniyal metastaz varlığı, tedaviye yanıtın olmaması, primer tümörün üst lob yerleşimliolması, mediastinal lenf nodu tutulumu ve LDH yüksekliği beyin metastazını belirleyen en önemlifaktörlerdir. Profilaktik kraniyal radyoterapi bu grup hastalarda beyin relapsını geciktirmek, yaşamkalitesini düzeltmek ve beyin metastazının mortalite ve morbiditesini azaltmak için düşünülebilir., We aimed to determine the risk factors for brain metastases among patients with advanced NSCLC. Aretrospective analysis was made for 163 advanced NSCLC patients. The patients were enrolled intotwo groups in terms of who developed brain metastases or not during follow-up. Age, gender,performance status, weight-loss, histopathologic type, localisation of the primary tumor, smokingstatus, response to treatment, and lactate dehydrogenase (LDH), albumin, heamoglobin levels at thetime of the diagnosis were analyzed by univariate and multivariate analysis. Cox proportional hazardmodel and Kaplan-Meier survival analysis.There were 40 (24.5%) patients who had brain metastasesat the follow-up. Risk factors for brain metastases were weight-loss, extracranial metastases, upperlocalisation of primary tumor, unresponsiveness of first-line chemotherapy regimen, mediastinal lymphnode involvement and high LDH level. Median survival was 44 weeks, overall survival rate at 1 yearwas 38%, median time to onset of brain metastases was 32 weeks and median survival from thediagnosis of brain metastases was 28 weeks. Weight-loss, extracranial metastases, upper localisationof primary tumor, unresponsiveness of first-line chemotherapy regimen, high LDH level andmediastinal lymph node involvement were the most important risk factors for the prediction of brainmetastases. Prophylactic cranial irradiation may be choise in those patients to delay brain relapse, toimprove quality of life and to decrease morbidity and mortality of brain metastases.

It has been presented that 7-10% of pulmonary metastasis are caused by testicular carcinoma.Choriocarcinoma is a germ cell tumor of testis and it has a high potential of metastasis. Hemorrhageinto metastatic lesions in advanced germ cell tumors having high content of choriocarcinoma cells isknown as “choriocarcinoma syndrome”.A case of a 28-year-old man who had hemorrhagic andlymphangitic metastases and pleural effusion admitted to the emergency department with severedyspnea is presented in this study., Akciğer metastazlarının %7-10’u testiküler karsinomlardan kaynaklanmaktadır. Koryokarsinom,yüksek metastaz potansiyeline sahip testisin germ hücre kökenli bir tümörüdür. Yoğun koriyokarsinomelemanları içeren ileri evre germ hücreli tümörlerin metastaz alanında yaptığı kanama “koryokarsinomsendromu” olarak tanımlanmaktadır. Burada 28 yaşında ağır dispne nedeniyle başvuran ve akciğergrafisinde yaygın lenfovasküler metastazları ve plevral efüzyonu olan genç bir erkek olgu sunulmuştur

Küçük hücreli dışı akciğer kanseri (KHDAK)'nde ADE I/D gen polimorfizmininsıklığını, bunun prognoz, tedavi yanıtı ve sağkalım üzerine etkilerini değerlendirmek amacıylabu çalışmayı planladık.Vaka-kontrol çalışması şeklinde 100 KHDAK hastası ve yaş uyumlu 85 kontrolvakası kabul edilerek ADE polimorfizmi genotip frekansı karşılaştırıldı. Hastalığın başlangıçyaşı, sigara öyküsü, hastalık evresi, histolojik türü, cerrahi-kemoterapi-radyoterapiuygulanması tıbbi kayıtlardan değerlendirildi. Kan örnekleri DNA izolasyonu ve PZR yapmakamacıyla toplandı.Yüz KHDAK hastasında 54 (% 54) DD, 42 (% 42) ID ve 4 (% 4) II genotipibulundu. Seksenbeş kişilik kontrol grubunda 35 (% 41.2) DD, 36 (% 42.4) ID ve 14 (% 16.4)II genotipi saptandı. D ve I allel frekansı KHDAK grubunda sırasıyla % 75 ve % 25 ikenkontrol grubunda sırasıyla % 61.8 ve % 38.2 bulundu. Hasta ve kontrol grupları arasında hemDD, ID ve II genotiplerinde (p=0.012) hem de allelik sıklıkları arasında anlamlı fark saptandı(p=0.012). KHDAK hastalarında tümörün histolojik türü, hastalık evresi, cinsiyet ile ADEgenotipi ve allelleri arasında anlamlı ilişki saptanamadı. Ancak hasta grubunda DD genotipiile 50 paket/yıl ve altında sigara kullanımı arasında anlamlı ilişki bulundu (p=0.05).Çalışmamızda KHDAK grubu ile kontrol grubu ADE genotipi ve alleleri arasındaanlamlı fark bulundu. Bu nedenle ADE gen polimorfizminin KHDAK oluşumunda olası birrisk faktörü olabileceği düşünüldü. Ayrıca hasta grubunda DD genotipi varlığı 50 paket/yıl vealtında sigara kullanan hastalarda KHDAK gelişiminde etkili olabilir. We aimed to determine the distribution frequencies of the Angiotensin I-ConvertingEnzyme (ACE) genotypes and alleles in non-small cell lung cancer (NSCLC) patientswhether or not homozygotes for the deletion (DD) genotype influenced on diseaseprogression.Case-control study was conducted with the comparison of the frequencies of ACEgenotype polymorphism of 100 NSCLC cases and 85 age-matched healthy subjects as controlgroup. Age of disease onset, smoking history, disease stage, histologic type of tumors,surgery, chemotherapy and radiation therapy were recorded from medical records. Bloodspecimens were collected to perform DNA isolation and PZR.Of the one hundred patients, 54 (54 %) had DD, 42 (42 %) had ID and 4 (4 %) had IIgenotypes. In the control group; 35 (41.2 %) had DD, 36 (42.4 %) had ID and 14 (16.4 %)had II genotypes. The deletion (D) and insertion (I) allele frequencies were 75 % and 25 % inNSCLC patients, and 61.8 % and 38.2 % in control group respectively. Patient group?s DDgenotype distribution (p=0.012) and D allelic frequency (p=0.012) were significantly differentfrom control group. DD genotype was also significantly found to correlate with a history of50 pack-years and less smoking (p=0.05) in patient group.Distribution frequencies of ACE genotypes and alleles were different in NCSLCpatients than control group, so ACE gene polymorphism may be a suitable risk factor inNSCLC. DD genotype could have a role for developing of NSCLC in patients with smokinghistory equal or less than 50 pocket/year. 78