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Background: Breast lymphedema is a common complication of breast cancer treatments but there are limited studies about the treatment of breast lymphedema. The aim of this study was to investigate the acute effects of manual lymphatic drainage (MLD), compression with exercise on the local tissue water percentage, pain, and stiffness following breast-conserving surgery and radiotherapy. Materials and Methods: Twenty-two patients (52.54 ± 12.18 years, 28.55 ± 5.11 kg/m2) were included. The sociodemographic and clinical information was recorded. The pain and stiffness severity were measured with Visual Analog Scale. Measurements of water percentages in local tissue were performed in all quadrants of the breast with the Moisture Meter D Compact device. All measurements were performed baseline, after MLD, and after compression with exercise. Results: There was a significant difference in local tissue water percentages between the affected and unaffected sides before treatment. The percentage of water only in the lower outer quadrant of the affected breast increased significantly after acute treatment (p: 0.002). In addition, pain (p: 0.001) and stiffness (p: 0.001) scores decreased. Conclusions: Local tissue water percentages increased with MLD and decreased with compression with exercise. In the treatment of breast lymphedema, MLD and compression bandage with exercise may be beneficial in the management of the symptoms of swelling, pain, and stiffness. [ABSTRACT FROM AUTHOR]

Railway systems are preferred to solve traffic problems and are becoming backbones of transportation in cities especially in metropoles where transportation demands are high. At the point of enabling railway system investments which need big money source, decision taking at evaluation process especially for developing countries, is taking big import. In the literature, Net Present Value Analysis (NPVA), Benefit Cost Analysis (BCA) and Internal Efficiency Analysis (IEA) methods, which only take into account the numerical values, are used in the evaluation of transportation investments. Apart from these methods, another method used in this field is Multi Criteria Decision Making (MCDM). This method is not just evaluating economic sides of investments like previous methods, it is also making possible evaluating both verbal and economic values together by handling environment compatibility, relevance to historic tissue, integration with current transportation nets and using fields. In this study, prioritization will be made among alternative rail system projects planned to be used in Istanbul by utilizing the proposed MCDM methods to be used in the evaluation of transportation investments. For this purpose, Istanbul Metropolitan Municipality (IMM) projects, which are planned to be constructed throughout Istanbul, are considered as an alternative. As a result of the comprehensive literature study, the criteria were identified by determining the criteria used in the evaluation of transportation investments in the world and then by the experts who decided which of these criteria would be appropriate for Istanbul. At this stage, the most preferred Analytical Hierarchical Process (AHP) for transportation investment evaluation problems was used and alternative weights were found by using the Best Worst Method (BWM) which had not been used before in this kind of problem solving, and the comparison of two methods was made. As a result of the analysis, the findings were evaluated and several recommendations were made to determine the most appropriate project among the ones to be planned. [ABSTRACT FROM AUTHOR]

Abstract Purpose Turkish Radiation Oncology Study Group investigated local recurrence rates and prognostic factors in patients with ductal carcinoma in situ (DCIS) of the breast treated with breast conservative surgery (BCS) followed by radiotherapy (RT) and Eastern Cooperative Oncology Group (ECOG) Study E5194 were compared with the original study. Patients and methods Totally 252 patients were evaluated retrospectively. Prognostic factors that might influence local control (age, nuclear grade, comedo necrosis, surgical margins, tumor size, hormone receptor status) were compared. The eligibility criteria of ECOG 5194 were stratified into two groups as in the original study and were compared for local control. Results The median follow-up time was 59 (21–220) months. Local recurrence was observed in 9 patients (3.6%) who had invasive carcinoma (3 patients) and DCIS (6 patients). Ten years local control rates was 91.8% respectively. We found that the risk of ipsilateral breast recurrence was significantly higher in women younger than 50 years old (p = 0.016). In addition, a statistically significant trend was found in patients with tumor larger than 1 cm and HER2 positive tumors (p = 0.051, p = 0.068 respectively). When 12-year results were compared with the ECOG 5194, adjuvant RT produced an absolute difference of 11% in low-intermediate and 20% in high grade in local control. Conclusion In our study, the 10-year local control rate was 92% and younger than 50 years old was the most important unfavorable prognostic factor for local recurrence. There was provided 20% absolute local control with adjuvant radiotherapy which eligibility criteria of ECOG 5194 high grade group. Highlights • Our aim in this study; local recurrence rates and prognostic factors were investigated with DCIS of the breast treated with BCS and radiotherapy. The outcomes were compared with ECOG 5194 low risk groups. • We have identified the risk of ipsilateral breast recurrence was significantly higher in women younger than 50 years old. In addition, significant trend was found in patients with tumor larger than 1 cm and HER2 positive tumors. • The risk of local recurrence was significantly higher in patients with high grade lesions, comedo necrosis, HER2 positive tumors in under age of 50. • Compared with the ECOG 5194 study, adjuvant RT produced an absolute difference of 11% in low to intermediate grade and 20% in high grade in terms of providing local control. [ABSTRACT FROM AUTHOR]

Purpose To investigate the feasibility of carotid sparing intensity modulated radiation therapy (CS-IMRT) to minimize the radiation dose to carotid arteries for comprehensive irradiation of breast cancer patients who have risk factors for atherosclerosis. The dose distribution of CS-IMRT technique and the conventional irradiation technique were also compared. Patients and methods Ten patients who were previously treated with comprehensive three-dimensional conformal radiation therapy (3DCRT) were selected. DICOM data were used to contour the carotid artery and to create the virtual CS-IMRT plans for each patient. 3DCRT and CS-IMRT plans were compared in terms of conformity index, homogeneity index, and the doses to organ at risk and carotid arteries. Results The homogeneity and conformity indices were better with CS-IMRT plans compared to 3DCRT plan. The homogeneity index was 1.13 vs 1.11 (p = 0.007) for 3DCRT and CS-IMRT and the conformity index was 0.96 vs 0.97 (p = 0.006) for 3DCRT and CS-IMRT. The radiation dose to the carotid arteries were reduced by applying CS-IMRT without compromising the target volume coverage. When the carotid artery was considered as organ at risk for CS-IMRT planning, the median of V50 was decreased to 0% from 12.5% compared to 3DCRT plans (p = 0.017). The median of the maximum dose to the carotid artery was decreased under 50 Gy with CS-IMRT. Conclusions CS-IMRT can significantly reduce the unnecessary radiation dose to the carotid arteries compared with conventional 3DCRT technique while maintaining target volume coverage. CS-IMRT technique can be considered for breast cancer patient with high risk of atherosclerosis. [ABSTRACT FROM AUTHOR]

Purpose: To compare the incidence and severity of acute and chronic hematologic toxicity (HT) in patients treated with three-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) for curative treatment of cervical cancer and to ascertain the dosimetric parameters of two techniques associated with acute and chronic HT. Materials and Methods: A total of 127 patients with cervical cancer receiving concomitant pelvic radiotherapy (RT) and cisplatin were evaluated. Pelvic bone marrow (BM) was contoured for each patient and divided into five sub-regions: lumbosacrum (LS), ilium (IL), lower pelvis (LP), pelvis (P), and whole pelvis (WP). The volume of each BM region receiving 10,20,30, and 40 Gy was calculated (V10, -V20, -V30, and -V40). The lowest level of hemoglobin, leukocyte, neutrophil, and platelet counts were obtained during chemoradiotherapy and six months after RT. The nadir values were graded according to Common Terminology Criteria for Adverse Events (version 3.0). Results: Grade 2 or greater acute anemia, leukopenia, neutropenia, thrombocytopenia was observed in 2%, 41.5%, 12%,and 0% in 3DCRT group and in 27%, 53%, 24.5%, and 4.5% in IMRT group, respectively. Grade 2 or greater chronic anemia, leukopenia, neutropenia, and thrombocytopenia was observed in 11%, 10%, 6%, and 0% in 3DCRT group and in 11%, 9%, 4.5%, and 0% in IMRT group, respectively. LSV30,40; IL-VI 0,20,30,40; LP-V10,20,40; P-V10,20,30,40, and TP-V10,20,30,40 were significantly reduced with IMRT planning compared to 3DCRT planning. Logistic regression analysis of potential predictors showed that none of the dosimetric parameters were significant for predicting acute and chronic HT. Conclusion: The present findings showed that IMRT planning reduced irradiated BM volumes compared to 3DCRT planning. However, no difference between the two techniques was observed in terms of acute and chronic HT. Further studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Abstract: Background: In the management of malignant pleural mesothelioma, radiotherapy has been used for the purpose of prophylaxis to reduce the incidence of recurrence at surgical insertion sites or palliate the symptoms. Aim: The purpose of the study was to evaluate the techniques and effectiveness of radiotherapy in malignant pleural mesothelioma. Materials and methods: Forty-four (18 female, 26 male) patients diagnosed with malignant pleural mesothelioma were retrospectively evaluated. All patients had surgery or thoracoscopic biopsy for diagnosis, staging or treatment and all received palliative or prophylactic radiotherapy. Fifty-seven percent of the patients received chemotherapy. Results: Prophylactic radiation was applied to 27 patients with 4–15MeV electron energies. The median radiotherapy dose was 30Gy with 3Gy daily fraction dose. During treatment, 12 patients had grade 1 erythema according to the RTOG scale. In 3 (12%) patients, a local failure at treatment field was observed. Palliative radiotherapy was applied to 17 patients for pain palliation. The median radiation dose was 40Gy with 2Gy daily fraction dose by using 6–18MV photon and/or 4–12MeV electron energies. Two patients had grade 1 erythema and one patient had grade 2 odynophagy according to the RTOG scale. For 10 (59%) patients, palliation of chest pain was delivered. No late toxicity was observed for all cases. Conclusion: Our experience showed that prophylactic and palliative radiotherapy are effective and safe therapy modalities in malignant pleural mesothelioma in preventing seeding metastasis at intervention sites or relieving pain. Prospective randomized studies are still needed to determine the benefits of radiotherapy application and to indicate optimum dose schemes. [Copyright &y& Elsevier]

Abstract: Background: The use of HDR in the treatment of soft tissue sarcoma had been on the rise. However, there was limited study to evaluate the effect of different fractionation schemes on soft tissue and the optimal HDR scheme. Aims: We aimed to assess the histopathologic changes on soft tissue after different HDR brachytherapy doses. Methods: The subjects were divided into three groups. Each group included 10 limbs. Group A had only an applicator without radiation, group B received a total of 24Gy at 6Gy per fraction, twice a day, and group C received a total of 13.5Gy in a single fraction. The histopathologic findings were grouped into soft tissue pathology-1 (edema, inflammation, endothelial proliferation, necrosis) and soft tissue pathology-2 (atrophy, calcification, vascular hyalinization, fibrosis) (STP-1–2). Results: The highest mean grade values of STP-1 and STP-2 were observed in group C (0.95 and 1.45) in comparison to group A (0.45 and 0.85) and group B (0.65 and 0.9). The difference in STP-1 was found significant only between groups A and C and the difference in STP-2 was found both between groups A and C and groups B and C. Conclusion: In our experimental study it was shown that the fractionated interstitial HDR had both lower rate and severity of toxicity in comparison to a single high dose fraction. Before using a single fractionated regimen in the clinic, the increased morbidity related to the irreversible early toxicities or progressive late toxicities should be kept in mind. [ABSTRACT FROM AUTHOR]

Objective Trichothiodystrophy (TTD) is a rare group of autosomal recessive disorders of DNA repair characterized by photosensitivity, ichthyosis, sulfur-deficient brittle hair, intellectual impairment, decreased fertility, and short stature. Tay Syndrome refers to TTD with ichthyosis. Osteosclerosis and retarded skeletal age associated with TTD were reported in the literature. But osteochondrosis of the femur head (Perthes disease) with Tay syndrome had been reported in only one article. In this presentation, We report a case of Tay syndrome with additional features of Perthes disease. Case A 6 years-old-female presented to our clinic with complaint of frequently fell-down, knee pain for one year. She has classic clinical fetures of TTD including ichthyosis, alopecia, developmental delay, short stature, mental retardation, progeria-like face, tiger-tail banding of the hair shaft on polarizing microscopy. Brain MR imaging showed both diffuse dysmyelination and osteosclerosis findings. Hip MRI revealed stage III Perthes disease. Conclusion Tay syndrome is a rare autosomal recessive genodermatosis localized 19q13.2-q13.3, 6p25.3. Addition to the characteristic findings of this syndrome, also Perthes disease may be seen. The presence of diffuse dysmyelination, axial osteosclerosis and Perthes disease allow a spesific diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the impact of prostate-specific membrane antigen (PSMA) PET/CT compared with conventional imaging on treatment outcomes for node-positive prostate cancer (PCa) patients who underwent androgen deprivation therapy (ADT) and external radiotherapy (RT)., Patients and Methods: A multicentric, retrospective study recruited patients with node-positive PCa patients who underwent conventional radiological evaluation or PSMA PET/CT and received ADT and RT at 3 hospitals from 2009 to 2021 were enrolled. Patients underwent prostate and pelvis RT, accompanied by a minimum of 6 months of ADT. The primary endpoints were progression-free survival (PFS) and PCa-specific survival (PCSS). Cox regression analyzed the association of survival with potential prognostic factors, whereas logistic regression identified the predictors of bone and lymph node metastasis., Results: The median follow-up time was 64.0 months. The majority of patients (64.1%) underwent PSMA PET/CT for staging. The 5-year rates of PFS and PCSS were 63.7% and 83.7%, respectively. Disease progression was observed in 90 patients (36.3%). In multivariable analysis, ADT duration of less than 24 months and post-RT prostate-specific antigen (PSA) nadir were prognostic for PFS. Early clinical T stage and PSMA PET/CT predicted better PCSS. Patients staged with PSMA PET/CT had exhibited significantly higher 5-year PCSS rates than compared with those staged with conventional imaging (95.1% vs 76.9%; P = 0.01). Shorter ADT duration and higher PSA levels after RT independently predicted bone metastasis in multivariable logistic regression. Advanced T stage, shorter ADT duration, and higher PSA levels after neoadjuvant ADT predicted nonregional lymph node recurrence., Conclusions: ADT with pelvis RT is an effective treatment option for node-positive PCa patients. The PSMA PET/CT outperformed conventional imaging in PCSS, emphasizing the importance of precise clinical staging for patients undergoing definitive RT., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: To evaluate survival and prognostic factors associated with survival among patients who underwent reirradiation for recurrent/ progressive primary brain tumors., Material and Methods: A multicenter, retrospective study (7 centers, N=236) was conducted by the Neuro-oncology Group of the Turkish Radiation Oncology Association., Results: Median overall survival (OS) was 11 months and 1- and 2-year survival rates were 48% and 22%, respectively. Survival was negatively correlated with cumulative biologically effective dose (BED10) (r=-0.158, p=0.016) and cumulative equivalent dose in 2-Gy fractions (EQD2) (r=-0.158, p=0.016). In univariate analysis, survival was associated with performance status (p < 0.001), histopathology at diagnosis and recurrence (p < 0.001), radiotherapy (RT) method used for recurrence (p=0.025), tumor volume at recurrence (p=0.014), cumulative EQD2 ( < 110 vs. ≥110 Gy, p=0.038), and cumulative BED10 ( < 130 vs. ≥130 Gy, p=0.022). In multivariate analysis, tumor volume at recurrence (HR=1.68, 95% CI=1.06-2.64, p=0.025), Karnofsky Performance Status score (HR=5.7, 95% CI=3.26-9.98, p < 0.001), and histopathology at recurrence (glioblastoma vs. high-grade glioma: HR=0.48, 95% CI=0.26-0.88, p=0.019; glioblastoma vs. low-grade glial tumor: HR=0.16, 95% CI=0.08-0.34, p < 0.001) were found to be independent prognostic factors. Radionecrosis was detected in 25% (n=58) of the patients. Re-resection was associated with a higher rate of radionecrosis (37.7% vs. 18%, p=0.002)., Conclusion: The prognostic factors most strongly associated with survival in glioma patients undergoing reirradiation were Karnofsky Performance Status score below 70, glioblastoma histopathology, and tumor volume greater than 4.5 cm3. In addition, survival time was negatively correlated with cumulative EQD2 and BED10. The rate of radionecrosis was higher in patients who underwent re-resection compared those who did not.

The aim of this study was to examine the prognostic factors and treatment outcomes of cervical esophageal carcinoma (CEC) patients who underwent definitive chemoradiotherapy (CRT). The clinical data of 175 biopsy-confirmed CEC patients treated with definitive CRT between April 2005 and September 2021 were retrospectively analyzed. The prognostic factors predicting overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS) were assessed in uni- and multivariable analyses. The median age of the entire cohort was 56 years (range: 26-87 years). All patients received definitive radiotherapy with a median total dose of 60 Gy, and 52% of the patients received cisplatin-based concurrent chemotherapy. The 2-year OS, PFS, and LRFS rates were 58.8%, 46.9%, and 52.4%, respectively, with a median follow-up duration of 41.6 months. Patients' performance status, clinical nodal stage, tumor size, and treatment response were significant prognostic factors for OS, PFS, and LRFS in univariate analysis. Non-complete treatment response was an independent predictor for poor OS (HR = 4.41, 95% CI, 2.78-7.00, p < 0.001) and PFS (HR = 4.28, 95% CI, 2.79-6.58, p < 0.001), whereas poor performance score was a predictor for worse LRFS (HR = 1.83, 95% CI, 1.12-2.98, p = 0.02) in multivariable analysis. Fifty-two patients (29.7%) experienced grade II or higher toxicity. In this multicenter study, we demonstrated that definitive CRT is a safe and effective treatment for patients with CEC. Higher radiation doses were found to have no effect on treatment outcomes, but a better response to treatment and a better patient performance status did., Competing Interests: The authors declare that they have no conflicts of interest to report regarding the present study., (© 2023 Guler et al.)

Background and Purpose: The optimal treatment for adults with newly diagnosed medulloblastoma (MB) has not been defined. We report a large series of cases from the Rare Cancer Network., Material and Methods: Thirteen institutions enrolled 206 MB patients who underwent postoperative radiotherapy (RT) between 1976 and 2014. Log-rank univariate and Cox-modeled multivariate analyses were used to analyze data collected., Results: Median patient age was 29 years; follow-up was 31 months. All patients had the tumor resected; surgery was complete in 140 (68%) patients. Postoperative RT was given in 202 (98%) patients, and 94% received craniospinal irradiation (CSI) and, usually, a posterior fossa boost. Ninety-eight (48%) patients had chemotherapy, mostly cisplatin and vincristine-based. The 10-year local control, overall survival, and disease-free survival rates were 46%, 51%, and 38%, respectively. In multivariate analyses, Karnofsky Performance Status (KPS) ≥80 and CSI were significant for disease-free and overall survival (P ≤ .04 for all); receiving chemotherapy and KPS ≥80 correlated with better local-control rates., Conclusions: Patients with high KPS who received CSI had better rates of disease-free and overall survival. Chemotherapy was associated with better local control. These results may serve as a benchmark for future studies designed to improve outcomes for adults with medulloblastoma., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: To analyze whether the expression of matrix metalloproteinases (MMPs) and their tissue inhibitors are associated with tumor response to preoperative chemoradiotherapy in rectal cancer patients., Methods and Materials: Forty-four patients who had undergone preoperative chemoradiotherapy were evaluated retrospectively. Treatment consisted of pelvic radiotherapy and two cycles of 5-fluorouracil plus leucovorin. Surgery was performed 6-8 weeks later. MMP-2, MMP-9, and tissue inhibitors of metalloproteinase-1 and -2 expression was analyzed by immunohistochemistry of the preradiation biopsy and surgical specimens. The intensity and extent of staining were evaluated separately, and a final score was calculated by multiplying the two scores. The primary endpoint was the correlation of expression with tumor response, with the secondary endpoint the effect of chemoradiotherapy on the expression., Results: Preoperative treatment resulted in downstaging in 20 patients (45%) and no clinical response in 24 (55%). The pathologic tumor response was complete in 11 patients (25%), partial in 23 (52%), and none in 10 (23%). Positive MMP-9 staining was observed in 20 tumors (45%) and was associated with the clinical nodal stage (p = 0.035) and the pathologic and clinical response (p < 0.0001). The staining status of the other markers was associated with neither stage nor response. The overall pathologic response rate was 25% in MMP-9-positive patients vs. 52% in MMP-9-negative patients (p = 0.001). None of the 11 patients with pathologic complete remission was MMP-9 positive., Conclusions: Matrix metalloproteinase-9 expression correlated with a poor tumor response to preoperative chemoradiotherapy in rectal carcinoma patients.