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İmmunoterapi, bağışıklık sisteminin güçlendirilmesi ile birçok kanser türünde yanıt, yanıt süresi ve sağkalım açısından etkinliği kanıtlanmış bir tedavidir. Yanıt oranları %20 olup dirençli hastalarda immunoterapi ile sinerjik etki yaratan yeni tedavilere gereksinim vardır. Radyoterapi ile tümör hücrelerinden salınan antijenik uyarı tümörün bağışıklık sistemi tarafından daha kolay tanınmasını sağlayarak immunoterapinin tamamlayıcısı olabilir. Radyoterapinin, ışınlanan hedef dışındaki metastazlar üzerindeki sistemik etkisi “abscopal” etki olarak tanımlanmış olup immuno-radyoterapinin temel amacı “abscopal” etkiyi uyandırmaktır. İmmuno-radyoterapinin yanıt ve sağkalıma anlamlı katkısı öncelikle malign melanom ve akciğer kanserlerinde gösterilmiş olup diğer solid tümörlerde de gelecek vaat eden önemli bir tedavi yöntemi olarak görülmektedir. Immunotherapy is a treatment proven to be effective in terms of response, duration of response and survival in many types of cancer by strengthening the immune system. The response rates are 20%, and new treatments that produce synergistic effect with immunotherapy are needed in resistant patients. Antigenic stimulation released from tumor cells with radiotherapy can complement immunotherapy by making the tumor more easily recognized by the immune system. The systemic effect of radiotherapy on metastases other than the irradiated target is defined as “abscopal” effect and the main purpose of immuno-radiotherapy is to evoke the “abscopal” effect. The significant contribution of immuno-radiotherapy to response and survival has been shown primarily in malignant melanoma and lung cancers, and is seen as a promising treatment method in other solit tumors as well.

Küçük hücreli dışı akciğer kanseri (KHDAK)’nin en sık metastaz yaptığı organlardan biri beyindir. Beyin metastazı olan hastalar tedavi edilmediğinde ortalama yaşam süresi aylarla sınırlıdır. Bu çalışmanın amacı beyin metastazı yapmış evre 4 KHDAK hastalarda beyin metastazı için cerrahi tedavi uygulamasının onkolojik sonuçlarını göstermektir. Kliniğimizde 2004-2012 yılları arasında KHDAK tanısı konan ve BM nedeniyle cerrahi tedavi uygulanan 59 hastanın verileri prospektif olarak kaydedildi ve retrospektif olarak incelendi. Hastaların cerrahi ve onkolojik sonuçları irdelendi. Sağ kalım süresi beyin metastazı tanısı konulduğu tarih ile ölüm tarihi veya mevcut en son takip arasındaki zaman olarak hesaplandı. Hastaların 51’i erkek, 8’i kadın, ortalama yaş 56.92 (37-81) yıl idi. Cerrahi olarak 55 hastaya total eksizyon, 4 hastaya subtotal eksizyon yapıldı. Ameliyat sonrası mortalite saptanmadı. Patolojik inceleme sonucunda 55 hastada cerrahi sınırlar tümörsüz, 4 hastada ise cerrahi sınır mikroskobik pozitif olarak bildirildi. Ameliyat sonrasında tüm hastalara palyatif kranial radyoterapi ve sistemik kemoterapi verildi. 11 hastaya(%18,6) akciğerdeki primer kitleye kemoradyoterapi verildi. 8 hastaya akciğere yönelik cerrahi lobektomi, 7 hastaya pnömonektomi uygulandı. Medyan genel sağkalım süresi 12,00 (1,0-159,0) aydı. Hastaların 12, 24 ve 60 aylık sağkalım oranları sırasıyla %47.5, %28.8 ve %13.5 olarak bulundu. Üç olguda ise 10 yılın üzerinde genel sağ kalım elde edildi. Beyin metastazı yapmış KHDAK’lu hastalarda kranial metastazektomi hastaların sağkalımına olumlu katkı sağlayabilir. The brain is one of the organs that non-small cell lung cancer (NSCLC) metastasizes most frequently. The life expectancy is limited to months in patients with brain metastasis (BM), which is not treated. This study aims to show the oncological outcomes of surgical treatment of cranial lesion in patients with stage 4 NSCLC. The data of 59 patients who were diagnosed with NSCLC and underwent surgical treatment of BM between 2004 and 2012 in our clinic were prospectively recorded and analyzed retrospectively. The surgical and oncological outcomes of the patients were studied. Survival was calculated as the time between the diagnosis of BM and the date of death or the last followup. Fifty-one of the patients were male, and eight were female, and the median age was 56.9 (37-81) years. Fifty-five patients underwent total excision, and four patients underwent subtotal excision. No postoperative mortality was detected. As a result of the pathological examination, the surgical margins were reported as tumor-free in 55 patients, and microscopically positive in 4 patients. Palliative cranial radiotherapy and systemic chemotherapy were given to all patients after surgery. Eleven patients (18.6%) underwent chemoradiotherapy to the primary mass in the lung. Lobectomy and pneumonectomy were performed in 8 and 7 patients. The median overall survival was 12.00 (1.0159.0) months. The 12, 24, and 60-month survival rates of the patients were 47.5%, 28.8%, and 13.5%, respectively. In three cases, overall survival over ten years was obtained. Cranial metastasectomy may contribute positively to the survival of patients with NSCLC.

Bu çalışma, 16. Ulusal Medikal Fizik Kongresi’nde (28-30 Ekim 2017, Antalya) poster bildiri olarak sunulmuştur. Volumetrik ark (t-VMAT) tekniği ile radyoterapi (RT) uygulanan malign glial tümörlü hastalarda mevcut tedavi planına karşın 1 ark VMAT ve statik 5 alan yoğunluk ayarlı RT tekniği dozimetrik olarak karşılaştırıldı. Çalışmaya en az 50 Gy RT alan 18 malign glial tümörlü olgu dahil edildi. Saçlı deri ortalama, 1 ve 9 cc dozları için 16, 30 ve 24 Gray eşik değerleri kullanıldı. Yöntemler arasında planlama tedavi volümü ve riskli organ dozları açısından anlamlı fark bulunamadı. Planlamanın hangi yöntem ile yapıldığı önemli olmaksızın saçlı derinin planlamaya dahil edilmesiyle birlikte saçlı deri dozlarının anlamlı azaldığı görüldü (p < 0.05). Oniki aylık izlem süresi içinde akut dönemde saç kaybı yaşamalarına rağmen hiçbir olguda kalıcı saç kaybı görülmedi. Bu çalışma ile saçlı derinin tedavi planına dahil edilmesinin hedef volüm dozları açısından olumsuz etkisi olmadığı gibi hastalarımızın kalıcı saç dökülmesinin yaratacağı kozmetik ve psikososyal yan etkilerden korunabileceği ortaya konulmuştur. In malign glial tumors treated with radiotherapy (RT); despite the current treatment plan with volumetric arc (t-VMAT) technique, 1 arc VMAT and static 5 field intensity modulated RT technique were compared dosimetrically. Sixteen malign glial tumors treated with at least 50 Gy RT were included. Sixteen, 30 and 24 Gray thresholds doses were used for mean, 1 and 9 cc scalp volumes. There was no statistically significant difference between methods in terms of planning treatment volume and risky organ doses. Significant reductions in scalp doses were observed (p < 0.05) with the inclusion of scalp regardless of the planning methods. Despite the hair loss in acute period, there was no permanent hair loss in any case in 12-month follow-up. It has been shown by this study, the inclusion of scalp into the treatment plan does not have a negative effect on the target volume doses, and our patients may be protected from cosmetic and psychosocial side effects caused by permanent hair loss.

Bu çalışma, 16. Ulusal Medikal Fizik Kongresi’nde (28-30 Ekim 2017, Antalya) poster bildiri olarak sunulmuştur. Akciğer kanserinin radyoterapi (RT) ile tedavisinde; üç boyutlu konformal RT (3BKRT), yoğunluk ayarlı RT (YART) ve volümetrik ark terapi (VMAT) teknikleri kullanılarak hedef volüm ile kritik organ dozlarının karşılaştırılması amaçlanmıştır. Bu çalışma için; küratif RT ile tedavi edilen 50 küçük hücreli dışı akciğer kanseri (KHDAK) tanılı hasta seçilerek, 3BKRT, YART ve VMAT tedavi planları oluşturuldu. homojenite indeksi (HI), konformite indeksi (CI), planlama tümör volümü (PTV) ve kritik organların aldığı doz değerleri karşılaştırıldı. Tedavi planları arasında PTV’nin Dmean (p= 0,080) değeri açısından anlamlı fark görülmedi; ancak D98% (p= 0,001) değeri VMAT tekniğinde üstün bulundu. Tüm akciğerin 5 Gy alan (V5) % değeri için (p= 0,001) VMAT tekniğinin diğer tekniklere göre daha üstün olduğu görüldü. Sonuç olarak; her üç RT tekniğinde hedef volümün istenen dozu aldığı ancak; özellikle radyasyon pnömonisi gibi yan etkilerin azaltılması açısından VMAT tekniğinin daha üstün olduğu anlaşılmıştır. Teknolojik gelişmeler ışığında akciğer kanserli hastaların RT’sinde güncel tedavi yaklaşımının VMAT tekniği olduğunu söyleyebiliriz. It is aimed to compare the target volume and critical organ doses using three dimensional conformal RT (3DCRT), intensity modulated RT (IMRT) and volumetric arc therapy (VMAT) techniques in lung cancer treated with RT. For this study; 50 patients with non-small cell lung cancer (NSCLC) who were treated with curative RT were selected and 3DCRT, IMRT and VMAT treatment plans were created. homogeneity index (HI), conformity index (CI), planning tumor volume (PTV) and dose values of critical organs were compared. There was no significant difference between treatment plans in terms of Dmean (p = 0,080) value of PTV; but D98% (p = 0.001) superior with VMAT technique. The VMAT technique was found to be superior to the other techniques for percent volume of lung receiving more than 5 Gray (V5) (p = 0.001). As a result; in all three RT techniques the target volume received the desired dose; it is understood that the VMAT technique is superior in terms of reducing side effects, especially radiation pneumonia. We can say that the current treatment approach is VMAT technique in the RT of patients with lung cancer in the light of technological developments.

Purpose This Rare Cancer Network (RCN) study was performed in pediatric nasopharyngeal carcinoma (PNPC) patients to evaluate the optimal dose of radiotherapy and to determine prognostic factors. Patients and Methods The study included 165 patients with the diagnosis of PNPC treated between 1978 and 2003. The median age was 14 years. There were 3 (1.8%) patients with stage I, 1 (0.6%) with IIA, 10 (6.1%) with IIB, 60 (36.4%) with III, 44 (26.7%) with IVA, and 47 (29%) with IVB disease. While 21 (12.7%) patients were treated with radiotherapy (RT) alone, 144 (87.3%) received chemotherapy and RT. The median follow-up time was 48 months. Results The actuarial 5-year overall survival (OS) was 77.4% (95% CI: 70.06–84.72), whereas the actuarial 5-year disease-free survival (DFS) rate was 68.8% (95% CI: 61.33–76.31). In multivariate analysis, unfavorable factors were age >14 years for LRC ( p =0.04); male gender for DMFS ( p =0.03); T3/T4 disease for LRFS ( p =0.01); and N3 disease for DFS ( p =0.002) and OS ( p =0.002); EBRT dose of less than 66Gy for LRFS ( p =0.02) and LRRFS ( p =0.0028); and patients treated with RT alone for LRFS ( p =0.0001), LRRFS ( p =0.007) and DFS ( p =0.02). Conclusion Our results support the current practice of using combined radiation and chemotherapy for optimal treatment of NPC. However, research should be encouraged in an attempt to reduce the potential for long-term sequelae in pediatric patients given their relatively favorable prognosis and potential for longevity.

2009-2012 arasında üç boyutlu konformal teknikle definitif radyoterapi (3DCRT) ± eşzamanlı kemoterapi (KT) uygulanmış ve en az 6 ay yaşayan küçük hücreli dışı akciğer kanserli olgular incelendi. Toplam doz, biyolojik efektif doz (BED) eşdeğerine dönüştürülerek normal doku komplikasyon olasılığı (NTCP) hesaplandı. İstatistiki analiz Şubat 2013?te SPSS v.20 ile uygulandı. Medyan yaş 59 (aralık 36-81) olup bloklu konformal (n: 37), 3DCRT (n: 11) ve yoğunluk ayarlı RT (IMRT) (n: 20) ile medyan 63 Gy (aralık: 54-70 Gy) uygulandı. Neoadjuvan, eşzamanlı, adjuvan KT sırasıyla; 29, 49, 41 olguda verildi. Akut grad (G) 1-3 özafajit, akut G1-2 radyasyon pnömonisi (RP), radyasyon fibrozisi sırasıyla; %48, %13, %18 oranında gelişti. Tedavi şekli, RT dozu, tümör BED, dozimetrik faktörler ve KT ile RP arasında anlamlı ilişki gösterilemedi (p >0,05). Fizik ve biyolojik mean akciğer dozu (MLD) arasında iyi bir korelasyon vardı (0,93). Medyan MLD 17 Gy, MLDbiyo 16,7 Gy, V30 %20,5, NTCP 0,142 bulundu. NTCP ile V30, MLD, MLDbiyo arasında pozitif korelasyon vardı (p 59,4 Gy alan hasta oranı, tümör BED3(Gy), BED10(Gy) daha fazla bulunurken (p= 0,02, p= 0,02, p= 0,02), >63 Gy alanlarda fark bulunamadı (p=0,3). Ellibeş Gy alan özafagus volümü RP olmayanlarda daha az bulundu (p=0,03). Medyan-2 yıl genel sağkalım (GSK) 27 ay, %51, medyan-2 yıl hastalıksız sağkalım (HSK); 18 ay, %42 bulundu. PET/BT ile 3. ay yanıt GSK için anlamlı idi (p= 0,009). Radyasyon pnömonisi ile GSK farkı bulunmadı (p= 0,3). Univaryat analizde; MLD yanında kalp V40 ?%80 GSK için (p= 0,03), kalp V40 ?%80 ve kalpmean ?2578 cGy HSK için (p= 0,005, p= 0,03) olumlu faktörler olarak bulundu. Multivaryat analizde; GSK için 6. ay yanıt (p= 0,001), fx dozu 1,8 Gy (p= 0,002), MLD 59,4 Gy (p= 0,01), tümör BED3(Gy) ?100,8 Gy (p= 0,01) anlamlı bulundu. Çalışmamızda RP risk tahmini için MLD ile NTCP arasında doğrusal bir korelasyon olduğu gözlendi. Hastaya uygun RT tekniğini seçerken düşük doz alan büyük volüm dozları (V5-V10) ve yüksek doz alan küçük volüm dozlarına (V40-V50) dikkat etmemiz gerektiği ortaya konmuştur. MLD?nin 20 Gy altında tutulabildiği doz aralığı 59.4-63 Gy arasında olup terapötik aralığın adaptif RT teknikleri ile artırılabileceği düşünülmektedir. Anahtar sözcükler: Definitif konformal radyoterapi, yan etkiler, dozimetrik faktörler, radyasyon pnömonisi, sağkalım. The patients with non-small cell lung cancer treated by definitive three-dimensional conformal radiotherapy (3DCRT) ± concurrent chemotherapy (CT) from 2009 to 2012 and those who survive for at least 6 months were analyzed. Total dose was converted to biological effective dose equivalent (BED) and normal tissue complication probability (NTCP) was calculated. Statistical analysis was performed with SPSS v.20 at 20 February 2013. The median age was 59 (range: 36-81) and a median of 63 Gy (range: 54-70 Gy) was delivered with conformal RT using customized blocks (n: 37), 3DCRT (n: 11) and intensity-modulated RT (IMRT) (n: 20). Neoadjuvant, concurrent, adjuvant CT were given to 29, 49, 41 patients, respectively. Acute grade (G) 1-3 esophagitis, acute G1-2 radiation pneumonitis (RP) and radiation fibrosis was developed with rates of 48%, 13%, and 18%, respectively. It was not demonstrated a significant relationship between RP and treatment type, RT dose, tumor BED, dosimetric factors and CT (p >0,05). There was a good correlation between physical and biological mean lung dose (MLD) (0,93). The median MLD, MLDbio, V30 and NTCP were found 17 Gy, 16,7 Gy, 20,5% and 0,142. There was a positive correlation between NTCP and V30, MLD, MLDbio (p 59.4 Gy, tumor BED3(Gy), BED10(Gy) (p= 0,02, p= 0,02, p= 0,02) in patients with MLD 63 Gy (p= 0,3). Volume of the esophagus received 55 Gy was lower in those without RP (p= 0,03). Median-2-year overall survival (OS) were found 27 months, 51% and median-2-year disease-free survival (DFS) were found 18 months, 42%. Response with PET/CT at 3 months was statistically significant for OS (p= 0,009). There was no difference in OS with RP (p= 0,3). On univariate analysis; besides MLD, heartV40 ?80% for OS (p= 0,03) and heart V40 ?80%, heartmean ?2578 cGy for DFS (p= 0.005, p= 0.03) were found favorable factors. On multivariate analysis; response at 6 months (p= 0,001), fx dose 1.8 Gy (p= 0,002), MLD 59.4 Gy (p= 0,01), tumor BED3(Gy) ?100.8 Gy (p= 0,01) were significant for DFS. In our study, a linear correlation was observed between MLD and NTCP in terms of risk prediction. It is showed that when choosing the individualized RT technique for patients should pay attention to the low doses to large volumes (V5-V10) and high doses to small volumes (V40-50). MLD can be kept below 20 Gy dose range of 59.4-63 Gy and therapeutic range is thought to be increased with adaptive RT techniques. Key Words: Definitive conformal radiotherapy, side effects, dosimetric factors, radiation pneumonitis, survival. 74

Background: Our aim in the present study was to describe the quality of life (QOL), evaluate pulmonary function, and compare demographic and clinical characteristics with QOL in long-term survivors of non-small cell lung cancer treated with radical or postoperative radiotherapy. Methods: Twenty-eight patients were recruited in the study. QOL was evaluated using The European Organization for Research and Treatment of Cancer, Quality of Life Core Questionnaire (EORTC QLQ-C30, v.3). Statistical analysis was performed by SPSS 14. Results: Patients' files were reviewed in October 2006. Median duration of follow-up was 46 months (range: 25-125 months). Seven of 9 scales were found to meet the minimal reliability limit (Cronbach's alpha >0.70). The lowest and highest reliability coefficients were 0.56 and 0.93 for social and role functioning, respectively. All interscale correlations were statistically significant (P < 0.01). The strongest positive correlation was found between physical functioning and, role and cognitive functioning (r = 0.59, r = 0.37 or P = 0.01, P = 0.05, respectively). The highest correlation of EORTC QLQ-C30 and the Katnofsky performance scale (KPS) during the questionnaire was found to be with physical functioning and constipation (r = 0.41. r = 0.44 or P = 0.02, P = 0.01, respectively). When the effect of various demographic and clinical parameters on QOL was evaluated; initial KPS, age, educational level, health insurance status, stage, chemotherapy, comorbid disease, and passive smoking were determined as significant factors influencing QOL. Physical, role, cognitive, and emotional functions were found to be significantly lower in the presence of dyspnea (r = 0.42, r = 0.58, r = 0.50, r = 0.63 or P = 0.02, P < 0.01, P < 0.01, P < 0.05, respectively). Regarding the symptom scales, dyspnea was found to be correlated with increasing of fatigue, pain, insomnia, and appetite loss (r = 0.52, r = 0.40, r = 0.64, r = 0.38 or P < 0.01, P = 0.03, P < 0.05, P = 0.04, respectively). The parameters of pulmonary function tests (FEV1, FVC, and FEV1/FVC) did not show any significant relation with any scale of QOL. Conclusion: Overall, we found that QOL of our patients who survived at least 2 years after radiotherapy, was good. The Turkish version of the EORTC QLQ-C30, v.3 is a valid and reliable instrument for Turkish lung cancer patients and can be used in clinical studies. We believe further studies are needed to have a better understanding of patients' pretreatment and posttreatment .

We have performed a prospective evaluation of the efficacy, safety and convenience of the transdermal therapeutic system - fentanyl (TTS-F) in Turkish cancer patients when it was newly available in Turkey. Ninety-nine patients with historically confirmed malignancy and pain entered the study; the mean age was 55.1 (16-58) years. The study duration was 28 days. Transdermal therapeutic system - fentanyl was used in opioid-naive or pre-treated patients. Most patients reported a decrease in pain severity. Use of rescue medication decreased from day 4 to day 28. The majority of patients rated patch convenience of use as excellent. A total of 22.2% of patients experienced adverse events that were either probably related or very likely to be related to the study drug. The majority of the adverse events mentioned were related to the digestive system. Eighteen serious adverse events were reported by 13 patients. Six events were doubtfully related, and 12 events were not related to the study drug. Four patients died during the trial. None of these deaths was attributed to the study drug. In conclusion, the trial showed that TTS-F is easily managed, effective and will help to enable the appropriate opioid administration to patients who are suffering from cancer pain in Turkey.

ÖZETAmaç: Küçük hücre dışı akciğer karsinomu (KHDAK) tanısı ile postoperatifveya definitif radyoterapi (RT) uygulanmış ve en az iki yıl yaşayan olgularda,solunum fonksiyonları ve yaşam kalitesi (YK) üzerinde etkili faktörleribelirlemektir.Gereç ve Yöntem: UÜTF Radyasyon Onkolojisi AD, RadyoterapiMerkezi'nde 1995-2004 yılları arasında KHDAK tanısı ile postoperatif veyadefinitif amaçlı RT uygulanmış ve en az iki yıl yaşayan 28 hasta yaşamkalitesi ve pulmoner fonksiyonlar açısından değerlendirildi. Hastalarınortanca yaşı 55 (sınırlar:39-74) olup, 2 (%7)'si kadındı. Radyoterapi, 16(%57) hastaya postoperatif, 12 (%43) hastaya definitif olarak uygulanmıştı.Üç (%11) hasta evre II B, 13 (%46) hasta evre IIIA ve 12 (%43) hasta da evreIIIB idi. Solunum fonksiyon testleri (SFT) spirometre ile yapılırken, YKdeğerlendirmesi için ?European Organization for Research and Treatment ofCancer Quality of Life Core Questionnaire? (EORTC QLQ-C30) soruanketinin 3. versiyonu kullanıldı. statistiki analizler SPSS 14 paket programkullanılarak yapıldı.Bulgular: Croncbach's-alfa ile ölçülen güvenilirlik testine göre YK anketi,sosyal fonksiyon (cronbach's-α=0,56) dışındaki tüm skalalar için güvenilirbulundu (cronbach's-α>0,60). Yaşın artması ile fizik fonksiyonda azalmasaptandı (p=0,045). Eğitim düzeyi ile YK arasındaki ilişki incelendiğindeeğitim düzeyi yüksek olanlarda diğerlerine göre YK daha düşük bulundu(p=0,042). Komorbid hastalık varlığı yaşam kalitesini azaltan bir faktör olarakbulundu (p=0,020). Evrenin ilerlemesiyle ağrı (p=0,044) ve yorgunluk(p=0,031) semptomunda artma görüldü. KPS ile kognitif (p=0,033) ve fizikfonksiyonlar (p=0,029) arasında pozitif ilişkili olduğu saptandı.Fizik fonksiyon ile rol (p=0,001) ve kognitif fonksiyon (p=0,050)arasında anlamlı ilişki saptandı. Global yaşam kalitesi, fonksiyonelskalalardan sadece fizik fonksiyon (p=0,025) ve semptom skalalarından iseisadece yorgunluk (p=0,031) ile ilişkili bulundu. Dispne (p=0,026), ağrı(p=0,004), yorgunluk (p=0,000), iştah kaybı (p=0,000) ve bulantı-kusma(p=0,004) semptomlarının fizik fonksiyonu anlamlı ölçüde azaltan faktörlerolduğu görüldü. Bu faktörlere ek olarak uyku bozukluğunun kişinin hayattakirol (p=0,045) ve emosyonel (p=0,010) fonksiyonlarını anlamlı derecededüşürdüğü bulundu. SFT parametreleri ile YK anket parametreleri arasındaanlamlı ilişki saptanmadı (p>0,05).Sonuç: Çalışmamızda yaşam kalitesinin yaş, evre, komorbid hastalık, eğitimseviyesi, performans durumu gibi faktörlerden etkilendiğini saptadık. Bunedenle KHDAK'li olguların tedavi planlaması sırasında daha kaliteli biryaşam için bu faktörlerin göz önünde bulundurulması gerekebilir.Anahtar Kelimeler: Küçük Hücre Dışı Akciğer Kanseri, radyoterapi, solunumfonksiyonları, yaşam kalitesi.ii SUMMARYRESPIRATORY SYMPTOMS AND QUALITY OF LIFE IN NON-SMALLCELL LUNG CANCERPURPOSE: The aim of the study is to identify the factors which influencesthe respiration functions and quality of life (QOL) in the patients who weretreated with radiotherapy definitive or postoperatively and lived at least twoyears with the diagnosis of non-small cell lung carcinoma (NSCLC) .MATERIALS AND METHODS: In the Radiotherapy Center of UludagUniversity- Department of Radiation Oncology we have examined the qualityof life and pulmonary functions of 28 patients who were treated post-operative or definitive radiotherapy between 1995-2004 years and, who livedat least two years after non-small cell lung carcinoma (NSCLC) diagnosis.The patients were at an average age of 55 (range: 39-74) and two of themwere women. Radiotherapy was applied to the 16 of the patients (57%)postoperatively and to the 12 of the patients (43%) definitively. Three of thepatients (11%) were stage II B, 13 were stage III A, and 12 of them werestage III B. QOL was investigated through the 3rd version of ?EuropeanOrganization for Research and Treatment of Cancer Quality of Life CoreQuestionnaire? (EORTC QLQ-C30), while the tests of respiration functionswere made by using spirometry. Statistical analyses were made by usingSPSS 14 program.OUTCOMES: According to the reliability test (measured throughCroncbach?s-alfa) this Quality of Life Questionnaire was reliable (cronbach?s-α>0,60) regarding all the scales except for social function (cronbach?s-α=0,56). A decrease on physical functions was identified as the ageincreased (p=0,045). When the relation between educational level and QOLwas investigated, the QOL was relatively low for the patients whoseeducational levels were higher (p=0,042). The existence of comorbid diseaseiwas found to be a factor decreasing quality of life (p=0,020). Pain and fatiguesymptoms were increased in advanced stages (p=0,044; p=0,031). It wasidentified that there was a positive relation between Karnofsky PerformanceScale (KPS) and cognitive- physical functions (p=0,033; p=0,029).A significant relationship was found between physical functions, role(p=0,001) and cognitive functions (p=0,050). Global quality of life was foundto be related only with physical functions (p=0,025) in the functional scalesand related only with fatigue (p=0,031) in the symptom scales. It was foundthat dyspnea (p=0,026), pain (p=0,004), fatigue (p=0,000), loss of apetite(p=0,000) and nausea-vomitting (p=0,004) symptoms decrease the physicalfunctions significantly. In addition to these factors, sleep disorder was foundto decrease the role (p=0,045) and the emotional (p=0,010) functions of theindividual, significantly. There was no significant relation between RespiratoryFunctional Test parameters and QOL questionnaire parameters (p>0,05).CONCLUSION: In the present study it was found that quality of life waseffected by factors such as age, stage, comorbid disease, educational leveland performance status. Hence, these factors should be considered duringthe treatment planning of patients of NSCLC in order to have a more qualifiedlife.KEY WORDS: Non-small cell lung cancer, radiotherapy, respiratoryfunctions, quality of life.ii 40

Purpose: We aim to determine infections occuring in patients with non-small cell lung cancer during radiotherapy (RT). Methods and materials: A total of 181 patients had been treated with thoracic radiotherapy between October 1995 and December 1999. Radiotherapy was given using 1.8-3 Gray (Gy) fraction daily, five fractions a week for a total dose of 59.4 Gy (30-70.2 Gy). A complete history was collected retrospectively for each patient. All microbiological examinations were performed according to the routine procedures of the hospital laboratory. Numeric and categoric variables were employed such as sex, age, performance status, histology, stage, chemotherapy, usage of corticosteroids, neutropenia, surgery, hospitalization, associated diseases, smoking during treatment, package per year of cigarette smoking, dose of radiotherapy, and response rates. Results: Infections developed in 84 patients (46%, 84/181) during thoracic radiotherapy. A 101 episodes of infections developed in these patients. Most patients suffered from sputum production (65%), cough (59%), auscultation findings (31%) and fever (31%). Gram-negative bacteria were the most frequently isolated pathogens in the cultures of specimens (70%, 16/23 samples). Neoadjuvant chemotherapy (OR = 4.81; 95% CI, 1.57-9.12; p = 0.003) and neutropenia (OR = 4.25; 95% CI, 1.44-6.89; p = 0.009) were found as risk factors for influencing infection based on logistic regression analyses. Package per year of cigarette smoking was found statistically significantly higher in patients with infections than patients without infections (p = 0.001). A slight increase in infections, which was of borderline statistical significance (p = 0.07), was observed in patients age over 70. Ciprofloxacin and clarithromycin were the most frequently used agents in treatment. Median survival was 9 months in the patients with infection and 13 months in the 97 patients without infection. Overall survival seemed to be statistically significantly better in patients without infection than patients with infection (p = 0.042) calculated using Kaplan-Meier method. Based on Cox regression analyses; overall survival was not correlated to presence of infection but associated with poor performance status ( 5940 cGy (OR = 2.06; 95% CI, 0.72-7.18; p = 0.007) and the absence of response to treatment (OR = 2.45; 95% CI, 0.89-14.23; p < 0.001) were also found to be risk factors for survival. Conclusions: Infections are important causes of morbidity and mortality in lung cancer patients. The control of infection in these patients may improve the survival. Predisposing factors and treatment management approaches in non-small cell lung cancer should be defined carefully.

Modern kanser tedavi yaklaşımları ile kürabilite ve sağkalım arttığı için tedavi sonrası ikinci primer tümör görülme sıklığı da artmıştır. İkinci primer tümör insidansının; erkek cinsiyette, ileri yaşta ve ilk tanıdan itibaren geçen süre ile ilişkili olarak arttığı bildirilmiştir. İkinci primer akciğer kanseri insidansı en çok akciğer kanserli hastalarda incelenmiş ve %0.5 oranında bulunmuştur. Akciğerde saptanan nodülün metastaz veya ikinci primer tümör olup olmadığının ayırımı önemlidir. İkinci primer akciğer kanserini intrapulmoner metastazdan ayırtedici tanı kriterleri olarak; farklı histolojik tip, karsinoma insitu orijin ve radyolojik olarak primer akciğer kanserini destekleyecek görünüm olması gerektiği bildirilmiştir. Renal hücreli karsinomlu bir olgumuzda ilk tanıdan 31 ay sonra ikinci primer akciğer kanseri saptanması üzerine ikinci primer akciğer tümörlü olgularımız değerlendirilmiştir. Cure rates and survival have shown dramatic improvement for patients with cancer due to modern cancer treatments. The incidence of second primary malignancy seems to have increased in recent years and were significantly associated with gender (male), age and calendar year at diagnosis of the first cancer. The incidence of second primary carcinoma of the lung was evaluated in most cases of primary lung cancer. The average incidence of second lung cancer in patients with lung cancer was found as 0.5%. Distinguishing single lung metastasis from primary lung cancer in patients with a solitary lung nodule is important. The criteria for diagnosing lung cancer as a second primary or intrapulmonary metastase were declared to be the different histologic type, origination from carcinoma in situ and gross appearance suggestive of primary lung cancer according to radiologic findings. We found second primary lung cancer in a patient 31 months after initial diagnosis of primary renal cell carcinoma. Thereby, we reviewed second primary lung malignancies.

Purpose: A prospective phase II trial was conducted by the Institute of Oncology, istanbul University in December 1994 on patients with locally-advanced non-small cell lung cancer to assess acute toxicity and the feasibility of a combination of radiosensitizer and accelerated radiotherapy with concomitant boost. Materials and methods: Patients were irradiated using 'large' fields (primary tumour and locoregional lymph nodes) with 1.8 Gy per fraction, five fractions a week. Reduced 'boost' fields (primary and involved nodes only) were also irradiated twice-weekly 1.8 Gy per fraction in ten fractions concomitantly 6 h after the administration of large field. Total radiation dose was 63 Gy in 5 weeks (45 Gy 'large' fields and 18 Gy 'boost'). The maximum allowed dose to the spinal cord was 3750 cGy. Cisplatinum, 6 mg/m(2) was given daily just before 'large' field irradiation, Results: As of January1997, 15 patients were evaluated (median follow-up of 12.5 months with a range of 5.5-23 months). The overall acute toxicity rate was 38% and Grade 3 acute toxicity was 8%. Grade 4 or greater acute toxicities were not observed. The overall rate of cisplatinum-induced nausea and vomiting was 80% (severe in 60%), but all were easily treated with antiemetics. Complete response rate (clinical and radiological) was 40% and an overall response rate was 73%. Median survival was 16 months and progression-free survival was 5.5 months (range of 2.5-21 months). Conclusions: Toxicity was well tolerated and no treatment-related death occurred with this combined treatment regimen. Although it appears that better local control rates can be achieved, additional phase II/III studies are needed. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.