Browsing by Author "Haydaroǧlu A."

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    Prognostic factors in definitive radiotherapy of uterine cervical cancer
    (2003) Yalman D.; Aras A.B.; Özkök S.; Duransoy A.; Çelik Ö.K.; Özsaran Z.; Haydaroǧlu A.
    Purpose: To determine the prognostic factors related to local control and survival in 257 patients with uterine cervical cancer treated with definitive radiotherapy (RT). Materials and Methods: The medical records of 257 patients treated with definitive RT from January 1987 to December 1998 were reviewed retrospectively. Pretreatment and treatment parameters were analyzed to determine their prognostic value on local control and survival. Survival analyses were performed using the Kaplan-Meier method. The log-rank test was used for univariate analyses and the Cox regression model was used for multivariate analyses. Results: Median age was 55 (range 25-82). Squamous cell carcinoma was the most common histologic type (89.1%). The distribution per FIGO Stage was IIA: 13.2%; IIB: 54.9%; IIIA: 3.9%; IIIB: 19.8%; IVA: 8.2%. Ninety-eight patients (38.1%) were treated with external RT alone; 134 (52.1%) received both external RT and intracavitary brachytherapy; 21 (8.2%) received external RT and chemotherapy and four (1.6%) received external RT, intracavitary brachytherapy and chemotherapy. Median follow-up duration was 50 months (range 24-155 months). The failure rate was 51.8% with 26.5% of patients having only local failure, 16.7% only distant failure and 8.6% both local and distant failure. Five-year local progression-free, disease-free and overall survival rates were 58.1%, 44% and 63.7%, respectively. In univariate analysis the prognostic factors identified for local progression-free survival were histology (p = 0.008), FIGO stage (p < 0.001), initial hemoglobin (Hgb) level (p = 0.001), total radiation dose (p = 0.039), use of brachytherapy (p = 0.001) and of chemotherapy (p = 0.037) and enlarged paraaortic nodes (p = 0.016). In multivariate analysis the prognostic factors were FIGO stage (p = 0.014), initial Hgb level (p = 0.040), and use of brachytherapy (p = 0.013). The prognostic factors identified for disease-free survival were histology (p = 0.011), FIGO stage (p < 0.001), initial Hgb level (p < 0.001), use of brachytherapy (p = 0.001) and of chemotherapy (p = 0.014) in univariate analysis; and FIGO stage (p < 0.001), initial Hgb level (p = 0.017), total tumor dose (p = 0.034), use of brachytherapy (p = 0.006) and of chemotherapy (p = 0.021) in multivariate analysis. Factors influencing overall survival were FIGO stage (p < 0.001), initial Hgb level (p = 0.006), overall treatment time (p = 0.028), total tumor dose (p = 0.007), use of brachytherapy (p < 0.001), enlarged paraaortic (p < 0.001) and pelvic nodes (p = 0.004) in univariate analysis; and FIGO stage (p < 0.001), overall treatment time (p = 0.031), enlarged paraaortic (p = 0.007) and pelvic lymph nodes (p = 0.043) in multivariate analysis. Conclusion: Definitive RT is an effective treatment for patients with uterine cervical cancer. There are many prognostic factors influencing treatment outcome. Brachytherapy and chemotherapy must be added in appropriate patients to improve the outcome. Future prospective trials should be undertaken to confirm the validity of these factors and to individualize the treatment strategy for every patient.
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    Evaluation of anxiety levels during intracavitary brachytherapy applications in women with gynecological malignancies
    (2007) Kamer S.; Özsaran Z.; Çelik Ö.; Bildik O.; Yalman D.; Bolukbaşi Y.; Haydaroǧlu A.
    Purpose: To evaluate the anxiety levels of women treated for gynecological malignancies using intracavitary brachytherapy. Methods: Anxiety levels prior to and after intracavitary brachytherapy application and factors influencing anxiety levels were evaluated. Women were evaluated for quality of life and psychological status before each brachytherapy application using the Hospital Anxiety and Depression Scale (HADS). Scores were grouped as follows: 0-7 = normal, 8-10 = borderline, 11-21 = abnormal. Women were also questioned about other factors which could affect anxiety levels such as marital status, education level, number of pregnancies and prior surgical history. Results: Between January 2003 and August 2004, 146 women with a median age of 56 years were evaluated (range: 27-80). Eighty-six women had cervix uteri carcinoma and 63 had endometrial carcinoma. Sixty-seven women were premenopausal and 85 women were postmenopausal. The median pregnancy number was three (range = 0-10). Eighty-nine women had at least three children. Sixty-seven women had had previous operations. One hundred and twenty-five women were married and 24 women were unmarried or widowed. Before treatment, the anxiety scores were scored as normal in 49 (32%), borderline in 41 (28%), and abnormal in 59 (40%). Anxiety levels were lower in 69 women during the last application as compared with the pretreatment levels (p = 0.00). Marital status and pregnancy number showed a significant correlation with anxiety scores (p = 0.04). Age, level of education or having had a previous operation showed no significant correlation with anxiety level. Conclusion: These results indicate that intracavitary brachytherapy is associated with anxiety. Women need to be given detailed information before the brachytherapy application to reduce anxiety. Additional studies are needed to determine it.