Browsing by Subject "brain metastasis"

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    Intracerebral metastasis showing restricted diffusion: Correlation with histopathologic findings
    (2010) Duygulu G.; Ovali G.Y.; Çalli C.; Kitis O.; Yünten N.; Akalin T.; Islekel S.
    Objective: We aimed to detect the frequency of restricted diffusion in intracerebral metastases and to find whether there is correlation between the primary tumor pathology and diffusion-weighted MR imaging (DWI) findings of these metastases. Material and methods: 87 patients with intracerebral metastases were examined with routine MR imaging and DWI. 11 hemorrhagic metastatic lesions were excluded. The routine MR imaging included three plans before and after contrast enhancement. The DWI was performed with spin-echo EPI sequence with three b values (0, 500 and 1000), and ADC maps were calculated. 76 patients with metastases were grouped according to primary tumor histology and the ratios of restricted diffusion were calculated according to these groups. ADCmin values were measured within the solid components of the tumors and the ratio of metastases with restricted diffusion to that which do not show restricted diffusion were calculated. Fisher's exact and Mann-Whitney U tests were used for the statistical analysis. Results: Restricted diffusion was observed in a total of 15 metastatic lesions (19, 7%). Primary malignancy was lung carcinoma in 10 of these cases (66, 6%) (5 small cell carcinoma, 5 non-small cell carcinoma), and breast carcinoma in three cases (20%). Colon carcinoma and testicular teratocarcinoma were the other two primary tumors in which restricted diffusion in metastasis was detected. There was no statistical significant difference between the primary pathology groups which showed restricted diffusion (p > 0.05). ADCmin values of solid components of the metastasis with restricted diffusion and other metastasis without restricted diffusion also showed no significant statistical difference (0.72 ± 0.16 × 10-3 mm2/s and 0.78 ± 21 × 10-3 mm2/s respectively) (p = 0.325). Conclusion: Detection of restricted diffusion on DWI in intracerebral metastasis is not rare, particularly if the primary tumor is lung or breast cancer. However we found that there is no correlation between the metastasis showing restricted diffusion and primary pathology. Prospective studies with larger groups and more information are necessary regarding the correlation between the primary tumor histopathology and the ADC values of metastasis with restricted diffusion. © 2009 Elsevier Ireland Ltd. All rights reserved.
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    Postoperative Radiotherapy in the Management of Resected Non-Small-Cell Lung Carcinoma: 10 Years' Experience in a Single Institute
    (2010) Karakoyun-Celik O.; Yalman D.; Bolukbasi Y.; Cakan A.; Cok G.; Ozkok S.
    Purpose: This study reports the long term outcomes of postoperative radiotherapy in patients with resection for non-small-cell lung cancer (NSCLC). Methods and Materials: A total of 98 patients with resected NSCLC who received postoperative radiotherapy (PORT) between January 1994 and December 2004 were retrospectively analyzed. The most frequently performed surgical procedure was lobectomy (59 patients), followed by pneumonectomy (25), wedge resection (8), and bilobectomy (6). Postoperative radiotherapy was delivered as an adjuvant treatment in 71 patients, after a wedge resection in 8 patients, and after an R1 resection in 19 patients. The PORT was administered using a Co-60 source in 86 patients and 6-MV photons in 12 patients. A Kaplan-Meier estimate of overall survival, locoregional control, and distant metastasis-free survival were calculated. Results: Stages included I (n =13), II (n = 50), IIIA (n = 29), and IIIB (n = 6). After a median follow-up of 52 months median survival was 61 months. The 5-year overall survival, locoregional control, and distant metastasis-free survival rates for the whole group were 50%, 78%, and 55% respectively. The RT dose, Karnofsky performance status, age, lateralization of the tumor, and pneumonectomy were independent prognostic factors for OAS; anemia and the number of involved lymph nodes were independent prognostic factors for LC. Conclusions: Doses of PORT of greater than 54 Gy were associated with higher death rate in patients with left-sided tumor, which may indicate a risk of radiation-induced cardiac mortality. © 2010 Elsevier Inc.
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    Sorafenib in Metastatic Renal Cell Carcinoma With Sarcomatoid Differentiation
    (2010) Lekili M.; Muezzinoglu T.; Nese N.; Temeltas G.
    Targeted therapy in the management of metastatic renal cell cancer has been recently introduced to urology practice. The drugs used for management are used in a very limited number of patients and only for clear cell histology. We present a case where we administered sorafenib, a multikinase inhibitor of tumor-cell proliferation and angiogenesis, to a patient with metastatic renal cell carcinoma of clear cell histology. We found that our results were different from those of previously reported studies, because sarcomatoid differentiation was evident in a histological examination of this case. There was an excellent response to sorafenib. This case report might provide evidence that antiangiogenic agents may be active in any histological type of renal cell carcinoma. However, there are no available data to demonstrate the duration of response and survival benefit. © 2010 Elsevier.
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    Prognostic factors in metastatic brain tumors: Study of 62 patients; [Metastatik beyin tümörlerinde prognostik faktörler: 62 hastalık çalışma]
    (Ege University Press, 2012) Duransoy Y.K.; Selçuki M.; Gökçe T.; Duransoy A.
    Background: Brain metastases are the major cause of morbidity and mortality in patients with cancer. Variety of clinical and autopsy studies showed that brain metastases develop at 15%-45% of all cancer patients during the course of the disease and 1/2-2/3 of them were symptomatic. Average life expectancy of cancer patients with untreated metastatic brain tumors are approximately 1-2 months. Methods: We investigated the prognostic factors of removal of metastatic brain tumors in patients who admitted to neurosurgery department. Eighteen of 80 patients in the program excluded for various reasons and this study was completed with the remaining 62 cases. Results: Our study showed that neurological and general status, the extension of surgical resection, presence of the extra-cranial metastases at diagnosis and localization of the primary focus affect the prognosis. Conclusion: In the planning of treatment of patients with metastatic brain tumors, colleagues have to keep in mind level of neurological and general status, the extension of surgical resection, presence of the extra-cranial metastases at diagnosis and localization of the primary focus affect the prognosis. Surgical resection is beneficial for improving neurological status and survival of patients in brain metastases. Local control is essential and can be achieved with one of the adjunct therapies following the surgery.
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    Predictive factors for the development of brain metastases in patients with malignant melanoma: A study by the Anatolian society of medical oncology
    (2014) Gumusay O.; Coskun U.; Akman T.; Ekinci A.S.; Kocar M.; Erceleb O.B.; Yazici O.; Kaplan M.A.; Berk V.; Cetin B.; Taskoylu B.Y.; Yildiz A.; Goksel G.; Alacacioglu A.; Demirci U.; Algin E.; Uysal M.; Oztop I.; Oksuzoglu B.; Dane F.; Gumus M.; Buyukberber S.
    Background: The development of brain metastases (BMs) was associated with poor prognosis in melanoma patients. Patients with BMs have a median survival of <6 months. Melanoma is the third most common tumor to metastasize to the brain with a reported incidence of 10-40 %. Our aim was to identify factors predicting development of BMs and survival. Patients and methods: We performed a retrospective analysis of 470 melanoma patients between 2000 and 2012. The logistic regression analyses were used to identify the clinicopathological features of primary melanoma that are predictive of BMs development and survival after a diagnosis of brain metastases. Results: There were 52 patients (11.1 %) who developed melanoma BMs during the study period. The analysis of post-BMs with Kaplan-Meier curves has resulted in a median survival rate of 4.1 months (range 2.9-5.1 months). On logistic regression analysis site of the primary tumor on the head and neck (p = 0.002), primary tumor thickness (Breslow >4 mm) (p = 0.008), ulceration (p = 0.007), and pathologically N2 and N3 diseases (p = 0.001) were found to be significantly associated with the development of BMs. In univariate analysis, tumor thickness and performance status had a significant influence on post-BMs survival. In multivariate analysis, these clinicopathologic factors were not remained as significant predictive factors. Conclusions: Our results revealed the importance of primary tumor characteristics associated with the development of BMs. Ulceration, primary tumor thickness, anatomic site, and pathologic ≥N2 disease were found to be significant predictors of BMs development. © 2013 Springer-Verlag Berlin Heidelberg.
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    Prognostic significance of the baseline serum uric acid level in non-small cell lung cancer patients treated with first-line chemotherapy: a study of the Turkish Descriptive Oncological Researches Group
    (Humana Press Inc., 2014) Tanriverdi O.; Cokmert S.; Oktay E.; Pilanci K.N.; Menekse S.; Kocar M.; Sen C.A.; Avci N.; Akman T.; Ordu C.; Goksel G.; Meydan N.
    Non-small cell lung cancer (NSCLC) is one of the most common cancers. Most of the patients are inoperable at the time of diagnosis, and the prognosis is poor. Many prognostic factors have been identified in prior studies. However, it is not clear which factor is more useful. In this study, we investigated whether uric acid, the last breakdown product of purine metabolism in humans, has a prognostic significance in advanced NSCLC. A total of 384 NSCLC patients at stage IIIB/IV and who did not meet exclusion criteria were included in this retrospective cross-sectional study. The patients’ serum uric acid levels before first-line chemotherapy and demographic (age, gender, smoking), clinical (performance status, weight loss, disease stage, first-line treatment regimen), laboratory (hemoglobin, lactate dehydrogenase), and histologic (histologic type, tumor grade) characteristics were recorded. First, a cut-off value was determined for serum uric acid level. Then, the patients were stratified into four groups (quartiles) based on their serum uric acid levels. Descriptive statistics, univariate and multivariate analyses, and survival analyses were used. Majority of the patients were males, smokers and metastatic at time of diagnosis and had history of weight loss and adenocarcinoma upon pathological examination. The serum uric acid levels of all patients were determined as 4.9 ± 2.9 (range 1.9–11.3). The patients were stratified according to quartiles of serum uric acid concentration with cutoff values defined as <3.08 mg/dL (lowest quartile, Group 1), 3.09–5.91 mg/dL (Group 2), 5.92–7.48 mg/dL (Group 3), and >7.49 mg/dL (highest quartile, Group 4). Among the patients who had serum uric acid levels over 7.49, it was observed that those who also had squamous cell carcinoma had a greater rate of brain metastasis, a shorter time lapse until brain metastasis, and lower overall survival rate. It can be assumed that NSCLC patients who had histologically shown squamous cell carcinoma display brain metastasis and poor prognosis. It can be recommended to repeat this study with larger patient series including immunohistochemical, molecular, and wider laboratory investigations. © 2014, Springer Science+Business Media New York.
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    Evaluation of treatment outcomes of triple-negative breast cancer
    (Medknow Publications, 2016) Cinkaya A.; Akin M.; Sengul A.
    Purpose: Breast cancer is the most common cancer in women. Treatment responses are variable depending on tumor morphological characteristics, clinical characteristics, and hormonal receptor levels. In current medical practice, estrogen receptor (ER), progesterone receptor (PGR), and human epidermal growth factor receptor 2 (HER2) levels have been identified as important prognostic factors; they can change prognosis and treatment modalities. In this study, the prognostic factors of patients with triple-negative breast cancer (TNBC) were examined retrospectively. Materials and Methods: Some 110 cases with negative prognostic and predictive proteins (ER, PGR, and HER2) were included in this study. Median follow-up was 56 months. Recurrences, overall survival, and prognostic factors were evaluated. Results: We revealed in our triple-negative series that nodal status, tumor size, whole breast radiation doses, and type of surgery are the most useful prognostic markers. Conclusion: Triple-negative breast cancers, especially basal-like subtypes, have bad prognoses. They have high histopathological grades and high risk of invasion. This group can make early metastases and expected survival is usually short. We need to focus on new treatment strategy modalities on this group, and pretreatment values of different prognostic markers are well-identified, such as androgen receptors, basal cytokeratin expression, and BRCA gene status.
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    Prognostic factors of patients who received chemotherapy after cranial irradiation for non-small cell lung cancer with brain metastases: A retrospective analysis of multicenter study (Anatolian Society of Medical Oncology)
    (Wolters Kluwer Medknow Publications, 2018) Inal A.; Kodaz H.; Odabas H.; Duran A.; Seker M.; Inanc M.; Elkiran E.; Gunaydin Y.; Menekse S.; Topcu T.; Urakci Z.; Tastekin D.; Bilici M.; Cihan S.; Geredeli C.; Sezer E.; Uncu D.; Arpaci E.; Ozturk B.; Bal O.; Uysal M.; Tanriverdi O.; Gumus M.; Oven Ustaalioglu B.; Suner A.; Cokmert S.; Hacibekiroglu I.; Aydin K.; Isikdogan A.
    Purpose: Almost half of all patients diagnosed with non-small cell lung cancer (NSCLC) have distant metastases at presentation. One-third of patients with NSCLC will have brain metastases. Without effective treatment, the median survival is only 1 month. However, it is difficult to treat brain metastases with systemic chemotherapy since the agents have difficulty crossing the blood-brain barrier. Therefore, it is important to estimate the patient's survival prognosis. The aim of this study was to analyze prognostic factors for survival in Turkish patients who received chemotherapy after cranial irradiation for NSCLC with brain metastases. Methods: We retrospectively reviewed 698 patients with brain metastases resulting from NSCLC. Ten potential prognostic variables were chosen for analysis. Univariate and multivariate analyses were conducted to identify prognostic factors associated with overall survival (OS). Results: Among the 10 variables for univariate analysis, six were identified to have prognostic significance; these included sex, smoking history, histology, number of brain metastases, extracranial metastases, and neurosurgical resection. Multivariate analysis by the Cox proportional hazard model showed that a smoking history, extracranial metastases, and neurosurgical resection were independent negative prognostic factors for OS. Conclusion: Smoking history, extracranial metastases, and neurosurgical resection were considered independent negative prognostic factors for OS. These findings may facilitate pretreatment prediction of survival and can be used for selecting patients for more appropriate treatment options. © 2017 Journal of Cancer Research and Therapeutics | Published by Wolters Kluwer - Medknow.
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    Role of increased mean platelet volume (MPV) and decreased MPV/platelet count ratio as poor prognostic factors in lung cancer
    (Blackwell Publishing Ltd, 2018) Omar M.; Tanriverdi O.; Cokmert S.; Oktay E.; Yersal O.; Pilancı K.N.; Menekse S.; Kocar M.; Sen C.A.; Ordu C.; Goksel G.; Meydan N.; Barutca S.
    Objectives: In this study, they investigated whether mean thrombocyte volume (MPV) and MPV/platelet count ratio have a prognostic significance in advanced NSCLC or not. Methods: A total of 496 NSCLC patients at stage IIIB/IV and did not meet exclusion criteria were included in the study. The demographic features (age, gender, smoking habit), clinical characteristics (performance status, weight loss, disease stage, first-line treatment regimen), laboratory tests (levels of hemoglobin, lactate dehydrogenase and calcium as well as MPV, MPV/platelet count ratio and counts of white blood cell, platelet), and histological features (histologic type, tumor grade) were recorded. Results: The MPV levels of all patients were determined as 10.2 {plus minus} 3.4 (range, 6.4-14.1 fL). With ROC curve analysis, the MPV/PC ratio was associated with a sensitivity of 67.8% and a specificity of 84.8% at a cutoff value of 0.47424 for presence of brain metastasis at the time of diagnosis. Univariate analysis showed that OS was significantly shorter in the group with an increased MPV level than in the other group (median OS time 6.8 months vs. 11.5 months, log-rank, P =.032). Multivariate analysis confirmed that an increased MPV level was an independent poor prognostic factor for OS (HR: 1.704, 95% CI: 1.274-3.415, P =.014). Conclusions: Unlike results of previous studies, the study showed that increased MPV was an important prognostic factor in patients with NSCLC. Hence, an increased MPV level may be used as a prognostic biomarker to estimate for poor overall survival in patients with NSCLC. © 2017 John Wiley & Sons Ltd
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    Systemic Immune Inflammation Index as a Key Marker of Survival and Immune-related Adverse Events in Immune Checkpoint Inhibitor Therapy
    (College of Physicians and Surgeons Pakistan, 2022) Ekinci F.; Balcik O.Y.; Demir B.; Gursoy P.; Ozveren A.; Erdogan A.P.
    Objective: To evaluate the prognostic significance of the new index designed by formulating neutrophil, lymphocyte, and platelet counts in patients with metastatic disease receiving immune checkpoint inhibitors (ICI) and its effect on the immune-related adverse events (irAEs). Study Design: Cohort study. Place and Duration of Study: Department of Medical Oncology, University of Manisa Celal Bayar, University of Aydin Adnan Menderes, and University of Ege, and Izmir Kent Hospital, Turkey, from January 2016 to April 2020. Methodology: Patients with metastatic disease receiving ICI sufficient follow-up data were included. Patients, who had received treatment for a minimum of 3 months, were evaluated for the response. Systemic immune-inflammation index (SII) was calculated as neutrophil (/L) × (lymphocyte (/L) / platelet (/L). The cut-off value was determined by examining the area under the receiver operating characteristic (ROC) curve for the SII value. The endpoints of this study included overall survival (OS) and progression-free survival (PFS). Results: A total of 168, patients who received ICI in the metastatic stage, were evaluated. The OS of the patients with low SII scores was 110.8 months (95% CI, 88.2-133.5), while patients with high SII scores were 36.0 months (95% CI, 28.4-43.6) and reached statistical significance (p <0.001). The results of univariate (HR=3.376, 95% CI, 1.986-5.739, p<0.001 and multivariate (HR=2.792, 95% CI, 1.495-5.215, p=0.011) analyses were statistically significant as well. Conclusion: The SII score in patients with metastatic disease receiving ICI was closely related to the prognosis. Patients with a high SII score are associated with a worse prognosis, these patients develop fewer irAEs. © 2022 College of Physicians and Surgeons Pakistan. All rights reserved.
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    Unexpected Metastatic Localizations of Prostate Cancer Determined by68Ga PSMA PET/CT: Series of Four Cases; [68 Ga PSMA PET/BT’de Saptanan Prostat Kanserinin Nadir Metastaz Lokalizasyonları: Dört Olgu]
    (Galenos Publishing House, 2022) Mütevelizade G.; Sezgin C.; Gümüşer G.; Sayit E.
    Prostate-specific membrane antigen (PSMA) is a transmembrane protein with overexpression in most prostate cancer cells. Gallium-68-(68Ga) PSMA positron emission tomography/computed tomography (PET/CT) imaging is a game-changer in the management of prostate cancer.68Ga PSMA PET/CT scan is advanced and a promising radioligand has high sensitivity in determining lesions of prostate cancer with a high tumor to background ratio. The most common areas of metastasis are the bone and pelvic lymph nodes. The prognosis of prostate cancer is mainly determined by the status of metastases. The presence and the localization of metastases affects treatment planning. In our cases, we presented some examples of uncommon sites of metastases such as the brain, adrenal glands, penis and orbit. Improvements in imaging techniques, such as68Ga PSMA PET/CT have led to the possibility to make more determination of rare metastase sites in prostate cancer patients. © 2022 by Turkish Society of Nuclear Medicine Molecular Imaging and Radionuclide Therapy published by Galenos Yayınevi.