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    Could the Neutrophil to Lymphocyte Ratio be a Poor Prognostic Factor for Non Small Cell Lung Cancers?
    (ASIAN PACIFIC ORGANIZATION CANCER PREVENTION, 2014) Kacan, Turgut; Babacan, Nalan Akgul; Seker, Metin; Yucel, Birsen; Bahceci, Aykut; Eren, Ayfer Ay; Eren, Mehmet Fuat; Kilickap, Saadettin
    Background: Although many prognostic factors have been identified for lung cancers, new ones are needed to determine the course of the disease. Recently, a high neutrophil to lymphocyte ratio (NLR) prior to surgery or treatment has been shown to be an indicator of prognosis for cancer. The aim of this study was to investigate the value of NLR as a prognostic factor and the correlation between NLR and other probable clinical prognostic factors in non small cell lung cancer patients prior to treatment. Materials and Methods: Data of patients who were diagnosed with non-small cell lung cancer in our institution were retrospectively reviewed. Demographic and clinicopathologic characteristics were recorded. NLR was calculated before the application of any treatment. Results: A total of 299 patients, 270 (90%) males and 29 (10%) females, were included in the study. Age (p<0.001) stage (p<0.001), Eastern Cooperative Oncology Group performance status (p<0.001), weight loss (p<0.001), anemia (p<0.001), histopatology (p<0.001), NLR >= 3 (p=0.048), NLR >= 4 (p=0.025) and NLR >= 5 (p=0.018) were found to be the prognostic factors. Age, anemia, Eastern Cooperative Oncology Group performance status, the stage, NLR (>= 5) were an independent prognostic factors. There was a positive correlation between NLR and the Eastern Cooperative Oncology Group performance status (0.23, p=0.001), the C reactive protein levels (r=0.36, p<0.001). Conclusions: Prior to treatment high NLR was found as an independent poor prognosis factor. Besides, NLR correlated with Eastern Cooperative Oncology Group performance status and the C reactive protein levels.
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    The impact of radiotherapy on quality of life for cancer patients: a longitudinal study
    (SPRINGER, 2014) Yucel, Birsen; Akkas, Ebru Atasever; Okur, Yillar; Eren, Ayfer Ay; Eren, Mehmet Fuat; Karapinar, Hanife; Babacan, Nalan Akgul; Kilickap, Saadettin
    The aim of this study was to assess for changes in quality of life (QOL) among cancer patients who undergo radiotherapy (RT) and to identify factors that influence QOL in this group. Three hundred sixty-seven cancer patients who received curative RT were investigated using the EORTC QLQ-C30 questionnaire at the start of RT, end of RT, and 1 and 6 months post-RT. The patients were 49 % women, 51 % men, and median age at diagnosis was 57 years (range, 16-86 years). Compared to pre-RT, at the end of RT, the global health status score (p < 0.001), nausea/vomiting (p < 0.001), and apetite loss scores (p < 0.001) were significantly poorer. Compared to the end of RT, at 1 and 6 months post-RT, global health status, all functional, and all symptom scores were significantly improved (p < 0.001). Patient sex influenced scores for pain (p = 0.036), appetite loss (p = 0.027), and financial difficulty (p = 0.003). Performance status influenced scores for global health status (p = 0.006), physical functioning (p < 0.001), cognitive functioning (p = 0.001), and role functioning (p = 0.021). Comorbidity influenced fatigue score (p < 0.001). Cancer stage influenced scores for physical functioning (p = 0.001), role functioning (p = 0.010), and fatigue (p < 0.001). Treatment modality (chemoRT vs. RT alone) influenced scores for physical functioning (p = 0.016), fatigue (p < 0.001), nausea/vomiting (p = 0.009), and appetite loss (p < 0.001); and RT field influenced scores for nausea/vomiting (p = 0.001), appetite loss (p = 0.003), and diarrhea (p = 0.037). Radiotherapy dose functioning (p < 0.001), cognitive functioning (p < 0.001), social functioning (p < 0.001), fatigue (p < 0.001), and pain (< 60 vs a parts per thousand yen60 Gy) had an effect on scores for physical functioning (p < 0.001), role functioning (p < 0.001), emotional (p < 0.001), insomnia (p < 0.001), constipation (p < 0.001). While RT negatively affects cancer patients' QOL, restoration tends to be rapid and patients report significant improvement by 1 month post-RT. Various patient- and disease-specific factors and RT modality affect QOL in this patient group. We advocate measuring cancer patients' QOL regularly as part of routine patient management.
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    Lung Cancer in Women: A Single Institution Experience with 50 Patients
    (Asian Pacific Organization Cancer Prevention, 2014) Babacan, Nalan Akgul; Yucel, Birsen; Kilickap, Saadettin; Seker, Mehmet Metin; Kacan, Turgut; Olcas, Ilknur Koc; Eren, Ayfer Ay
    Background: Lung cancer is the most common cause of cancer-related death worldwide. The incidence of lung cancer is aproximately 7-8 thousand percent in Turkish women. In this study, we aimed to evaluate the clinical, pathological properties and survival data of female patients with lung cancer who were treated in our center. Materials and Methods: From 2007 to 2012, 50 women with lung cancer were enrolled. Patient data were evaluated retrospectively. Results: The median age was 61 (40-81). Forty patients (80%) were diagnosed with non small cell lung cancer (NSCLC), 10 patients (20%) were small cell carcinoma (SCC). Twelve (24%) patients were smokers and 13 of 16 non-smokers had a history of exposure to asbestos. The most common histologic subtype was adenocarcinoma (46%) and this accounted for 71% in patients with exposure to asbestos. The most common initial Eastern Cooperative Oncology Group (ECOG) performance score was 1 (24 patients, 48%) and initial stage was IV (25 patients, 50%) in the study group. During the median 15 months (1-96 months) follow-up period: 1 year overall survival (OS) was 68%, 2-year overall survival was 36% and the median survival time was 19 months. According to univariate analysis, poor ECOG performance status, advanced stage, anemia and weight loss at time of diagnosis were negative prognostic factors. However, adenocarcinoma sub-type was a positive prognostic factor. Conclusions: In this study NSCLC sub-type, poor ECOG performance score, advanced stage, anemia and weight loss were prognostic factors in Turkish women with lung cancer.
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    Survival Analysis and Prognostic Factors for Neuroendocrine Tumors in Turkey
    (ASIAN PACIFIC ORGANIZATION CANCER PREVENTION, 2013) Yucel, Birsen; Babacan, Nalan Akgul; Kacan, Turgut; Eren, Ayfer Ay; Eren, Mehmet Fuat; Bahar, Seher; Celasun, Mustafa Gurol; Seker, Mehmet Metin; Hasbek, Zekiye
    Background: This study aimed to determine the demographical distribution, survival and prognostic factors for neuroendocrine tumors monitored in our clinic. Materials and Methods: Data for 52 patients who were admitted to Cumhuriyet University Medical Faculty Training Research and Practice Hospital Oncology Center between 2006 and 2012 and were diagnosed and treated for neuroendocrine tumors were investigated. Results: Of the total, 30 (58%) were females and 22 (42%) were males. The localization of the disease was gastroenteropancreatic in 29 (56%) patients and other sites in 23 (44%). The most frequently involved organ in the gastroenteropancreatic system was the stomach (n=10, 19%) and the most frequently involved organ in other regions was the lungs (n=10, 19%). No correlation was found between immunohistochemical staining for proteins such as chromogranin A, synaptophysin, and NSE and the grade of the tumor. The patients were followed-up at a median of 24 months (1-90 months). The three-year overall survival rate was 71%: 100% in stage I, 88% in stage II, 80% in stage III, and 40% in stage IV. The three-year survival rate was 78% in tumors localized in the gastroenteropancreatic region, and 54% in tumors localized in other organs. In the univariate analysis, gender, age, performance status of the patients, grade, localization, surgical treatment, and neutrophil/lymphocyte ratio (<= 5 versus >5) affected the prognosis of the patients. Conclusions: Most of the tumors were localized in the gastroenteropancreatic region, and the three-year survival rate in tumors localized in this region was better than the tumors localized in other sites. Surgical treatment was a positive independent prognostic factor, whereas Grade 3 and a neutrophil/lymphocyte ratio of > 5 were negative independent prognostic factors.
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    The Impact of Everolimus and Radiation Therapy on Pulmonary Fibrosis
    (Mdpi, 2020) Eren, Mehmet Fuat; Eren, Ayfer Ay; Sayan, Mutlay; Yucel, Birsen; Elagoz, Sahende; Ozguven, Yildiray; Vergalasova, Irina
    Background and objectives:Everolimus (EVE) is a mammalian target of the rapamycin (mTOR) inhibitor that is widely used in cancer patients. Pulmonary toxicity, usually manifesting as interstitial pneumonitis, is a serious adverse effect of this drug. Radiation therapy, which is often administered in conjunction with chemotherapy for synergistic effects, also causes pulmonary fibrosis. In view of pulmonary damage development in these two forms of cancer treatment, we have examined the effect of EVE administration individually, in combination with radiation given in varying sequences, and its relation to the extent of pulmonary damage.Materials and Methods:We performed an experimental study in albino rats, which were randomized into five groups: (1) control group, (2) EVE alone, (3) EVE 22 h after radiation, (4) EVE 2 h after irradiation, and (5) only radiation. Sixteen weeks after thoracic irradiation, rat lung tissue samples were examined under light microscopy, and the extent of pulmonary damage was estimated. After this, we calculated median fibrosis scores in each group.Results:The highest fibrosis score was noted in Group 4. Among the five groups, the control group had a significantly lower median fibrosis score compared to the others. When the median fibrosis score of the group that received concurrent EVE with radiation therapy (RT) (Group 4) was compared with that of the control group, the difference was statistically significant (p= 0.0022). However, no significant differences were achieved among the study groups that received EVE only or RT only, whether concurrently or sequentially (p> 0.05).Conclusion:EVE is an effective treatment option for the management of several malignancies and is often combined with other therapies, such as radiation, for a more efficient response. However, an increased risk of pulmonary fibrosis should also be anticipated when these two modalities are combined, as they both can cause pulmonary damage, especially when administered concurrently.