Publications (12)31.15 Total impact
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Article: The role of 18F-FDG PET/CT in the assessment of suspected recurrent gastric cancer after initial surgical resection: can the results of FDG PET/CT influence patients’ treatment decision making?
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ABSTRACT: Purpose 18F-fluorodeoxyglucose (FDG) PET/CT has been widely used for staging, re-staging and for monitoring therapy-induced changes and response to therapy in patients with various types of cancer, but its utilization for gastric cancer has been limited. The purpose of this study was to evaluate the clinical role of FDG PET/CT in the detection of gastric cancer recurrence as compared with diagnostic CT and to assess the impact of FDG PET/CT results on patients’ treatment planning. MethodsThirty-four patients with suspected recurrent gastric cancer, who had previously undergone curative gastrectomy and lymph node dissection, were retrospectively analysed. The diagnostic CT and FDG PET/CT imaging were performed for all patients as clinically indicated. The results of FDG PET/CT were compared with the findings of the diagnostic CT. The changes in the clinical management of patients according to the results of FDG PET/CT were also evaluated. ResultsFDG PET/CT was performed in 19 patients (55.9%) due to the suspicion of distant metastasis at diagnostic CT. The remaining 15 patients were suspected to have local recurrence at diagnostic CT (n = 4) or gastroscopy (n = 1) and due to an increase in tumour markers or clinical manifestations (n = 10). The FDG PET/CT result was positive in 23 patients (67.6%) and negative in 11 patients (32.4%). In total, 24 (70.6%) of the 34 patients had documented recurrent disease by histopathology in 7 (29.1%) and by clinical follow-up in 17 (70.9%), while 11 patients had no evidence of recurrent disease. FDG PET/CT correctly confirmed recurrent disease in 23 of the patients with recurrence and it was classified as true-positive in these patients. However, FDG PET/CT was false-negative in one patient but recurrent disease was confirmed by histopathology. The overall sensitivity, specificity, accuracy, positive and negative predictive values of FDG PET/CT were significantly superior to those of diagnostic CT (95.8 vs 62.5%, 100 vs 10%, 97 vs 47%, 100 vs 62.5% and 90.9 vs 10%, respectively, p = 0.012) in the detection of recurrent gastric cancer after initial surgery. The FDG PET/CT results changed the patients’ management in 18 (52.9%) cases by leading to the use of previously unplanned treatment procedures in 9 (50%) patients and the avoidance of previously planned therapeutic procedures in 9 (50%) patients. ConclusionFDG PET/CT is a superior post-therapy surveillance modality for the diagnosis of recurrent gastric cancer compared with diagnostic CT imaging after initial surgery. In addition, integrated FDG PET/CT was specifically helpful in optimizing the treatment plan and it might play an important role in treatment stratification in the future. KeywordsPET/CT-FDG-Diagnostic CT-Gastric cancer-Recurrence-Clinical managementEuropean journal of nuclear medicine and molecular imaging 04/2012; 38(1):64-73. · 4.99 Impact Factor -
Article: The Importance of Multifocal/Multicentric Tumor on the Disease-Free Survival of Breast Cancer Patients: Single Center Experience.
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ABSTRACT: OBJECTIVES:: Multifocal/multicentric breast cancers have been comprehensively studied and their outcomes have been compared with unifocal tumors. We evaluated the impact of multifocality and multicentricity on the disease-free survival (DFS) and overall survival of breast cancer patients and tried to analyze the correlation between multifocality/multicentricity (M/M) and other prognostic factors. MATERIAL AND METHODS:: Between 1994 and 2009, we analyzed retrospectively 697 breast cancer patients. Multicentric and multifocal breast cancer were defined as the presence of 2 or more invasive tumor foci within the different quadrants of the same breast or within a same quadrant of the breast, respectively. M/M and other prognostic factors were evaluated using univariate and multivariate analyses. RESULTS:: Multifocal/multicentric tumors were seen in 107 (15.4%) of the 697 breast cancer patients. pT and pN stage were related with the presence of multifocal/multicentric tumors. As tumor size increased and the number of axillary lymph nodes metastasis increased, the incidence of M/M increased significantly (P=0.003 vs. P=0.02, respectively). Overall, the median DFS time of patients with multifocal/multicentric tumors was significantly worse than that of the unifocal tumors (55 vs. 137 mo, P<0.001). Multivariate analysis showed that the presence of M/M was the most important prognostic factor for DFS (P=0.001, hazard ratio (HR): 0.33; 95% confidence interval (CI), 0.18-0.58), as were pN stage and extracapsular extension of the tumor (P=0.01, HR: 1.74; 95% CI, 1.13-2.69) (P=0.03, HR: 1.9; 95% CI, 1.04-3.47, respectively). M/M were not also statistically significant prognostic factors in breast cancer for overall survival (P=0.06). CONCLUSIONS:: M/M imparts an unfavorable prognosis on the DFS of breast cancer patients in comparison to unifocal tumors and the presence of multifocal/multicentric tumors were associated with advanced pT and pN stages.American journal of clinical oncology 09/2011; · 2.21 Impact Factor -
Article: Tissue and serum adiponectin levels in patients with gastric cancer: are there any correlations between adiponectin levels and histopathological variables?
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ABSTRACT: Adiponectin is secreted from adipose tissue and is characterized by hyperinsulinemia, which is related with obesity. Adiponectin levels are significantly lower in gastric cancer patients than in healthy controls. The aim of this study was to investigate the relationship between adiponectin levels in serum, tumor tissue and normal tissue with some other insulin resistance parameters. A total of 35 patients with gastric cancer who had undergone curative gastrectomy by standard lymph node dissection were enrolled in this study. Their serum adiponectin levels, tumor tissue and normal breast tissue adiponectin levels were compared. The mean adiponectin levels of the tumor tissue, normal gastric tissue and serum were 48.6±2.9 (range, 39.7-50.6), 48.3±4.2 (range, 34.4-50.69) and 49.4±0.83 (range, 48.2-50.2), respectively. There was no relationship between the adiponectin levels in serum, normal tissue and tumor tissue (p=0.08). There was an inverse relationship between normal tissue adiponectin levels and insulin levels (p=0.002, r=-0.5), but this association was not detected with adiponectin levels in tumor and serum (p>0.05). Relationships between adiponectin levels in serum, normal tissue and tumor tissue for gastric cancer patients were not found. The small sample size in this study may have influenced the results. However, we believe that our results constitute a first in evaluating the tissue adiponectin levels in gastric cancer tissue.Hepato-gastroenterology 07/2011; 58(110-111):1841-6. · 0.66 Impact Factor -
Article: F-18 FDG PET/CT imaging and bronchoscopic image of tracheal recurrence in patient with non-small-cell lung cancer.
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ABSTRACT: We report tracheal recurrence in patient with non-small-cell lung cancer (NSCLC) who was diagnosed with F-18 fluorodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) during follow-up period. A 56-year-old man presented with mediastinum involvement of NSCLC (clinical stage IIIA). After 3 cycles of neoadjuvant platinum-based chemotherapy, he underwent right pneumonectomy. Because tumor in the right main bronchus was located <2 cm distal to the carina, pathologic stage IIB (T3N0M0) disease was diagnosed according to seventh addition of American Joint Committee on Cancer (AJCC) TNM classification. Thereafter, adjuvant 3 cycles of chemotherapy was administered. At the 21st month of follow-up period, he presented with dyspnea and inspiratory stridor. FDG PET/CT was performed and it revealed multiple intense uptake foci in the trachea (SUVmax = 10.1) compatible with malignant tracheal nodules. After rigid bronchoscopy and biopsy were carried out, tracheal recurrence was confirmed. We conclude that it would be interesting to investigate the use of FDG PET/CT in the work-up of tracheal recurrence of NSCLC. Tracheal recurrence was confirmed with rigid bronchoscopy and biopsy.Clinical nuclear medicine 05/2011; 36(5):367-9. · 3.92 Impact Factor -
Article: A case of metastatic breast cancer successfully treated with lapatinib plus capecitabine therapy.
Archives of Gynecology 02/2011; 283(2):405-7. · 0.91 Impact Factor -
Article: The role of ¹⁸F-FDG PET/CT in the assessment of suspected recurrent gastric cancer after initial surgical resection: can the results of FDG PET/CT influence patients' treatment decision making?
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ABSTRACT: (18)F-fluorodeoxyglucose (FDG) PET/CT has been widely used for staging, re-staging and for monitoring therapy-induced changes and response to therapy in patients with various types of cancer, but its utilization for gastric cancer has been limited. The purpose of this study was to evaluate the clinical role of FDG PET/CT in the detection of gastric cancer recurrence as compared with diagnostic CT and to assess the impact of FDG PET/CT results on patients' treatment planning. Thirty-four patients with suspected recurrent gastric cancer, who had previously undergone curative gastrectomy and lymph node dissection, were retrospectively analysed. The diagnostic CT and FDG PET/CT imaging were performed for all patients as clinically indicated. The results of FDG PET/CT were compared with the findings of the diagnostic CT. The changes in the clinical management of patients according to the results of FDG PET/CT were also evaluated. FDG PET/CT was performed in 19 patients (55.9%) due to the suspicion of distant metastasis at diagnostic CT. The remaining 15 patients were suspected to have local recurrence at diagnostic CT (n = 4) or gastroscopy (n = 1) and due to an increase in tumour markers or clinical manifestations (n = 10). The FDG PET/CT result was positive in 23 patients (67.6%) and negative in 11 patients (32.4%). In total, 24 (70.6%) of the 34 patients had documented recurrent disease by histopathology in 7 (29.1%) and by clinical follow-up in 17 (70.9%), while 11 patients had no evidence of recurrent disease. FDG PET/CT correctly confirmed recurrent disease in 23 of the patients with recurrence and it was classified as true-positive in these patients. However, FDG PET/CT was false-negative in one patient but recurrent disease was confirmed by histopathology. The overall sensitivity, specificity, accuracy, positive and negative predictive values of FDG PET/CT were significantly superior to those of diagnostic CT (95.8 vs 62.5%, 100 vs 10%, 97 vs 47%, 100 vs 62.5% and 90.9 vs 10%, respectively, p = 0.012) in the detection of recurrent gastric cancer after initial surgery. The FDG PET/CT results changed the patients' management in 18 (52.9%) cases by leading to the use of previously unplanned treatment procedures in 9 (50%) patients and the avoidance of previously planned therapeutic procedures in 9 (50%) patients. FDG PET/CT is a superior post-therapy surveillance modality for the diagnosis of recurrent gastric cancer compared with diagnostic CT imaging after initial surgery. In addition, integrated FDG PET/CT was specifically helpful in optimizing the treatment plan and it might play an important role in treatment stratification in the future.European Journal of Nuclear Medicine 01/2011; 38(1):64-73. · 4.53 Impact Factor -
Article: Pulmonary toxicity in patients receiving docetaxel chemotherapy.
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ABSTRACT: Pulmonary toxicity can rarely be seen with cytotoxic agents. We aimed at investigating the pulmonary toxicity of docetaxel in patients other than lung carcinoma. Forty patients were investigated prospectively. Spirometry, DLCO and high-resolution computed tomography (HRCT) scans were applied to all patients before and 14-21 days after completion of docetaxel. We used a HRCT scoring system that was based on the previous studies. We have seen no pulmonary symptoms that may reflect pulmonary toxicity. There were statistically significant differences between pre- and post-treatment values of FEV1 (L/s), FEV1/FVC (%), DLCO/VA (DLCO/L), DLCO/VA (%) (P<0.05), FEF25-75 (L/s), FEF25-75 (%) (P<0.01), DLCO (mL/mmHg/min), DLCO (%) (P<0.001), Also, there was a statistically significant difference between the pre- and post-treatment HRCT scores. There was a statistical relationship between post-treatment HRCT scores, number of docetaxel cycles (r=0.49, P<0.0001) and docetaxel cumulative dose (r=0.61, P<0.0001). Docetaxel caused a significant decline in pulmonary function tests (PFTs) and progression in HRCT scores but the symptoms of patients were not consistent with these differences. The negative effects of docetaxel on PFTs and HRCT scores should be investigated more reliably by increasing the number of patients with further studies.Medical Oncology 12/2010; 27(4):1381-8. · 2.14 Impact Factor -
Article: Does the metastatic lymph node ratio influence the disease-free survival of patients with breast cancer: single-center experiences.
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ABSTRACT: Axillary lymph nodes (ALNs) are the most important prognostic factor for survival in breast cancer. Pathological evaluation can affect the number of involved lymph nodes. In the current study, we evaluated whether the metastatic lymph node ratio (n ratio) is important in predicting disease-free survival (DFS) for breast cancer patients. From 802 breast cancer cases, 427 patients with ALN metastasis were analyzed retrospectively. The n ratio was categorized as n ratio 1 (1-10%), n ratio 2 (10.01-50%) and n ratio 3 (>50%). DFS was established according to the Kaplan-Meier method. Predicting risk factors for relapse were analyzed using the Cox proportional hazards model. The n ratio was significantly higher in breast cancer patients with advanced pathologic pT, pN and clinical stage, undifferentiated histology, lymphovascular and extracapsular invasion, more resected ALNs and positive progesterone receptor. In the univariate analysis, multicentricity, necrosis, grade, pN stage, estrogen receptor and progesterone receptor positivity, trastuzumab and neoadjuvant chemotherapy usage, the presence of inflammatory breast cancer and n ratio were found to be important factors in predicting DFS. Multivariate analysis indicated that multicentricity, neoadjuvant chemotherapy, trastuzumab usage and n ratio were significantly associated with prognosis. The n ratio is inexpensive, easily available and a simple prognostic factor for breast cancer patients with positive ALNs.Oncology 11/2010; 79(1-2):105-11. · 2.27 Impact Factor -
Article: Eight-cycle rituximab therapy resulted in complete remission in primary cutaneous marginal zone lymphoma.
Leukemia research 03/2010; 34(7):e160-3. · 2.36 Impact Factor -
Article: Prognostic significance of perineural invasion in patients with gastric cancer who underwent curative resection.
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ABSTRACT: The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated in a few studies, but had not reached a consensus. The aim of this study was to determine the prognostic value of PNI in patients with gastric cancer who underwent curative resection. We retrospectively analyzed 238 patients who had undergone curative gastrectomy. Paraffin sections of surgical specimens from all patients were stained with hematoxylin and eosin. PNI was defined when carcinoma cells infiltrated into the perineurium or neural fascicles. PNI and the other prognostic factors were evaluated by univariate and multivariate analysis. PNI was detected as positive in 180 of the 238 patients (75.6%). pT stage, tumor size, lymph node metastasis, clinical stage, tumor differentiation, Borrmann classification, histological type, lymphatic vessel invasion, and blood vessel invasion were closely associated with the presence of PNI. The PNI-positive tumors had significantly larger size and more lymph node metastasis than the PNI-negative tumors (P = .001 and P < .001, respectively). The median survival of the PNI-positive patients was significantly worse than that of the PNI-negative patients (28.1 vs. 64.9 months, P = .001). Multivariate analysis indicated that the positivity of PNI was an independent prognostic factor (P = .02, hazard ratio [HR]: 2.75; 95% confidence interval [95% CI]:1.12-3.13) as were classical clinicopathological features. Our results showed that the frequency of PNI was high in patients with gastric cancer who underwent curative gastrectomy and the proportion of PNI positivity increased with progression and clinical stage of disease. PNI may be useful in detecting patients who had poor prognosis after curative resection in gastric cancer.Annals of Surgical Oncology 03/2010; 17(8):2037-44. · 4.17 Impact Factor -
Article: The role of PET-CT in the differential diagnosis of thymic mass after treatment of patients with lymphoma.
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ABSTRACT: Thymic hyperplasia is a common phenomenon in both children and young adults after chemotherapy and may explain the finding of a mediastinal mass in patients with malignant lymphoma after complete remission. In the present study, we report 5 cases with malignant lymphoma presenting with a mediastinal mass on CT scan after completion of chemotherapy diagnosed as thymic hyperplasia by PET-CT imaging. We retrospectively analyzed 5 patients who presented with anterior mediastinal masses a median of 4 months (range 3-6) after achieving complete remission following successful treatment for malignant lymphoma. Three patients were diagnosed with Hodgkin's lymphoma (HL) and the others with non-Hodgkin's lymphoma (NHL). The median age of the patients was 23 (range of 18-47). PET-CT was performed on these patients to determine the characteristics of a mass which had been detected on CT. PET-CT was performed for all patients, and the thymic masses demonstrated only mild FDG uptake considered to be consistent with thymic hyperplasia. During a median of 24 months of follow-up, all patients were recurrence-free with a median survival of 15 months (range 10-26 months). It is important to be aware of the possibility of thymic hyperplasia after chemotherapy to avoid misdiagnosis or over-staging of disease, as well as unnecessary biopsies, especially when the presenting anterior mediastinal mass was originally located near the thymus on CT scan. Mild FDG PET uptake was sufficient for the diagnosis of benign disease in the cases in this study.Medical Oncology 02/2010; 28(1):258-64. · 2.14 Impact Factor -
Article: Is metastatic lymph node ratio superior to the number of metastatic lymph nodes to assess outcome and survival of gastric cancer?
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ABSTRACT: The aim of this study was to determine the prognostic value of metastatic lymph node ratio (n ratio). We retrospectively analyzed 202 patients who had undergone curative gastrectomy. The prognostic factors including UICC/AJCC TNM classification and n ratio were evaluated by univariate and multivariate analysis. The n ratio was significantly higher in patients with gastric tumors with undifferentiated histology, greater size, lymphatic vessel, blood vessel and perineural invasion (PNI), and advanced stage. Multivariate analysis indicated that n ratio and pN classification were independent prognostic factors, as were age, tumor size, Borrmann classification, PNI, and tumor differentiation. The receiver operating characteristics (ROC) analysis showed that the sensitivity and the specificity of the presence of lymph node metastasis with 16 lymph nodes resected - which was required to assess the presence of lymph node involvement - were 67.1 and 66.6%, respectively. Three-year overall survival (OS) rates and the median OS time were lower in patients with <16 lymph nodes resected compared to the patients who had >16 lymph nodes resected (p = 0.04). Our results showed that n ratio and pN classification were independent prognostic indicators for OS of patients with radically resected gastric cancer, but the superiority of n ratio to pN stage could not be proved.Onkologie 01/2010; 33(3):101-5. · 0.87 Impact Factor
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Institutions
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2011–2012
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Lutfi Kirdar Kartal Education and Research Hospital
İstanbul, Istanbul, Turkey
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