A New Approach to the Treatment of Metastatic Paraganglioma: Sorafenib

Meral Gunaldi,Ismail Oguz Kara,Berna Bozkurt Duman,Cigdem Usul Afsar,Melek Ergin,Arbil Avci 대한암학회 2014 Cancer Research and Treatment Vol.46 No.4

Paragangliomas are relatively rare chromaffin cell tumors which may be cured throughresection. Patients with paragangliomas may develop metastatic diseases. There isno consensus regarding refractory chemotherapy for treatment of metastatic disease. In this report, we presented a case of a 43-year-old woman who was admitted to thehospital with a history of episodic headaches, diaphoresis, and weakness. Elevatedplasma catecholamine levels and a right paraaortic mass were observed on computedtomography. The mass was excised, and a diagnosis of paraganglioma was confirmed. After 20 months of follow-up, local recurrence and metastases were detected in thethorax, abdomen, and skeletal system. Plasma and urinary catecholamine levels werehigh. Chemotherapy was administered, and no improvement was observed. Therefore,following this palliative conventional chemotherapy, sorafenib was administered forthree months, and, finally, positron emission tomography showed that the patient’slesions had completely regressed.

Utility of Peripheral Blood Parameters in Predicting Breast Cancer Risk

Okuturlar, Yildiz,Gunaldi, Meral,Tiken, Elif Eda,Oztosun, Bugra,Inan, Yesim Ozdem,Ercan, Tarik,Tuna, Savas,Kaya, Ali Osman,Harmankaya, Ozlem,Kumbasar, Abdulbaki Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.6

Purpose: We aimed to study the inflammatory parameters of complete blood count in breast cancer cases. Materials and Methods: This retrospective study covered 178 breast cancer patients and 107 age and body mass index matched healthy women. Complete blood count parameters, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and MPV/platelet were analyzed. Results: The leukocyte, neutrophil and neutrophil/lymphocyte ratio were higher in the patient group (p values 0.001, 0.0001 and 0.0001, respectively) while haemoglobin and hematocrit were higher in the control group (p=0.0001 for both). Logistic regression analysis showed that elevated neutrophils and platelet distribution width (PDW) (OR: 0.627, 95%CI: 0.508-0.774, p=0.001 and OR: 1.191 95%CI: 1.057-1.342 p=0.003) were independent variables for predicting breast cancer. The cut-off value for the neutrophil/lymphocyte ratio was 2.56. Conclusions: According to our study results, neutrophil levels as part of complete blood count may be used as an independent predictor of breast cancer risk.

Retrospective Analysis of 498 Primary Soft Tissue Sarcomas in a Single Turkish Centre

Duman, Berna Bozkurt,Gunaldi, Meral,Ercolak, Vehbi,Afsar, Cigdem Usul,Sahin, Berksoy,Erkisi, I. Melek Koksal,Kara, Oguz,Paydas, Semra,Gonlusen, Gulfiliz,Sertdemir, Yasar Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.8

Background: Soft tissue sarcomas (STS) must be managed with a team involving pathologists, radiologists, surgeons, radiation therapists and medical oncologists. Treatment modalities and demographic charasteristics of Turkish STS were analysed in the current study. Material-Methods: Primary adult STS followed between 1999-2010 in Cukurova University Medical Faculty Department of Medical Oncology were analzied retrospectively Results: Of the total of 498 patients, 238 were male and 260 female. The most seen adult sarcomas were leomyosarcoma (23%). Localization of disease was upper extremity (8.8%), lower extremity (24.7%), head-neck 8.2%, thoracic 8%, retroperitoneal 5.6%, uterine 12.4%, abdominal 10%, pelvic region 3.6 and other regions 10%. Some 13.1% were early stage, 10.2% locally advanced, 8.2% metastatic and 12.2% recurrent disease. Patients were treated with neoadjuvant/adjuvant (12%) or palliative chemotherapy (7.2%) and 11.4% patients did not receive chemotherapy. Surgery was performed as radical or conservative. The most preferred regimen was MAID combination chemotherapy in the rate of 17.6%. The most common metastatic site was lung (18.1%). The overall survival was 45 months (95%CI 30-59), 36 months in men and 55 months in women, with no statistically significant difference (p=0.5). The survival rates were not different between the group of adjuvant and palliative chemotherapy (respectively 28 versus 18 months) (p=0.06), but radical surgery at 37 months was better than 22 months for conservative surgery (p=0.0001). No differences were evident for localization (p=0.152). Locally advanced group had higher overall survival rates (72 months) than other stages (p=0.0001). Conclusion: STS can be treated successfully with surgery, chemotherapy and radiotherapy. The survival rates of Turkish people were higher in locally advanced group; these results show the importance of multimodality treatment approach and radical surgery.

Pancreatic Carcinoma, Thrombosis and Mean Platelet Volume: Single Center Experience from the Southeast Region of Turkey

Afsar, Cigdem Usul,Gunaldi, Meral,Kum, Pinar,Sahin, Berksoy,Erkisi, Melek,Kara, Ismail Oguz,Paydas, Semra,Duman, Berna Bozkurt,Ercolak, Vehbi,Karaca, Feryal,Uyeturk, Ummugul,Guner, Sebnem Izmir Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.21

Background: The aim of this study was to investigate the general characteristics of patients with deep vein thrombosis (DVT) and pancreatic cancer as well as evaluate the relationship between mean platelet volume (MPV), DVT and survival. Materials and Methods: Seventy-seven patients with pancreatic cancer, who were admitted to Cukurova University Medical Faculty, Department of Medical Oncology, were enrolled in the study Results: The mean age was $59{\pm}20$. Forty-nine (63.6%) were men and 28 women (36.4%). Sixty-eight (88.3%) patients had adenocarcinoma and 9 (11.7%) had a malignant epithelial tumor. Thirty-six (46.7%) had liver metastasis at diagnosis. Twenty-six (33.8%) patients were alive, 20 (26%) were dead and in 31 (40.2%) the status was unknown. Only 14 (18.1%) patients had DVT. In 42 (54.5%) patients MPV values were normal, in 28 (36.4%) patients they were above normal, and in 7 (9.1%) patients they were below normal. There was no statistically significant difference between gender, tumour localization, chemotherapy and survival rates (p:0.56, p:0.11, p:0.21). There was no significant difference between DVT, gender, localisation, histological subtype, the presence of metastasis, stage and if the patient had been treated with chemotherapy (p:0.5, p:0.6, p:0.2, p:0.32, p:0.1, p:0.84). There was also no significant difference between MPV and DVT (p:0.57) but there was a significant difference between liver metastasis and DVT (p:0.02). Age, stage, the presence of metastasis and DVT were prognostic in pancreatic cancer patients. Conclusions: Cases of pancreatic cancer with liver metastasis should be studied more carefully as thrombosis is more common in these patients.

Retrospective Analysis of Neoadjuvant Chemotherapy for Breast Cancer in Turkish Patients

Duman, Berna Bozkurt,Afsar, Cigdem Usul,Gunaldi, Meral,Sahin, Berksoy,Kara, I. Oguz,Erkisi, Melek,Ercolak, Vehbi Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.8

Background: Neoadjuvant systemic chemotherapy is the accepted approach for women with locally advanced breast cancer. Anthracycline- and taxane-based regimens have been extensively studied in clinical trials and consequently are widely used. In this study aimed to research the complete response (pCR) rates in different regimens for neoadjuvant setting and determine associated clinical and biological factors. Methods: This study included 63 patients diagnosed with breast carcinoma among 95 patients that had been treated with neoadjuvant chemotherapy between 2007 and 2010. TNM staging system was used for staging. The histologic response to neoadjuvant chemotherapy was characterized as a pCR when there was no evidence of residual invasive tumor in the breast or axillary lymph nodes. Biologic subclassification using estrogen receptor (ER), progesterone receptor (PR), HER2 were performed. Luminal A was defined as ER+, PR+, HER2-; Luminal B tumor was defined as ER+, PR-, HER2-; ER+, PR-, HER2+; ER-, PR+, HER2-; ER+, PR+, HER2+; HER2 like tumor ER-, PR+, HER2+; and triple negative tumor ER, PR, HER2 negative. Results: Patients median age was 54.14 (min-max: 30-75). Thirty-two patients (50.8%) were premenapousal and 31 (49.2%) were postmenapousal. Staging was performed postoperatively based on the pathology report and appropriated imaging modalities The TNM (tumor, lymph node, metastasis) system was used for clinical and pathological staging. Fifty-seven (90.5%) were invasive ductal carcinomas, 6 (9.5%) were other subtypes. Thirty nine (61.9%) were grade II and 24 (38.1%) were grade III. Seven (11.1%) patients were stage II and 56 (88.9) patients were stage III. The patients were classified for ER, PR receptor and HER2 positivity. Seventeen patients had complete response to chemotherapy. Forty patients (63.5%) were treated with dose dense regimen (cyclophosphamide 600 mg/m2 and doxorubicine 60 mg/m every two weeks than paclitaxel 175 mg/m2 every two weeks with filgrastim support) 40 patients (48%) were treated anthracycline and taxane containing regimens. Thirteen patients (76%) from 17 patients with pCR were treated with the dose dense regimen but without statistical significance (p=0.06). pCR was higher in HER2(-), ER(-), grade III, premenopausal patients. Conclusion: pCR rate was higher in the group that treated with dose dense regimen, which should thus be the selected regimen in neoadjuvant setting. Some other factors can predict pCR in Turkish patients, like grade, menopausal status, triple negativity, percentage of ER positivity, and HER2 expression.

Results of Endoscopic Surgery in Patients with Pituitary Adenomas : Association of Tumor Classification Grades with Resection, Remission, and Complication Rates

Erkan, Buruc,Barut, Ozan,Akbas, Ahmet,Akpinar, Ebubekir,Akdeniz, Yasemin Sefika,Tanriverdi, Osman,Gunaldi, Omur The Korean Neurosurgical Society 2021 Journal of Korean neurosurgical society Vol.64 No.4

Objective : The endoscopic endonasal transsphenoidal approach is a widely-used method for the surgical treatment of pituitary adenomas. We aimed to evaluate the results of endoscopic surgery by comparing preoperative classification methods and investigating their relationship with postoperative resection and remission rates and complications. Methods : We retrospectively reviewed the medical records of 236 patients (118 males) who underwent surgery for pituitary adenomas. Preoperative Knosp classification, tumor size (TS), suprasellar extension (SSE), postoperative resection and remission rates, and complications were evaluated. Results : The follow-up period was 3 months to 6 years. The patients' ages ranged between 16 and 84 years. Endocrinologically, 114 patients (48.3%) had functional adenoma (FA), and 122 patients (51.7%) had non-functional adenoma (NFA). Among the FA group, 92 (80.7%) showed remission. A statistically significant difference was found between patients with and without remission in terms of the Knosp, TS, and SSE classifications (p<0.01). Knosp, TS, and SSE classification grades were found to be correlated with the resection rates (p<0.01). Meningitis was seen in seven patients (3.0%), diabetes insipidus in 16 (6.9%; permanently in two [0.9%]), and rhinorrhea in 19 (8.1%). Thirty-six patients (15.3%) developed pituitary insufficiency and received hormone replacement therapy. Conclusion : The resection categories and remission rates of FAs were directly proportional to the adenoma sizes and Knosp grades, while the degree of suprasellar growth further complicated resection and remission rates. Adenoma sizes less than 2 cm and SSEs less than 1 cm are associated with favorable remission and resection rates.

Slide Session : OS-HEM-11 ; Hematology : Single Centre Experience of Serum Galactomannan Levels in the Diagnosis of Invasive Aspergillosis

( Yildiz Okuturlar ),( Fahir Ozkalemkas ),( Beyza Ener ),( Sibel Ocak Serin ),( Esra Kazak ),( Tulay Ozcelik ),( Vildan Ozkocaman ),( Atilla Ozkan ),( Halis Akalin ),( Meral Gunaldi ),( Ridvan Ali ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Invasive aspergillosis (IA)) is a serious cause of morbidity and mortality in immunocompromised patients with haematologic malignancy. The serum galactomannan enzyme immunoassay (GM-EIA; Platelia Aspergillus EIA; Bio-Rad) was cleared by the Food and Drug Administration at an optical density index cut-off of 0.5 for a probable diagnosis of invasive aspergillosis. In this prospective study GM-EIA (Platelia Aspergillus EIA, Bio-Rad) with 0.5cut-off value and sequential sensitivity-specificity for single, consecutive two and consecutive three positivity were investigated for the diagnosis of IA in neutropenic hematologic patients. Methods: Serum samples were taken twice a week from patients during their hospitalization. IA was classified according to European Organisation for Research and Treatment of Cancer and Mycoses Study Group Guidelines as “proven”, “probable”, and “possible”. The sensitivity was calculated from the results of patients with proven/propable and the specificity was calculated from the results of patients non-IPA patients. Results: In 165 consecutive febrile episodes in 106 patients, 80 (48.5%) episodes were defined with IA (4 proven, 11 probable, 65 possible) and 85 (51.5%) episodes were defined as non-IA. Per episode average 8.3 serum samples were examined for a total of 1385 serum samples. Cut-off value of single GM-EIA = 0.5 for proven/probable IA with sensitivity/specificity 100%/ 27%, two consecutive positive GM-EIA = 0.5 with sensitivity/specificity 86%/ 71% and three consecutive positive GM-EIA = 0.5 with sensitivity/specificity 73%/85% were obtained. Conclusions: Measuring the level of galactomannan twice a week and consecutive monitoring reduced the sensitivity and increased the specificity. Monitoring of the GM-EIA frequently from the first positivity can increase sensitivity/specificity.

Serum galactomannan levels in the diagnosis of invasive aspergillosis

( Yildiz Okuturlar ),( Fahir Ozkalemkas ),( Beyza Ener ),( Sibel Ocak Serin ),( Esra Kazak ),( Tulay Ozcelik ),( Vildan Ozkocaman ),( Hasan Atilla Ozkan ),( Halis Akalin ),( Meral Gunaldi ),( Ridvan A 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.6

Background/Aims: In this study, the sensitivity-specificity of galactomannan-enzyme immunoassay (GM-EIA) with a cut-off value of 0.5 for a single, two, or three consecutive positivity in the diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients with hematological malignancy was investigated. Methods: IPA was classified as “proven,” “probable,” or “possible” as described in the guidelines prepared by the European Organization for Research and Treatment of Cancer and Mycoses Study Group.” Serum samples were collected from the patients twice a week throughout their hospitalization. A total of 1,385 serum samples, with an average of 8.3 samples per episode, were examined. Results: Based on the 165 febrile episodes in 106 patients, 80 (48.5%) were classified as IPA (4 proven, 11 probable, 65 possible) and 85 (51.5%) as non-IPA. The sensitivity/ specificity was 100%/27.1% for a single proven/probable IPA with the cut of value of GM-EIA ≥ 0.5, 86.7%/71.8% for two consecutive positive results, and 73.3%/85.9% for three consecutive positive results. Conclusions: With the galactomannan levels measured twice a week, consecutive sensitivity decreased and specificity increased. Therefore, an increase may be obtained in sensitivity-specificity by more frequent monitoring of GM-EIA starting from the first day of positivity is detected.