Practice pointsr Locoregional breast recurrences still occur in more or less 5-20% of patients despite receiving adjuvant radiotherapy. r Resection alone provides limited local control with approximately 33% at 5-years compared to 42% with resection plus other oncologic treatments necessitating curative intent multidisciplinary approach. r Hyperthermia (HT) is the use of elevated temperature to the degrees of 40-44 • C for 30-60 min. The addition of HT to ionizing radiation results in a synergistic effect called radiosensitization. r Toxicity related to HT includes generally second-and third-degree skin and subcutaneous burns, which are usually self-limited making this combination a favorable easy to use modality. r Data addressing the use of HT in locoregional breast recurrences (LRBR) is well-validated and includes randomized trials and meta-analysis. r Thermoradiotherapy enhances local control rates in LRBR with minimal acute, late morbidity and is even more effective in previously irradiated group. r Two trials conducted by European Society for Hyperthermic Oncology will further clarify the multimodal treatment with chemotherapy in R1/R2 resection and neoadjuvant use of thermoradiotherapy.Breast cancer is a second common form of malignancy and is one of the leading causes of mortality among cancer patients across the world. Locoregional recurrence occurs in 5-20% of patients despite upfront treatment. Local therapy (surgery plus minus re-irradiation) with or without systemic therapy is generally recommended for management. Local control rates vary; months to years, but a significant percentage lives 5 years. Therefore, treatment strategies to increase response rates are significant. Hyperthermia is one of the most potent radiosensitizers and data from meta-analysis and randomized trials support its use with radiotherapy. This study reviews the biologic rationale and clinical evidence about concomitant use of hyperthermia and radiotherapy in locally-recurrent breast cancer patients. Chest wall or whole breast irradiation with or without regional nodal sites is indicated after modified radical mastectomy and breast conserving surgery (BCS), respectively. Although adjuvant radiotherapy (RT) effectively reduces locoregional recurrences, data from randomized trials have demonstrated that this type of recurrences still occur in more or less 5-20% of patients despite receiving adjuvant RT after surgery (mastectomy or BCS) [1][2][3][4][5][6].Although locally-recurrent breast cancer (LRBC) is usually accompanied by concurrent or subsequent distant metastases [3,7,8], a significant percentage, more than 50% live 5 years [9]. In a retrospective study of 145 patients with isolated locoregional recurrence of breast cancer following modified radical mastectomy without evidence of distant metastases, 5-year survival rates were 42% overall but it was 100% for a highly favorable subgroup [10].

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ÖZET Amaç:Rezidü ve/ veya nüks hipofiz adenomlarının tedavisinde stereotaktik radyocerrahi alternatif bir tedavi seçeneğidir. Bu yazıda kliniğimizde Cyberknife® stereotaktik radyocerrahi (SRC) uyguladığımız hipofiz adenomlu hastaların tedaviye yanıtlarının değerlendirilmesi amaçlanmıştır. Yöntemler: Dr. A.Y. Ankara Onkoloji Eğitim ve Araştırma Hastanesi Radyasyon Onkolojisi Kliniğinde, Ocak 2010-Haziran 2013 tarihleri arasında beşi fonksiyonel ve ikisi non-fonksiyonel olmak üzere toplamda yedi hipofiz adenomlu olguya SRC uygulandı. Olgularda ortanca yaş 36 (aralık, 30-60) ve olguların %71'i (n=5) erkek idi. Hemofili hastalığı olan bir hasta dışındaki tüm olgulara cerrahi uygulanmış idi. Fonksiyonel adenomlu dört olgu medikal tedaviye yanıtsız idi ve yinelemiş tümörlerinin olması nedeni ile radyocerrahi kararı alındı. İki olgu ise cerrahi sonrası kalıntı tümör nedeni ile, bir olguda cerrahi yapılamadığı için primer olarak SRC uygulandı. Reçete edilen ortanca doz, 22 Gy (aralık, 20-25 Gy), 3-5 fraksiyonda, ortanca %84 (aralık, %80-%93) izodoz ile uygulandı. Bulgular: Ortanca takip zamanı 18 ay (aralık, 14-55 ay) idi. Bir olgu (non-fonksiyonel) 55 aylık izleminde klinik ve radyolojik olarak tam yanıt gösterirken, bir fonksiyonel hipofiz adenomlu olgu ise progrese oldu. Yedi olgunun 6'sında (%86) radyolojik olarak tümör kontrolü sağlandı. Sonuç: Rezidü ve/ veya nüks hipofiz adenomlarının tedavisinde stereotaktik radyocerrahi etkin ve güvenli bir tedavi seçeneği olabilir. Anahtar Kelimeler: Cyberknife; Stereotaktik radyocerrahi; Hipofiz adenomu ABSTRACT Objective: Stereotactic radiosurgery is an alternative treatment option in recurrent or residual pituitary adenomas. In this study, pituitary adenoma patients' response to the stereotactic radiosurgery (SRS) with Cyberknife® were evaluated. Methods:, Totally 7 patients (5 functional and 2 non-functional adenoma) with pituitary adenomas underwent SRS in Dr. A.Y. Ankara Oncology Training and Research Hospital from January 2010 to June 2013. Median age was 36 (range, 30-60) and 71% of cases (n=5) were male. Surgery was applied to all patients except one who has hemophilia. SRS was applied to 4 cases with recurrent functioning adenomas that unresponsive to medical treatment,. Radiosurgery were performed in two cases due to residual tumor after surgery and one case that surgery cannot be done. The median prescribed dose was 22 Gy (range, 20-25 Gy), in 3 and 5 fractions, with median 84% isodose line (range, 80%-93%). Results: The median follow-up time was 18 months (14 to 55 months). One patient (non-functioning pituitary adenoma) showed clinical and radiological complete response after 55 months follow-up. One patient with a functioning pituitary adenoma was progressing. In 6 of the seven patients (86%) radiological tumor control were achieved. Conclusion: Stereotactic radiosurgery may be a safe and effective treatment option in the treatment of recurrent or residual pituitary adenomas.

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Kaposi sarcoma (KS) is an angio-proliferative malignant neoplasm of lymphatic endothelial origin which was described by Moritz Kaposi in 1872 [1,2]. Although there are four main subtypes, classic Kaposi sarcoma (CKS) is the most common in the Mediterranean region. Other subtypes are endemic (African), epidemic (human immunodeficiency virus [HIV]-related) and iatrogenic KS. The male Purpose: The aim of this study is to evaluate the treatment responses of Kaposi sarcoma patients treated with radiotherapy (RT). Materials and Methods: The data of 18 patients (40 different regions) who were treated for Kaposi sarcoma in Department of the Radiation Oncology, Ankara City Hospital, Turkey between March 23, 2010 to February 13, 2018 were evaluated retrospectively. The primary endpoint of the study was the clinical-subjective response after RT, and the secondary endpoint was the visual response assessment after RT. Results: In evaluating the patients' reported response of the lesions: 25 (62.5%) of complete response (CR), 12 (30%) of partial response (PR), and stable response was seen in 3 patients (7.5%). Patient reported response after RT was significantly higher in male sex (p = 0.002; odds ratio [OR] = 13.8, 95% confidence interval [CI], 2.7-70.0). Physician reported response rates were available for 28 lesions and CR was detected in 12 lesions (30%); PR was observed in 16 (40%). The relationship between physician reported outcome and RT techniques (electron, bolus, or water bolus) is close to the limit of statically significance (p = 0.052). Fewer lesions disappeared in patients with photon preference than electrons (p = 0.036; OR = 0.093; 95% CI, 0.009-0.950). Patients' reported complete response rates were significantly higher in the 20 Gy per 5 fractions treatment arm (p = 0.042; OR = 1.75; 95% CI, 1.1-2.7). Conclusion: RT is an effective local treatment with high response rates in the treatment of Kaposi sarcoma. The subjective-clinical response rate was higher in male sex and the visual response was higher in the 20 Gy per 5 fractions arm. Additional studies are needed to standardize RT dose and techniques.

Aim: Although prior literature has examined the treatment and patient-associated factors affecting the development and severity of acute radiodermatitis, there are relatively few prospective studies evaluating both. This study was prospectively designed to evaluate factors affecting the development and extent of radiation-induced acute skin toxicity called radiodermatitis (RD). Material and Method: A total of 63 patients who underwent radiotherapy (RT) in Ankara Atatürk Research and Education Hospital between July 2017 and October 2018 were evaluated. Patients’ demographic status, disease/treatment details, hemoglobin, ferritin, folic acid, Vit B12, and hemoglobin A1c values were recorded. The development and grade of RD were evaluated weekly by the same radiation oncologist using the Radiation Therapy Oncology Group (RTOG) radiation toxicity guideline. Results: There was no significant relationship between the development of any degree of RD and gender, concomitant chemotherapy (CT), pre-RT CT, comorbid disease, RT technique and blood parameters (Hb, Hba1c, ferritin, folic acid and B12). The development of grade 2-3 RD was significantly affected by the number of operations (p=0.032) and total dose of RT (p=0.008). In patients with grade 2/3 RD, the RT dose at which RD first appeared was 20 Gy (range, 14-36); in patients with grade 1 RD, this value was 32 Gy (range, 16-56) (p=0.018). Conclusion: There is no significant relationship between the development of acute radiodermatitis and Hba1c, hemoglobin, ferritin, B12 and folic acid levels. There was a significant correlation between grade of RD and repeated surgery, increase in total RT dose and early onset of RD.

Introduction: In thoracic radiotherapy (RT), heart sparing is very essential, as the high cardiac dose is associated with poor survival in patients with locally advanced non-small-cell lung cancer (NSCLC). The study aims to determine the doses exposed to heart substructures and coronary arteries by different RT techniques in central tumor irradiation in lung cancer. Methods: Twenty patients with NSCLC, irradiated between January 2018 and December 2020 in our department, were included in this study. Patients whose primary tumor was centrally located in the left lung were selected. The heart substructures [left atrium, right atrium (RA), left ventricle, and right ventricle] and coronary arteries (left main, left anterior descending, circumflex, and right coronary arteries) were delineated by the same physician. The doses of 60 Gy external RT were prescribed in 30 fractions using three-dimensional conformal radiotherapy (3D-CRT), static intensity-modulated radiotherapy (s-IMRT), and dynamic intensity-modulated radiotherapy (d-IMRT) techniques in all patients. The obtaining plans using three different techniques were compared. Results: The d-IMRT plans were statistically the best optimal plan for planning target volume (PTV) [Dmean (p = 0 04), Dmax (p < 0 0001), V95 (p < 0 0001), V107 (p < 0 0001), CI (p < 0 0001) and HI (p < 0 0001)]. The s-IMRT plans were significantly superior to 3D-CRT plans for PTV. RA Dmax and V45 were not different between the three techniques [Dmax (p = 0 148) and V45 (p = 0 12)]. The d-IMRT technique was significantly better in other heart substructures and coronary arteries. Conclusions: Compared to 3D-CRT and s-IMRT techniques, the d-IMRT technique provided the best protection in all heart substructures except for a few parameters (RA Dmax and V45 doses).

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