ÖzetAmaç: Bu çalışmada kemoradyoterapi (KRT) sırasında diyetisyen ve eğitim hemşiresiyle birlikte uygulanan yakın ve sürekli beslenme takibinin hastanın beslenme durumuna etkisi araştırıldı. Hastalar ve Yöntem: Prospektif planlanan çalışmaya küratif KRT endikasyonu konan, primer tümör bölgesi baş boyun (n=10), gastrointestinal sistem (n=3) ve akciğer (n=1) olan 14 gönüllü alındı. Beslenme durumu her hafta subjektif global değerlendirme (SGA) ile belirlenerek yeniden düzenlendi. Önerilen beslenme desteğine uyum ve beslenme parametrelerin takibi haftalık diyetisyen değerlendirmesi ve beslenme eğitim hemşiresinin ev ziyaretleriyle yapıldı. Ziyaretler sırasında beslenme parametreleri ile hasta ve bakım vericisinin önerilen beslenmeye uyumları ve beslenme desteğine bakışları değerlendirildi. Bulgular: KRT başında 3 hastada hafif malnütrisyon (SGA-B) saptandı. KRT sonunda sekizi hafif (SGA-B) biri şiddetli (SGA-C) 9 malnütrisyonlu hasta vardı. Bakım vericilerin beslenme önerilerine uyumu "tatminkar" ile "bundan iyisi olamaz" arasında değişirken yeni gelişen malnütrisyonlu hastaların hepsi baş boyun tümörlü olup bunlar beslenme desteğini reddeden (n=2), 80 yaş üzeri (n=2) ya da performansı baştan düşük (n=1) olan hastalardı. Sonuç: Kemoradyoterapi alan özellikle baş boyun tümörlü hastalarda ileri yaş ve düşük performans varlığında iyi bakım ve takip altında bile beslenme parametrelerinin bozulduğu görülmektedir. Risk faktörlerinin baştan tanımlanması beslenme desteğin çerçevesini çizmek adına yararlı olabilir.

Low dose weekly gemcitabine with concurrent radiotherapy is a tolerable regimen and have comparable outcomes with platinum-based combined treatments in muscle-invasive bladder cancer. Prospective randomized trials can help in understanding the safety and efficacy of this treatment specially in medically unfit patients.

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Aim: To analyze the dosimetric factors affecting long-term renal function in patients with gastric cancer following postoperative radiotherapy with concomitant chemotherapy to the upper abdomen. Methods: Between January 2005 and July 2010, 13 patients treated with three-dimensional conformal radiotherapy and concurrent fluorouracil-based chemotherapy (CRT) were included in this analysis. After a median follow-up of 55 months, creatinine, glomerular filtration rate (GFR), total kidney and left kidney volumes, before and after CRT and mercaptoacetyltriglycine (MAG3) scintigraphy, were used to evaluate the renal function and were correlated with the dosimetrics data. Results: Significant correlations were found in the loss of left kidney volume and V35 (20.6%) (p ¼ 0.035) and V40 (15.7%) (p ¼ 0.031) and in the loss of relative functional contribution of the main kidney and V35 Gy (p ¼ 0.027) and V40 Gy (p ¼ 0.019). In patients with a slightly low basal GFR (n ¼ 6), the relative functional contribution of the left kidney significantly decreased, regardless of the dosage. Conclusion: Functional renal impairment without any clinical signs or symptoms can be observed in low doses after radiotherapy. Careful treatment planning and a detailed evaluation of the functional renal capacity before treatment may help to reduce late renal toxicity.

The effect of magnesium and vitamin E pre-treatments on irradiationinduced oxidative injury of cardiac and pulmonary tissues in rats: a randomized experimental studyProfilaktik magnezyum ve E vitamini uygulamasının sıçanlarda ışınlamaya bağlı kalp ve akciğer dokusunda gelişen oksidan hasara etkileri: Randomize deneysel bir çalışma ABSTRACTObjective: The aim of this study was to investigate the effect of pre-treatment with the free radical scavenging molecules, magnesium and vitamin E, on lipid peroxidation to limit radiation-induced heart and lung injury. Methods: Female Sprague-Dawley rats were divided into 4 groups by a simple randomization method as saline-treated control (n=4), salinetreated irradiated (IR; n=6), magnesium sulphate-treated irradiation (IR) (Mg+IR; n=6) and vitamin E-treated IR (vit E+IR; n=6), respectively. The animals were given either saline, Mg (600mg/kg/day) or vit E (100 mg/kg/day) intraperitoneally for five days prior to irradiation. Twelve hours after the fifth injection, animals in irradiation groups were irradiated to 20 Gy using 6 MV photons in linear accelerator. Twenty-four hours later cardiac and lung tissue samples were obtained for determination of myeloperoxidase activity (MPO), malondialdehyde (MDA) levels, and luminol and lucigenin levels measured by chemiluminescence (CL) methods. Results: No significant changes were observed between cardiac and pulmonary MDA and CL results of the experimental groups. However, cardiac and pulmonary MPO activities in the saline-treated IR group were increased as compared to control group (p<0.05 for all), while in the Mg-pretreated and vit E pretreated groups neutrophil infiltration was reduced, reaching to statistical significance only in the Mg-pretreated group (p<0.05). Conclusion: Prophylactic use of magnesium sulfate has limited the infiltration of neutrophils to both the cardiac and pulmonary tissues at the early 24 h of irradiation. However, how limiting neutrophils as the sources of free radicals and inflammatory mediators would alter oxidative stress of heart and lung tissues in the long-term is not clear yet. (Anadolu Kardiyol Derg 2012; 12: 508-14) Key words: Heart, irradiation, lung, magnesium, radioprotection, vitamin E Original Investigation Özgün Araşt›rma 508ÖZET Amaç: Serbest radikal süpürücü moleküller olan magnezyum sülfat ve E vitamininin profilaktik kullanımının radyasyonun tetiklediği kalp ve akciğer hasarının önlenmesinde lipit peroksidasyonu üzerindeki etkileri incelendi. Yöntemler: Sprague-Dawley türü dişi sıçanlar basit rastgele randomizasyon yöntemi kullanılarak fizyolojik tuzlu su uygulanan kontrol (n=4), tek başına radyasyon (IR; n=6), radyasyon+magnezyum (Mg+IR; n=6) ve radyasyon+vitamin E (vit E+IR; n=6) ön-tedavisine göre gruplandırıldı. Fizyolojik tuzlu su, Mg (600 mg/kg/gün) ya da vit E (100 mg/kg/gün) radyasyondan önce 5 gün boyunca intraperitonal olarak uygulandı. Son enjeksiyondan 20 saat sonra radyasyon uygulanacak tüm gruplardaki sıçanlara 6 MV foton enerjisi ile 20 Gy iyonizan radyasyon uygulandı. ...

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ÖzetAmaç: Bu çalışmada lokal ileri evre özefagus kanseri tanısıyla neoadjuvan/ definitif kemoradyoterapi (KRT) uygulanan hastaların sonuçlarının bildirilmesi amaçlanmıştır.Hastalar ve Yöntem: Histolojik tanısı skuamöz hücreli 10, adenokarsinom 4, adenoskuamöz karsinom 1 olan, T3N0M0 5 veya T3N1M0/T4N0M0 10, toplam 15 hasta geriye dönük olarak incelendi. Ortanca radyoterapi dozu 50 Gy (1,8-2 Gy/gün, 5 fraksiyon/hafta) olup eş zamanlı kemoterapi radyoterapinin ilk ve son hafta sisplatin ve 5-florourasil olarak uygulandı. Bulgular: Eş zamanlı kemoterapinin kesintisiz uygulanabilirlik oranı %80 idi. Medyan takip 15 ay (aralık, 3-70 ay) idi. Neoadjuvan olarak tedavi edilen beş hastadan birinde lokal progresyon, üçünde uzak metastaz izlendi. Baştan definitif KRT planlanan hastalardan üçüne (%30) evrede küçülme izlenerek cerrahi önerildi. İki yıllık lokal kontrol (LK) %22, uzak metastazsız sağkalım (UMSK) %45 ve genel sağkalım (GSK) %31 olarak saptandı. Derece III disfaji oranı %6 idi.Sonuç: Lokal ileri evre özefagus kanserinde tedavi tartışmalıdır. Cerrahi şansını elde eden hastalarda daha uzun sağkalım ve lokal kontrol bildirilirken üçlü modalite tedavilerin yapılabilirliği merkezin deneyimi ile sınırlıdır. Bu nedenle tüm hastalar bireysel olarak ve multidisipliner yaklaşım ile değerlendirilmelidir. (Marmara Üniversitesi Tıp Fakültesi Dergisi 2012;25:74-7) Anah tar Ke li me ler: Cerrahi, Lokal ileri evre, Kemoradyoterapi, Özefagus kanseri Abstract Objective: In this study, we report our neoadjuvant/definitive chemoradiotherapy (CRT) experience in locally advanced esophageal cancer patients. Patients and Methods: A total of 15 patients were retrospectively evaluated. Histological diagnosis were as follows: squamous cell 10, adenocarcinoma 4, adenosquamous carcinoma1. Initial stage was T3N0M0 5 or T3N1M0/T4N0M0 10. Radiotherapy was administered at median of 50 Gy (1.8-2 Gy/day, 5 fractions/week) and cisplatin and 5-fluorouracil were given concurrently on the first and the last week of radiotherapy. Results: Continuous applicability of concurrent chemoradiotherapy was 80%. Median follow-up was 15 months (range, 3-70 months). One of the five patients who were treated with neoadjuvant approach had local progression,and three had distant metastasis. Three patients (30%) who were planned to be treated with definitive CRT had downstaging and surgery was recommended. Two-year local control rate was 22%, distant metastasis-free survival rate was 45% and overall survival rate was 31%. Grade III dysphagia was observed in 6% of patients. Conclusion: Treatment of locally advanced esophageal cancer remains controversial. Although patients who had surgery were reported to have longer survival and better local control rates, the feasibility of triple-modality treatment is limited to the center's experience. For this reason, all patients should be evaluated individually with a multidisciplinary approach. (Marmara Medical Journal 2012;25:74-7)

e16157 Background: To report our experience with adjuvant or salvage radiotherapy for prostate cancer and to assess the tolerance of the patients. Methods: The charts of 139 men who received postoperative radiotherapy (RT) after radical prostatectomy (RP) between 1997–2007 in two institutions were retrospectively analyzed. Thirty-seven percent received adjuvant RT and 63% salvage RT. The median age was 65 years (range: 43–80). Pathologic Gleason score was 2–6 in 24%, 7 in 56%, and 8–10 in 20%. Seminal vesicle involvement was reported in 34%, positive surgical margins in 72%, lymph node involvement in 7%, capsular perforation in 61%, and perineural invasion in 73% of the patients. The median PSA level before RT was 0.29ng/ml (range: 0–19ng/mL). Median time from RP to RT was 3 months (range, 1–12 months) in the adjuvant setting, and 27 months (range, 2–96 months) in the salvage setting. Nineteen percent received radiation to the pelvis, 81% to the prostate bed only. The median dose to the prostatic bed was 66.6Gy (range: 60–76Gy). Before, during or after RT 49% received androgen deprivation for a median of 6 months (range, 3–48 months). Biochemical failure is defined as a post-RT PSA level >0.2ng/mL. Results: The median follow up time was 41 months (range, 12–133 months). At 4 years, for the entire cohort biochemical control, metastasis free survival, and overall survival was 68%, 92%, and 94%, respectively. Although there was a significant difference in favor of the adjuvantly treated group for biochemical control (81% vs 60%, p = 0.03) in univariate analysis, multivariate analysis demonstrated that higher preoperative PSA level (p = 0.02), and lymph node involvement (p = 0.02) predicted for a worse PSA outcome. No grade 3 acute gastrointestinal (GI) or genitourinary (GU) toxicity was reported during the treatment. At 4 years, 4% of patients had Grade 2 late GI toxicity, 0.7% had grade 3 late GI, and 0.7% brade 4 late GI toxicity, while 16% of patients reported late grade 2 GU, and 4% had late grade 3 GU toxicity. Conclusions: Our results suggest that adjuvant RT may offer a better biochemical outcome in patients who underwent radical prostatectomy for prostate cancer. Overall, the number of high grade toxicities for postoperative RT was low. Therefore it can safely be used in appropriate setting. No significant financial relationships to disclose.