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Optimal timing of thoracic irradiation for limited stage small cell lung cancer:Current evidence and future prospects

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World Journal of Clinical Oncology 2022年第2期13卷 116-124页

作者： Omer Sager Ferrat Dincoglan Selcuk demiral hakan Gamsiz Bora Uysal Fatih Ozcan Onurhan Colak Esra Gumustepe Yelda Elcim Esin Gundem Bahar Dirican Murat Beyzadeoglu Gulhane Medical Faculty Department of Radiation Oncology University of Health SciencesAnkara 0090Turkey

Lung cancer is a global health concern as the leading cause of cancer related mortality worldwide.Small cell lung cancer(SCLC)poses a formidable challenge to the treating physicians with the worst prognosis among all lung cancers.However,limited stage SCLC(LS-SCLC)has a relatively better outcome with multimodality management.Efforts have been focused on optimal integration of treatment modalities to achieve an improved therapeutic ratio for patients with LS-SCLC.While chemotherapy and thoracic radiation therapy(TRT)are primary components of initial management for LS-SCLC,there is no consensus on optimal timing of TRT.Within this context,we herein provide a concise overview of current evidence and future prospects regarding the optimal timing of thoracic irradiation for LS-SCLC in light of the literature.

关键词： Small cell lung cancer Thoracic irradiation Limited stage small cell lung cancer Timing of thoracic radiation therapy Thoracic radiation therapy

Concise review of radiosurgery for contemporary management of pilocytic astrocytomas in children and adults

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World Journal of Experimental Medicine 2022年第3期12卷 36-43页

作者： Omer Sager Ferrat Dincoglan Selcuk demiral Bora Uysal hakan Gamsiz Esra Gumustepe Fatih Ozcan Onurhan Colak Ahmet Tarik Gursoy Cemal Ugur Dursun Ahmet Oguz Tugcu Galip Dogukan Dogru Rukiyye Arslan Yelda Elcim Esin Gundem Bahar Dirican Murat Beyzadeoglu Department of Radiation Oncology Gulhane Medical FacultyUniversity of Health SciencesAnkara 0090Turkey

Pilocytic astrocytoma(PA)may be seen in both adults and children as a distinct histologic and biologic subset of low-grade glioma.Surgery is the principal treatment for the management of PAs;however,selected patients may benefit from irradiation particularly in the setting of inoperability,incomplete resection,or recurrent disease.While conventionally fractionated radiation therapy has been traditionally utilized for radiotherapeutic management,stereotactic irradiation strategies have been introduced more recently to improve the toxicity profile of radiation delivery without compromising tumor control.PAs may be suitable for radiosurgical management due to their typical appearance as well circumscribed lesions.Focused and precise targeting of these well-defined lesions under stereotactic immobilization and image guidance may offer great potential for achieving an improved therapeutic ratio by virtue of radiosurgical techniques.Given the high conformality along with steep dose gradients around the target volume allowing for reduced normal tissue exposure,radiosurgery may be considered a viable modality of radiotherapeutic management.Another advantage of radiosurgery may be the completion of therapy in a usually shorter overall treatment time,which may be particularly well suited for children with requirement of anesthesia during irradiation.Several studies have addressed the utility of radiosurgery particularly as an adjuvant or salvage treatment modality for PA.Nevertheless,despite the growing body of evidence supporting the use of radiosurgery,there is need for a high level of evidence to dictate treatment decisions and establish its optimal role in the management of PA.Herein,we provide a concise review of radiosurgery for PA in light of the literature.

关键词： Pilocytic astrocytoma Radiosurgery Stereotactic irradiation Low-grade glioma Radiation oncology Children

Breathing adapted radiation therapy for leukemia relapse in the breast: A case report

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World Journal of Clinical Oncology 2019年第11期10卷 369-374页

作者： Omer Sager Ferrat Dincoglan Selcuk demiral Bora Uysal hakan Gamsiz Fatih Ozcan Onurhan Colak Yelda Elcim Bahar Dirican Murat Beyzadeoglu Department of Radiation Oncology Gulhane Medical Faculty University of Health SciencesAnkara

BACKGROUND Infiltration of the breast by leukemic cells is uncommon but may manifest as an oncological emergency requiring prompt management.Extramedullary relapse of T-cell acute lymphoblastic leukemia(T-ALL)within the breast is exceedingly rare and there is paucity of data in the literature regarding this entity.No consensus exists on management of isolated extramedullary breast relapses of T-ALL.Herein,we report a case of isolated extramedullary breast relapse of T-ALL treated with breathing adapted radiation therapy(BART)using the active breathing control(ABC)system.CASE SUMMARY The patient was a 33-year-old female with diagnosis of T-ALL.She received intensive systemic chemotherapy that resulted in complete remission of her disease,and then underwent allogeneic hematopoietic stem cell transplantation.After a 15 mo period without symptoms and signs of progression,the patient presented with palpable masses in both breasts.She complained from severe pain and swelling of the breasts.Imaging workup showed bilateral breast lesions,and diagnosis of breast infiltration by leukemic cells was confirmed after immunohistopathological evaluation.The patient suffering from severe pain,discomfort,and swelling of both breasts due to leukemic infiltration was referred to the Radiation Oncology Department for symptomatic palliation.Whole breast irradiation was delivered to both breasts of the patient with BART using the ABC system.The patient had complete resolution of her symptoms after treatment with BART.CONCLUSION BART with the ABC system resulted in complete resolution of the patient’s symptoms due to leukemic infiltration of both breasts with T-ALL.This contemporary treatment technique should be preferred for radiotherapeutic management of patients with leukemic infiltration of the breasts to achieve effective symptomatic palliation.

关键词： T-cell acute lymphoblastic leukemia Breast relapse Breathing adapted radiation therapy Active breathing control Case report

A concise review of immunotherapy for glioblastoma

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Neuroimmunology and Neuroinflammation 2018年第6期5卷 18-28页

作者： Omer Sager Ferrat Dincoglan Selcuk demiral Bora Uysal hakan Gamsiz Bahar Dirican Murat Beyzadeoglu Department of Radiation Oncology University of Health SciencesGulhane Medical FacultyAnkara 06018Turkey

Glioblastoma(GB)is the most common and aggressive form of primary brain tumors in adults with a universally poor prognosis despite multimodal management including surgery,chemotherapy and radiation therapy.Among the novel therapeutic strategies,immunotherapy deserves particular attention with its potential to evoke biologic response and harness the host immune system.Considerable success achieved for other tumors has elicited great enthusiasm and prompted research on immunotherapy for GB.While the central nervous system has traditionally been thought of as an immune-privileged site,our understanding is being refined with emerging evidence.Several studies have been conducted and more are under way to establish the role of immunotherapy in management of GB.Immunotherapy of GB has yet resulted in mixed success with conflicting research findings,emphasizing the need for extensive study before its integration into routine clinical practice.Although there is a lot of room for improvement,immunotherapy for GB may be feasible and serve as a viable management strategy broadening and strengthening the therapeutic armamentarium to combat this deadly disease.Herein,we present a concise review of immunotherapy for GB.

关键词： Glioblastoma immunotherapy glioma vaccine passive immunotherapy active immunotherapy cytokine therapy central nervous system

Adaptive radiation therapy of breast cancer by repeated imaging during irradiation

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World Journal of Radiology 2020年第5期12卷 68-75页

作者： Omer Sager Ferrat Dincoglan Selcuk demiral Bora Uysal hakan Gamsiz Fatih Ozcan Onurhan Colak Yelda Elcim Esin Gundem Bahar Dirican Murat Beyzadeoglu Department of Radiation Oncology Gulhane Medical FacultyUniversity of Health SciencesEtlikAnkara 06018Turkey

Breast cancer is the most frequent cancer among females and also a leading cause of cancer related mortality worldwide.A multimodality treatment approach may be utilized for optimal management of patients with combinations of surgery,radiation therapy(RT)and systemic treatment.RT composes an integral part of breast conserving treatment,and is typically used after breast conserving surgery to improve local control.Recent years have witnessed significant improvements in the discipline of radiation oncology which allow for more focused and precise treatment delivery.Adaptive radiation therapy(ART)is among the most important RT techniques which may be utilized for redesigning of treatment plans to account for dynamic changes in tumor size and anatomy during the course of irradiation.In the context of breast cancer,ART may serve as an excellent tool for patients receiving breast irradiation followed by a sequential boost to the tumor bed.Primary benefits of ART include more precise boost localization and potential for improved normal tissue sparing with adapted boost target volumes particularly in the setting of seroma reduction during the course of irradiation.Herein,we provide a concise review of ART for breast cancer in light of the literature.

关键词： Breast cancer Adaptive radiation therapy Tumor bed boost Computed tomography Imaging Replanning

Concise review of stereotactic irradiation for pediatric glial neoplasms:Current concepts and future directions

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World Journal of Methodology 2021年第3期11卷 61-74页

作者： Omer Sager Ferrat Dincoglan Selcuk demiral Bora Uysal hakan Gamsiz Onurhan Colak Fatih Ozcan Esin Gundem Yelda Elcim Bahar Dirican Murat Beyzadeoglu Department of Radiation Oncology Gulhane Medical FacultyUniversity of Health SciencesAnkara 06018Turkey

Brain tumors,which are among the most common solid tumors in childhood,remain a leading cause of cancer-related mortality in pediatric population.Gliomas,which may be broadly categorized as low grade glioma and high grade glioma,account for the majority of brain tumors in children.Expectant management,surgery,radiation therapy(RT),chemotherapy,targeted therapy or combinations of these modalities may be used for management of pediatric gliomas.Several patient,tumor and treatment-related characteristics including age,lesion size,grade,location,phenotypic and genotypic features,symptomatology,predicted outcomes and toxicity profile of available therapeutic options should be considered in decision making for optimal treatment.Management of pediatric gliomas poses a formidable challenge to the physicians due to concerns about treatment induced toxicity.Adverse effects of therapy may include neurological deficits,hemiparesis,dysphagia,ataxia,spasticity,endocrine sequelae,neurocognitive and communication impairment,deterioration in quality of life,adverse socioeconomic consequences,and secondary cancers.Nevertheless,improved understanding of molecular pathology and technological advancements may pave the way for progress in management of pediatric glial neoplasms.Multidisciplinary management with close collaboration of disciplines including pediatric oncology,surgery,and radiation oncology is warranted to achieve optimal therapeutic outcomes.In the context of RT,stereotactic irradiation is a viable treatment modality for several central nervous system disorders and brain tumors.Considering the importance of minimizing adverse effects of irradiation,radiosurgery has attracted great attention for clinical applications in both adults and children.Radiosurgical applications offer great potential for improving the toxicity profile of radiation delivery by focused and precise targeting of well-defined tumors under stereotactic immobilization and image guidance.Herein,we provide a concise review of stereotactic irradiation for

关键词： Radiosurgery Stereotactic irradiation Stereotactic radiosurgery Pediatric glioma Gamma knife Linear accelerator