Person: ALKIŞ, HİLAL
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ALKIŞ
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HİLAL
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Publication Metadata only Inflammatory markers to predict neoadjuvant chemoradiotherapy response in rectal cancer patients(2023-05-01) ALKIŞ, HİLAL; ADLI, MUSTAFA; Alkiş H., Özden G., Başkan Z., Bağcı Kılıç M., Gündüz H. K., Kornienko A., Devran B. Z., Adli M.Purpose or Objective Pretreatment inflammatory markers obtained from the complete blood count (CBC) can be predictive for treatment response in rectal cancer patients treated with neoadjuvant chemoradiotherapy (NACRT). The aim of this study was to determine the correlation between inflammatory markers and treatment response in rectal cancer patients treated with NACRT. Materials and Methods A total of 192 rectal cancer patients treated with NACRT were included in the study. Male/female ratio was 1.59. Clinical T stage was T2 in 13 patients, T3 in 162, and T4 in 17. Clinical N stage was N0 in 25 patients, N1 in 160, and N2 in 7. Radiation dose was 50-56 Gy to the primary tumor and 45-50.4 Gy to the regional lymph nodes. All patients received concurrent capecitabine (n=191) or 5-fluorouracil (n=1). Patients with no evidence of residual disease on DRE, MRI, and endoscopic evaluation following NACRT were determined as clinical complete responders. Patients with clinical (n=34) or pathological (n=27) complete response were classified as complete responders (CR) and the other response groups as non- complete responders (nCR) (n=131). Pretreatment absolute values of neutrophils (N), lymphocytes (L), monocytes (M), and platelets (P), plateletcrit (PCT), mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to- monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) were recorded as hematological inflammatory markers. Mann– Whitney U-test was used to compare the variables between the groups. Results Median age was 60 (18-86) years. Mean N, NLR, PLR, L, and LMR are given in the Table. Pretreatment N (p=0.042), NLR (p=0.001), and PLR (p=0.002) were significantly higher, while L (p=0.015) and LMR (p=0.004) were lower in nCR group compared to CR group. Pretreatment M, P, PCT, and MPV did not have any effect on the treatment response. Table. Mean (± SD) N, L, NLR, PLR, and LMR values according to treatment response. Markers Neutrophil (103/μL) Lymphocyte (103/μL) NLR PLR LMR Conclusion CR nCR 4.65 ± 1.41 5.21 ± 1.70 2.86 ± 4.85 1.99 ± 0.71 2.27 ± 1.05 3.03 ± 1.62 P value 0.042 0.015 0.001 0.002 0.004 130.36 ± 58.51 4.71 ± 4.85 164.20 ± 77.92 3.55 ± 1.62 Rectal cancer patients with lower pretreatment N, NLR, PLR, and higher L and LMR are more likely to have complete response following NACRT. These markers may be used to predict treatment response in rectal cancer patients treated with NACRT.Publication Metadata only Effect of PET/CT standardized uptake values on complete response to treatment before definitive chemoradiotherapy in stage III non-small cell lung cancer(SPRINGER INTERNATIONAL PUBLISHING AG, 2019) DANE, FAYSAL; Ercelep, O.; Alan, O.; Sahin, D.; Telli, T. A.; Salva, H.; Tuylu, T. B.; Babacan, N. A.; Kaya, S.; Dane, F.; Ones, T.; Alkis, H.; Adli, M.; Yumuk, F.PurposeThe standard treatment for patients with stage III non-small cell lung cancer (NSCLC), unsuitable for resection and with good performance, is definitive radiotherapy with cisplatin-based chemotherapy. Our aim is to evaluate the effect of the maximum value of standardized uptake values (SUVmax) of the primary tumor in positron emission tomography-computed tomography (PET/CT) before treatment on complete response (CR) and overall survival.MethodsThe data of 73 stage III NSCLC patients treated with concurrent definitive chemoradiotherapy (CRT) between 2008 and 2017 and had PET/CT staging in the pretreatment period were evaluated. ROC curve analysis was performed to determine the ideal cut-off value of pretreatment SUVmax to predict CR.ResultsMedian age was 58years (range 27-83years) and 66 patients were male (90.4%). Median follow-up time was 18months (range 3-98months); median survival was 23months. 1-year overall survival (OS) rate and 5-year OS rate were 72 and 19%, respectively. Median progression-free survival (PFS) was 9months; 1-year PFS rate and 5-year PFS rate were 38 and 19%, respectively. The ideal cut-off value of pretreatment SUVmax that predicted the complete response of CRT was 12 in the ROC analysis [AUC 0.699 (0.550-0.833)/P<0.01] with a sensitivity of 83%, and specificity of 55%. In patients with SUVmax<12, CR rate was 60%, while, in patients with SUV12, it was only 19% (P=0.002). Median OS was 26months in patients with pretreatment SUVmax<12, and 21months in patients with SUVmax12 (HR=2.93; 95% CI 17.24-28.75; P=0.087). CR rate of the whole patient population was 26%, and it was the only factor that showed a significant benefit on survival in both univariate and multivariate analyses.ConclusionPretreatment SUVmax of the primary tumor in PET/CT may predict CR in stage III NSCLC patients who were treated with definitive CRT. Having clinical CR is the only positive predictive factor for prolonged survival.Publication Metadata only Evaluation of predictive and prognostic importance of lung immune prognostic index in locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy(2023-06-01) ALKIŞ, HİLAL; ADLI, MUSTAFA; ARIKAN R., ALKIŞ H., IŞIK S., YAŞAR A., ÇELEBİ A., MAJİDOVA N., SEVER N., ADLI M., C. DEMİRCAN N.Objective: The systemic inflammatory response (SIR) is known as an important factor associated with tumorigenesis and tumor progression, and can be reflected by inflammatory markers. One of the markers that reflect this is the lung immune prognostic index (LIPI). It is based on a derived neutrophil-to-lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH) level. We aimed to investigate the significance of LIPI in locally advanced rectal cancer (LARC) patients treated with neoadjuvant chemoradiotherapy (NACRT). Methods: In this retrospective study, we stratified the patients according to LIPI score as good LIPI and intermediate (int)/poor LIPI. According to pathological response to NACRT, we divided the patients into two groups as those with complete response (CR) or near-CR, and those with partial response (PR) or poor/no response. We classified CR and near-CR as good response. We evaluated the predictive and prognostic significance of LIPI for NACRT response, disease-free survival (DFS), and overall survival (OS) by univariate and multivariate analyses. Results: We included 137 patients in the results, with 72 (52.6%) having good LIPI and 65 (47.4%) having int/poor LIPI. The median follow-up period was 44.7 months (range: 10-105 months). Thirteen patients (18.0%) in the good LIPI group and 22 patients (34.0%) in the int/poor LIPI group achieved good response. In multivariate analysis, we found only the LIPI score as an independent risk factor (hazard ratio (HR): 2.4, p = 0.04) for NACRT response. Median DFS was 89.2 months (95% CI: 11.4-167.0) in the int/poor LIPI group; however, the DFS of all study populations and patients in the good LIPI group did not reach the median value. In multivariate analysis for DFS, we identified abdominoperineal resection (APR) (HR: 2.21, p = 0.02), presence of tumor deposit (HR: 2.96, p = 0.003), and int/poor LIPI score (HR: 2.07, p = 0.02) as separate risk variables. OS of all study populations and the patients in the LIPI groups did not reach the median value. In multivariate analysis for OS, we identified APR (HR: 2.74, p = 0.02), surgical margin positivity (HR: 12.94, p < 0.001), and adjuvant CT (HR: 0.20, p = 0.002) as separate risk variables for OS. Conclusion: This is the first study investigating the predictive and prognostic significance of LIPI in LARC patients treated with NACRT. The results revealed that int/poor LIPI was associated with a higher rate of good response but shorter DFS compared to good LIPI. The baseline LIPI score serves as an easily accessible and useful prognostic index, and it has significant potential for making appropriate treatment decisions in LARC.Publication Open Access Neoadjuvan radyoterapi uygulanan rektum kanseri hastalarında mesane duvarı ve volümü dozlarının karşılaştırılması(2022-11-27) ALKIŞ, HİLAL; ADLI, MUSTAFA; Arslan I., Özden G., Gündüz H. K., Devran B. Z., Dağlı A., Alkiş H., Adli M.Purpose/Objective(s): To dosimetrically compare the bladder doses obtained from whole bladder volume and bladder wall only in neoadjuvant radiotherapy of locally advanced rectal cancer (LARC). Materials/Methods: Treatment planning CT images of 65 LARC patients (M/F: 41/24) treated with neoadjuvant radiotherapy were used. Median patient age was 60 (33-82). CT simulation images were taken in supine position with full bladder using iv contrast, with 3.75 mm slice thickness in all patients. Tumor location was proximal rectum in 2 patients, mid-rectum in 27 and distal rectum in 36. Primary tumor was contoured as GTV. CTV-tumor was covering GTV plus 2 cm proximally and distally, and mezorectum radially. Pelvic great vessels, starting from aortic bifurcation, were contoured with a 0.8 cm margin and pre-sacral and obturator regions were included to create CTV-LNs. Whole bladder (WB) and bladder wall only (BW) were separately contoured for study purpose. Prescribed dose was 50.4 Gy in 1.8 Gy/fx for PTV-LNs and PTV-tumor. All plans were done with VMAT using two full arcs. Maximum dose (Dmax), volumes (%) receiving 40 Gy (V40), 45 Gy (V45) and 50 Gy (V50) for WB and BW were recorded and compared. Paired t-test was used for statistical analysis. P<0.05 was accepted statistically significant. Results: Median GTV length was 8 (5-14) cm. Median GTV and total PTV volumes were 78.4 (30.5-330) and 1133 (784-11451.2) ml, respectively. Median WB and BW volumes were 522.5 (157.7-989.6) and 129.9 (33.2-211.3) ml, respectively. Median Dmax was 53.3 (49.5-54.6) Gy in both WB and BW (p=0.5). V40, V45 and V50 were significantly higher for BW than WB (p<0.0001) (Table). Median BW/WB ratios of V40, V45 and V50 were 1.6 (1.1-2.5), 2 (1.2-3.1) and 2.6 (1.6-3.8), respectively. Table. Median (min-max) whole bladder (WB) and bladder wall only (BW) volumes (ml) and volumes receiving 40 Gy (V40), 45 Gy (V45) and 50 Gy (V50) (%). WB BW Volume 522.5 (157.7-989.6) 129.9 (33.2-211.3) V40 26.7 (8.3-42.6) 42.1 (19.5-60.7) V45 17.5 (4-32.4) 33.8 (11.8-54.5) V50 7.6 (0-17.7) 20.9 (0-42.6) Conclusion: Except maximum bladder dose, bladder doses obtained from whole bladder volume does not represent bladder wall doses in LARC patients treated with neoadjuvant radiotherapy. Further studies are needed to evaluate clinical impact of these results. @font-face {font-family:\"Cambria Math\"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:-536870145 1107305727 0 0 415 0;}@font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-536859905 -1073732485 9 0 511 0;}p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:\"; margin:0cm; mso-pagination:widow-orphan; font-size:12.0pt; font-family:\"Times New Roman\",serif; mso-fareast-font-family:\"Times New Roman\";}.MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-family:\"Calibri\",sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Calibri; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:\"Times New Roman\"; mso-bidi-theme-font:minor-bidi;}div.WordSection1 {page:WordSection1;}Publication Metadata only R1 rezeksiyon ile opere edilmiş pankreas kanseri hastalarında adjuvan kemoradyoterapi zamanlamasının sağkalım sonuçlarına etkisi(2022-02-06) ARIKAN, RUKİYE; ALKIŞ, HİLAL; ARIKAN R., ALKIŞ H.Publication Open Access Timing of adjuvant chemoradiation for pancreatic cancer with positive surgical margins(2023-08-01) ALKIŞ, HİLAL; ADLI, MUSTAFA; ALKIŞ H., ARIKAN R., KORNIENKO A., GÜNDÜZ H. K., ADLI M.Aims: Impact of adjuvant chemoradiation timing on the outcome of pancreatic cancer patients with positive surgical margins is unknown. The aim of this study was to evaluate the effect of adjuvant chemoradiation timing for margin positive pancreatic cancer patients. Methods: A total of 36 pancreatic adenocarcinoma patients with positive surgical margins and received adjuvant chemoradiation were included in the study. The median radiation dose was 50.4 Gy in 28 fractions. The primary study variable was the timing of chemoradiation, grouped as immediate (after ≤ 1 cycle of chemotherapy) and delayed (after two or more cycles of chemotherapy) chemoradiation. Gemcitabine (n=16) and capecitabine (n=20) were chemotherapy regimens administered with radiation. Results: Median follow-up time was 23.7 months. Thirteen patients (36%) received immediate and 23 (64%) received delayed chemoradiation. For immediate and delayed treatment groups, median overall survival was 13.5 and 42.5 months, and disease-free survival was 6.4 and 18.8 months, respectively. Disease-free survival and overall survival were better with delayed chemoradiation (p=0.02). However, the two groups did not significantly differ in locoregional control (p=0.96). Conclusion: Delaying chemoradiation until completion of systemic therapy improves disease-free survival and overall survival without any difference in locoregional failure compared to early chemoradiation in pancreatic cancer patients with positive surgical margins.Publication Metadata only Evaluation of physical activity in cancer patients receiving radiation therapy(2023-05-01) ALKIŞ, HİLAL; ALKIŞ H., GÜNDÜZ H. K., KORNIENKO A., ÖZDEN G., BAĞCI KILIÇ M., ÇEÇEN S.Publication Open Access Tumor Response after Preoperative Chemoradiation Therapy with Simultaneous Integrated Boost Using Volumetric Modulated Arc Therapy in Locally Advanced Rectal Cancer(ELSEVIER SCIENCE INC, 2019-09) DEVRAN, BENNUR ZEYNAN; Adli, M.; Alkis, H.; Gulegen, B. Z.; Halil, S.; Degerli, A. Dagli; Ozturk, F.; Atalay, V.; Yegen, C.Publication Metadata only Meme koruyucu cerrahi sonrası radyoterapi uygulamaları(Akademisyen Kitabevi, 2022-01-01) ALKIŞ, HİLAL; ALKIŞ H.; Yıldırım , Berna Akkuş; Şen, Ebru; Sedef, Ali MuratPublication Metadata only Mide kanserinde radyoterapi(Türkiye Klinikleri Tıp Bilimleri Dergisi, 2019-01-01) ADLI, MUSTAFA; ALKIŞ, HİLAL; ADLI M., ALKIŞ H.
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