GÝRÝÞ ve AMAÇ: Bu çalýþmada kliniðimize herediter meme-over kanseri ve/veya aile öyküsü nedeniyle baþvuran hastalardaki BRCA1 ve BRCA2 varyantlarýnýn sýklýðýnýn tespiti ve literatür eþliðinde deðerlendirilmesi amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Çalýþmamýzdaki tüm hastalar güncel NCCN rehberi test kriterleri doðrultusunda seçilerek dahil edilmiþtir. Hastalarýmýzda BRCA1 ve BRCA2 genlerinin kodlayýcý bölgelerini dizilemek için Ion Torrent™ Oncomine™ BRCA Research Assay kullanýlmýþtýr. Ayrýca kopya sayýsý deðiþiklikleri tespit edilen tüm hastalar SALSA® MLPA® Probemix P002 BRCA1 ve Probemix P090 BRCA2 (MRC Holland) ile konfirme edildi.
BULGULAR: Çalýþmaya dahil edilen toplam 149 hastanýn 39’unda varyantlar (patojenik, muhtemel patojenik, klinik önemi belirsiz varyantlar ve kopya sayýsý deðiþiklikleri) tespit edilmiþtir. 2 hastamýzda (1’i BRCA1 geninde, 1’i BRCA2 geninde) daha önce literatürde tanýmlanmamýþ yeni varyantlar tespit edilmiþtir.
TARTIÞMA ve SONUÇ: Çalýþmamýzda BRCA1 ve BRCA2 varyantlarýnýn görülme sýklýðý %26,1 olarak belirlendi. Bu oran Türkiye'de yapýlan önceki çalýþmalara göre daha yüksek bulundu. Türk toplumundaki sýk varyantlarýn ve özellikle klinik önemi belirsiz varyantlarýn patojenitesinin daha net deðerlendirilebilmesi için daha fazla çalýþmaya ihtiyaç vardýr.

INTRODUCTION: In this study, it was aimed to determine the frequency of BRCA1 and BRCA2 variants in patients admitted to our clinic with hereditary breast-ovarian cancer and / or family history and to evaluate them in the light of the literature.
METHODS: All patients in our study were selected according to the current NCCN guideline test criteria. The Ion Torrent ™ Oncomine ™ BRCA Research Assay was used to sequence the coding regions of the BRCA1 and BRCA2 genes in our patients. In addition, all patients with copy number changes were confirmed with SALSA® MLPA® Probemix P002 BRCA1 and Probemix P090 BRCA2 (MRC Holland).
RESULTS: Variants (pathogenic, likely pathogenic, variants of uncertain clinical significance, and copy number variations) were detected in 39 of the 149 patients included in the study. Novel variants that were not previously described in the literature were detected in 2 patients, one of the BRCA1 and one of the BRCA2 gene, respectively.
DISCUSSION AND CONCLUSION: In our study, the incidence of BRCA1 and BRCA2 variants was found to be 26.1%. This rate was higher than previous studies conducted in Turkey. Further studies are needed to identify common variants in the Turkish pýopulation and to evaluate the patogenity of variants of uncertain clinical significance.

GÝRÝÞ ve AMAÇ: Pek çok kiþi kanser nedeniyle ölmekte. Hem doktorlar hem de araþtýrmacýlar, doðru hastalýk, teþhis ve prognoz takibinin yaný sýra direnç tahmini sunmak için çok çalýþýyorlar.
YÖNTEM ve GEREÇLER: RET germline ve somatik mutasyonlarýn önemini, spektrumunu ve farkýný incelemek için 25 hastaya likit biyopsi ve ailesel kanser paneli uygulandý. Hastalarýn çoðu ileri dirençli kanser ve / veya kalýtsal kanser (MEN2) tanýsýyla kliniði ziyaret etti. Toplam iki grup oluþturuldu: birinci grup germline (n = 7,% 28) ve ikincisi somatik (n = 18,% 72). Somatik için, Tier I-II-III varyantlarý ve germline için patojenik, muhtemelen patojenik ve VUS varyantlarý çalýþmaya dahil edilmiþtir.
BULGULAR: Ortalama yaþ 54.64 idi. Kadýn katýlýmcýlar (n = 14,% 56) erkeklerden (n = 11,% 44) önemli ölçüde daha fazla idi. Germline grubunda en yaygýn mutasyon "RET: c.2410G>A" idi. Somatik grupta, dokuz mutasyon nonsense veya çerçeve kaymasýydý ve en yaygýn mutasyonlar "RET: c.2324delinsGAC" ve "RET: c.1784A>G" idi. Nonsense veya çerçeve kaymasý RET varyantlarý, somatik grupta daha yüksek bir insidans gösterdi.
TARTIÞMA ve SONUÇ: Bildiðimiz kadarýyla bu, germline ve somatik varyantlar arasýndaki genetik deðiþkenlik baðlamýnda RET mutasyonlarýna odaklanan ilk araþtýrmadýr. Mevcut çalýþmanýn sonuçlarý, solid tümörlü hastalarýn, özellikle meme kanserinin, klinik özellikleri ve prognozu deðerlendirmek için RET sekansýna tabi tutulmasý gerektiðini göstermektedir. RET geninin yapýsý ve iþlevleri hakkýndaki keþifler, kanser hastalarý için klinik olarak daha uygun tedavi yaklaþýmlarýna yol açacak ve bireysel risk tahmini, tedavisi ve prognozunun iyileþtirilmesinde önemli bir rol oynayacaktýr.

INTRODUCTION: Many individuals die due to cancer, and both doctors and researchers work hard to offer accurate illness, diagnostic, and prognosis monitoring, as well as resistance prediction.
METHODS: A liquid biopsy and hereditary cancer panels were performed on 25 patients to examine the importance, spectrum, and diversity of RET germline and somatic mutations. Most of the patients visited the clinic with the diagnosis of advanced resistant cancers or hereditary cancer (MEN2). Two groups were formed: the first group was germline (n = 7, 28%), and the second was somatic (n = 18, 72%). For somatic, Tier I-II-III variants; for germline, pathogenic, likely pathogenic, and VUS variants have been included in the study.
RESULTS: The mean age was 54.64. There were significantly more female participants (n = 14, 56%) than males (n = 11, 44%). In the germline group, the most common mutation was ‘RET: c.2410G>A’. Nine mutations were nonsense or frameshift in the somatic group, and the most common mutations were ‘RET: c.2324delinsGAC’ and ‘RET: c.1784A>G’. Nonsense or frameshift RET variants showed a higher incidence in the somatic group.
DISCUSSION AND CONCLUSION: To the best of our knowledge, this is the first research to concentrate on RET mutations in the context of genetic variability between germline and somatic variants. The current study’s results indicate that patients with solid tumors, particularly breast cancer, should undergo RET sequencing to evaluate clinical features and prognosis. Discoveries about the structure and functions of RET gene will lead to more clinically relevant treatment approaches for cancer patients and will play an essential role in improving individual risk prediction, treatment, and prognosis.

GÝRÝÞ ve AMAÇ: Atezolizumab ve nivolumab, driver mutasyon yokluðunda, küçük hücre dýþý akciðer kanserinin (KHDAK) ikinci ve sonraki basamak tedavisinde PDL durumundan baðýmsýz olarak kullanýlabilen iyi bir seçenektir. Burada, metastatik KHDAK’li hastalarda ikinci ve sonraki sýra tedavide immünoterapinin etkinliðini ve güvenliðini deðerlendirmeyi tek Merkez deneyimi olarak amaçladýk.
YÖNTEM ve GEREÇLER: Çalýþmaya, ikinci veya sonraki sýralarda atezolizumab veya nivolumab alan toplam 37 metastatik KHDAK hastasý dahil edildi. Hastalarýn klinikopatolojik özellikleri ve saðkalým sonuçlarý analiz edildi. Güvenlik profili ve saðkalýmý öngörebilecek faktörler deðerlendirildi.
BULGULAR: Hastalarýn 29'u (% 78.4) erkek, 8'i (% 21.6) kadýn, ortanca yaþ 61 (aralýk: 42-80) idi. Bu hastalarýn 22'sinde (% 59.5) atezolizumab, 15'inde (% 40.5) nivolumab tercih edilmiþdi. Objektif yanýt oraný % 35.1 idi. Medyan 22.5 aylýk takipte, medyan progresyonsuz saðkalým 4.7 (PSK) ay iken, medyan genel saðkalým (OS) 24.1 ay olarak bulundu. PFS için tek deðiþkenli analizde, cinsiyet (p=0.03), yaþ (p=0.005), beyin metastazý varlýðý (p=0.02), PDL durumu>% 1 (p=0.035), ECOG PS (p=0.04) ve ilk sýra tedaviye iyi yanýt varlýðý (p=0.015) anlamlý prognostik göstergeler olarak bulundu. OS için ise, beyin metastazý varlýðý (p=0.03), PDL durumu>% 1 (p=0.027), ilk sýra tedaviye iyi yanýt varlýðý (p=0.022) ve atezolizumab tercihi (p=0.018) prognostik faktörler olarak bulundu.
TARTIÞMA ve SONUÇ: Gerçek hayat analizimiz, atezolizumab ve nivolumabýn, metastatik KHDAK hastalarýnýn ikinci ve sonraki basamak tedavilerinde iyi güvenlik profili ile saðkalýmý iyileþtirdiðini gösterdi.

INTRODUCTION: Immunotherapy agents such as atezolizumab and nivolumab are appropriate option for non-small cell lung cancer (NSCLC) accounts in the absence of driver mutation, regardless of PD -L1 expression in second and later line setting. Herein we aimed to evaluate the efficacy and safety of immunotherapy for the second and later line settings in metastatic NSCLC patients as a single center experience.
METHODS: Totally, 37 patients with metastatic NSCLC who received atezolizumab or nivolumab in the second or later lines were included. Clinicopathological features of patients and survival outcomes were analyzed. The safety profile and the factors that may predict survival were also evaluated.
RESULTS: Twenty-nine (78.4%) of patients were men and 8 of patients (21.6%) were woman with median age of 61 years (range: 42-80). Atezolizumab was preferred in 22 (59.5%) of these patients and nivolumab in 15 (40.5%) of them. Objective response rate was %35.1. At a median follow up 22.5 months, median progression-free survival (PFS) was 4.7 months, median overall survival (OS) was 24.1 months. Univariate analysis for PFS revealed that gender (p=0.03), age (p=0.005), the presence of brain metastasis (p=0.02), PDL status >%1 (p=0.035), ECOG PS (p=0.04) and the good response to frontline treatment (p=0.015) were found to be significant prognostic indicators. It also showed that the presence of brain metastasis (p=0.03), PDL status >%1 (p=0.027), good response to frontline treatment (p=0.022) and atezolizumab preference (p=0.018) were prognostic factors for OS.
DISCUSSION AND CONCLUSION: Our real-life analysis indicated that atezolizumab and nivolumab improved survivals with good safety profile in second and later lines treatment of metastatic NSCLC patients.

GÝRÝÞ ve AMAÇ: Otolog kök hücre transplantasyonu (OKHN) ile birlikte uygulanan yüksek doz kemoterapi, relaps/refrakter Hodgkin lenfoma (HL) veya Hodgkin dýþý lenfoma (NHL) olan hastalarda yaygýn olarak kullanýlan bir tedavi yöntemidir. Bu çalýþmanýn amacý, OKHN planlanan relaps/refrakter lenfomalý hastalarda BuCyE (busulfan, siklofosfamid ve etoposit) ve BEAM (karmustin, etoposit, sitarabin ve melfalan) hazýrlama rejimlerinin etkililiðini ve toksisitesini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Aralýk 2018 ile Kasým 2019 arasýnda BEAM (n=12) ve BuCyE (n=12) hazýrlýk rejimleri ile OKHN yapýlan nükseden veya dirençli HL (n=16) ve NHL (n=8) olan 24 hasta, Abdurrahman Yurtaslan Ankara Onkoloji Eðitim ve Araþtýrma Kemik Ýliði Nakli Ünitesi'nde incelendi. Gruplar hasta özellikleri, hematopoietik engraftman süresi, toksisite profilleri ve progresyonsuz saðkalým (PFS) açýsýndan karþýlaþtýrýldý.
BULGULAR: Gruplar arasýnda yaþ, cinsiyet daðýlýmý, ecog, sorror skoru, taný, OKHN öncesi evre (erken/geç), kemoterapi sayýsý, OKHN öncesi yanýt ve OKHN öncesi radyoterapi açýsýndan anlamlý farklýlýk saptanmadý (p> 0.05). BuCyE ve BEAM gruplarýnýn ortalama infüze edilen CD34+ hücre/kg sayýsý, nötrofil ve trombosit engraftman durumlarý, hastanede kalýþ süreleri, eritrosit ihtiyacý ve trombosit transfüzyonu benzer bulundu (p> 0.05). BuCyE grubunda daha fazla hastada mukozit ve nötropenik ateþ geliþti, ancak bu fark istatistiksel olarak anlamlý deðildi (p> 0.05). OKHN'den sonraki 13 aylýk (1–21 ay) medyan takipte, medyan PFS'ye ulaþýlamadý. Rejimler arasýnda PFS'de fark bulunmadý (p = 0.68).
TARTIÞMA ve SONUÇ: BuCyE'yi takiben OKHN, relaps/refrakter lenfoma hastalarýnda etkili bir hazýrlýk rejimidir. Bu rejim, karmustin içeren rejimlerin yerine geçebilecek önemli bir tedavi seçeneði olabilir. Bununla birlikte, ileriye dönük çalýþmalarýn yokluðunda, düþük düzeyde kanýt nedeniyle bir hazýrlama rejimi önermek zordur. Devam eden klinik araþtýrmalara katýlmak önemlidir.

INTRODUCTION: High-dose chemotherapy applied together with autologous stem cell transplantation (ASCT) is a commonly used treatment modality in patients with relapsed/refractory Hodgkin’s lymphoma (HL) or non-Hodgkin’s lymphoma (NHL). The aim of this study was to investigate the efficacy and toxicity of BuCyE (busulfan, cyclophosphamide, and etoposide) and BEAM (carmustine, etoposide, cytarabine, and melphalan) conditioning regimens in patients with relapsed/refractory lymphoma scheduled for ASCT.
METHODS: Between December 2018 and November 2019, 24 patients with relapsed or refractory HL (n = 16) and NHL (n = 8) who underwent ASCT following BEAM (n=12) and BuCyE (n=12) preparative regimens were analyzed retrospectively at Bone Marrow Transplantation Unit of Abdurrahman Yurtaslan Ankara Oncology Training and Research. The groups were compared in terms of patient characteristics, hematopoietic engraftment time, toxicity profiles, and progression free survival (PFS).
RESULTS: No significant differences were detected between the groups with regard to age, gender distribution, ecog, sorror score, diagnosis, pre-ASCT stage (early/late), chemotherapy line, pre-ASCT response and pre-ASCT radiotherapy(p > 0.05). The median number of infused CD34+ cells/kg, neutrophil and platelet engraftment statuses, duration of hospitalization, need for erythrocyte and platelet transfusion of BuCyE and BEAM groups were found to be similar (p > 0.05). More patients in the BuCyE group developed mucositis and febrile neutropenia, but this difference was not statistically significant (p > 0.05). At a median follow-up of 13 months(1–21 months) after ASCT, the median PFS could not be reached. No difference was found in PFS between regimes(p = 0.68).
DISCUSSION AND CONCLUSION: BuCyE followed by ASCT is an effective conditioning regimen in relapsed/refractory lymphoma patients. This regimen may be an important treatment option as a substitute for carmustine containing regimens. However, in the absence of prospective trials, it is difficult to suggest a conditioning regimen due to the low level of evidence. It is important to participate in ongoing clinical trials.

GÝRÝÞ ve AMAÇ: Glioblastoma multiforme (GBM), yetiþkinlerde en sýk görülen ve en kötü prognoza sahip primer beyin tümörüdür. Daha önce sistemik inflamasyon belirteci olan nötrofil-lenfosit oranýnýn (NLR), daha nadiren ele alýnan GBM hastalarýnda da olmak üzere farklý kanser türlerinde hem güçlü prediktif hem de prognostik deðere sahip olduðu gösterilmiþtir. Bu çalýþmanýn amacý; tedavi öncesi NLR'nun cerrahi / biyopsi sonrasý küratif kemoradyoterapi (KRT) alan GBM hastasýnýn saðkalým sonuçlarý üzerindeki prognostik deðerini ve NLR için belirli bir eþik deðerin eriþilebilirliðini deðerlendirmekti
YÖNTEM ve GEREÇLER: Bu çalýþma, hastane temelli, retrospektif gözlemsel bir vaka serisi çalýþmasýydý. Bu çalýþma, kliniklerimizde Ocak 2007'den Aralýk 2011'e kadar cerrahi / biyopsi ve ardýndan KRT uygulanan ön tedavi ve tedavi kayýtlarýna sahip 144 GBM hastasýný belirlemek için tasarlanmýþtýr. Hastalarýn yaþ, semptom, laboratuvar sonuçlarý ve tedavi Modaliteleri kaydedildi
BULGULAR: Tüm popülasyon için medyan takip süresi 15.1 (1.8-49.9) aydý ve bu analiz sýrasýnda 95 hasta (% 84.8) öldü. NLR cut-off deðerleri curve analizi kullnaýlarak sýrasýyla Genel saðkalým (OS) için 4,3 (EAA: 78,4;% 95 CI: 64,8-92) ve yerel rekürrenssiz saðkalým (LRFS) için 4,1 (AUC: 72,7;% 95 CI: 61-84,1) olarak tanýmlanmýþtýr. Düþük NLR, istatistiksel olarak anlamlý þekilde daha uzun medyan OS (23.2'ye karþý 12.7 ay p = 0.001) ve LRFS (13.9vs 9.6 ay; p <0.001) ve çok deðiþkenli analiz (her biri için p <0,001).ile de her iki parametre için daha uzun medyan saðkalým sonuçlarý ile iliþkilendirildi..
TARTIÞMA ve SONUÇ: Sonuç olarak, tedavi öncesi düþük NRL deðerleri, yüksek NLR ile baþvuranlara göre önemli ölçüde daha uzun OS ve LRFS ile iliþkilidir. Bu bulgular, baþlangýç NLR'si için ucuz, tekrarlanabilir ve rutin klinik uygulamada ölçümü kolay yeni, güçlü ve baðýmsýz bir prognostik deðer önerilebilir

INTRODUCTION: Glioblastoma multiforme (GBM) is the most common and miserable prognosis primary brain tumor in adults. Previously neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation has been demonstrated to have both strong predictive and prognostic value in different cancer types, which has rarely been addressed in GBM patients.The aim of this retrospective cohort study was to evaluatethe prognostic value of pretreatment NLR on survival outcomes of GBM patients who were underwent surgery/biopsy followed by definitive chemo-radiotherapy (CRT) and accessibility of a certain cut-off worth for NLR
METHODS: This study was a hospital-based retrospective observational case-series study. This study was designed to identify 144 GBM patients with full pretreatment and treatment records that underwent surgery/biopsy followed by CRT from January 2007 to December 2011 in our clinics. Age, symptoms, laboratory results and treatment modalities of patients were recorded.
RESULTS: The median follow-up time for the whole population was 15.1 (range1.8-49.9) months, with 95 patients (84.8%) being death at the time of this analysis. NLR cut-off values of 4.3 (AUC: 78.4;95% CI: 64.8-92)for overall- (OS) and 4.1 (AUC: 72.7; 95% CI: 61-84.1)forlocal recurrence-free survival (LRFS) were identified, respectively, by using receiver operating curve analysis. Low NLR was associated with significantly longermedian OS(23.2 vs. 12.7 months p=0.001), and LRFS (13.9vs 9.6 months; p<0.001) as well as longer median both of which retained its independent significant associationwith survival outcomes in the multivariate analysis (p<0.001 for each).
DISCUSSION AND CONCLUSION: In conclusion, pre-treatment Low-NLR values associate with significantly longer OS and LRFS than those presenting with high-NLR. These findings suggest a novel strong and independent prognostic value for baseline NLR which is cheap, reproducible and easy to measure in routine clinical practice.ce.

GÝRÝÞ ve AMAÇ: Glioblastom, kötü seyirli, eriþkinlerde en sýk görülen primer beyin tümörüdür. Standart tedavi sonrasý hastalarýn hemen hepsinde progresyon geliþmektedir. Progresyonda re-operasyon, sistemik tedaviler ve re-irradyasyon uygulanabilmektedir. Erken progrese olanlarýn prognozu geç progrese olanlara göre daha kötüdür. Bu çalýþmada progresyon zamanýna göre kurtarma tedavi seçeneklerinin irdelenmesi amaçlandý.
YÖNTEM ve GEREÇLER: Temmuz 2011-Mart 2016 arasýnda tedavi edilmiþ 73 nüks glioblastom tanýlý hasta restospektif olarak deðerlendirildi. Standart tedavi programý tamamlanmadan önce (≤9 ay) progrese olanlar ‘ERKEN’, tamamlandýktan sonra (>9 ay) progrese olanlar ‘GEÇ’ progresyon olarak tanýmlandý. Her iki grup için kurtarma tedaviler irdelendi. Saðkalým analizleri için Kaplan-meier metodu kullanýldý. Tek deðiþkenli analizlerde log rank, çok deðiþkenli analizde cox-regresyon testi kullanýldý.
BULGULAR: Ýlk tanýdan itibaren genel saðkalým 20 ay (%95 CI 17.0-22.9), 2 yýllýk genel saðkalým %32.9 olarak bulundu. Medyan progresyon zamaný 10 (1-42) aydý. Progresyon sonrasý genel saðkalým 8 ay (%95 CI 6.2-9.8) olarak saptandý. Çok deðiþkenli analizde, 9 aydan erken progresyon (p<0.001) ve destek tedavi (p<0.001) saðkalýmý negatif yönde etkileyen faktörler olarak bulundu. Geç progresyonda cerrahinin, sistemik tedaviden (medyan 27’ye karþý 10 ay, p: 0.005) ve destek tedavisinden (medyan 27’ye karþý 3 ay, p<0.001) daha iyi saðkalým saðladýðý gözlendi. Erken progresyonda ise re-operasyon ve destek tedavisi arasýnda fark saptanmadý (medyan 3’e karþý 1 ay, p: 0.143).
TARTIÞMA ve SONUÇ: Glioblastomda standart tedaviler sonrasý progresyon kaçýnýlmazdýr. Progresyon sonrasý saðkalým 1 yýldan kýsadýr ve kurtarma tedavi seçenekleri için uygun hasta seçimi önemlidir. Erken progresyon gösteren hastalarýn saðkalýmý düþüktür ve re-operasyon bu hastalar için uygun olmayabilir.

INTRODUCTION: We aimed to investigate salvage treatment options for glioblastoma and to explore the role of surgery in early progression.
METHODS: The study was designed as a retrospective review of 73 recurrent glioblastoma patients treated between July 2011 and March 2016. Patients were divided into two groups according to time of progression and re-treatments were analyzed for each. Early and late progressions were defined as progression before and after completion of the standard treatment package (≤9 months versus >9 months). Survival analysis were made with Kaplan-Meier method. Survival time comparisons between groups were made with Log-Rank test. Effect of variables on survival times were evaluated with Cox-Regression Analysis.
RESULTS: Median overall survival time from the first diagnosis was 20 months (95% CI 17.0-22.9) and 2-year survival rate was 32.9%. Median time to progression was 10 (1-42) months. Median post progression survival (PPS) time was 8 months (95% CI 6.2-9.8). In multivariable analysis, we found early progression (9 months or less, p<0.001) and the use of supportive care after progression (p<0.001) as negative prognostic factors for PPS. In late progression, re-operation provided higher rates of PPS than systemic therapy (median 27 vs 10 months, p: 0.005) and supportive care (median 27 vs 3 months, p<0.001). However, no significant difference was found between reoperation and supportive care in case of early progression (median 3 vs 1 months, p: 0.143).
DISCUSSION AND CONCLUSION: Progression is inevitable after standard treatment of glioblastoma. Survival after relapse is considered to be shorter than a year and appropriate patient selection is crucial when deciding on re-treatments. Survival rates of patients with progression earlier than 9 months are lower, and reoperation may not be an ideal option for this group.

GÝRÝÞ ve AMAÇ: Koronavirüs hastalýðý - 2019 (COVID-19), saðlýk hizmetinin diðer alanlarýnda olduðu gibi, baþ ve boyun onkolojisi hizmetlerinin uygulama düzenlerini deðiþtirmiþtir. Bu çalýþma, COVID-19'un, onkolojide özelleþmiþ üçüncü basamak bir akademik saðlýk kurumunun Kulak Burun Boðaz, Baþ Ve Boyun Cerrahisi Bölümü hizmetleri üzerindeki etkisini açýklamayý amaçlamaktadýr. Çalýþmamýz, pandemi sürecinde onkolojik olgulara hizmet veren üçüncü basamak bir saðlýk kurumunun Kulak Burun Boðaz bölümünde yürütülen tek merkezli tanýmlayýcý bir çalýþmadýr.
YÖNTEM ve GEREÇLER: Hastane bilgi yönetim sisteminden 2019 ve 2020 yýllarýnýn 1 Mart - 15 Mayýs tarihleri arasýnda 18 yaþýndan büyük olgularýn poliklinik baþvurusu, hastaneye yatýþ ve kulak burun boðaz ameliyatlarý sayýlarý ile yatýþ ve ameliyat endikasyonlarýna iliþkin veriler elde edildi. Baþ ve boyun bölgesi onkolojik cerrahisi planlanan asemptomatik preoperatif hastalarýn COVID-19 test sonuçlarýna iliþkin veriler ayný sistemden elde edildi.
BULGULAR: 2020'de poliklinik baþvurularýnýn toplam sayýsýnda 2019'a göre azalma saptandý. (16814'e 7108, % 57,7). Toplam hastaneye yatýþ sayýsý (278'e 129, p <0,001) ve toplam ameliyat sayýsýndaki (231'e 111, p <0,001) azalmaya raðmen, baþ ve boyun kanserleri nedeniyle olan ameliyat ve hastaneye yatýþ sayýlarý arttý. Asemptomatik hastalarýn ameliyat öncesi 88 COVID-19 testinden biri pozitifti. Bölüm personelinden enfekte olan kiþi olmadý.
TARTIÞMA ve SONUÇ: 2020 döneminde hasta sayýsýnda azalma olmakla birlikte baþ ve boyun onkolojisine yönelik olarak uygulanan iþlemlerin niteliksel özelliklerinde artýþ olmasý, saðlýk profesyonellerinin pandemi hizmetleri için çalýþmadýðý durumlarda dahi karþý karþýya olduðu zorluk / risklerde artýþa neden olmaktadýr.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has changed practice patterns of head and neck oncology services, as well as other service areas of health care. This study aims to describe the impact of COVID-19 on the services of the division of otorhinolaryngology, head and neck surgery at an academic tertiary referral hospital specialized in oncology. This is a single-center descriptive study conducted within the otorhinolaryngology department of a tertiary health care institution, which mainly provided service to oncological cases during the pandemic.
METHODS: Data of cases over 18 years old on the numbers of outpatient visits, hospitalizations, otorhinolaryngological surgeries, and indications were obtained from March 1 to May 15 for 2019 and 2020 from hospital information management system. Data on preoperative test results of asymptomatic patients for COVID-19, going through for head and neck oncological surgeries were obtained from the same system.
RESULTS: There is a decrease in the total number of outpatient visits in 2020 compared to 2019. (16814 vs. 7108, 57.7%). The numbers of hospitalizations and surgeries related to head and neck malignancies were increased despite the decrease in the total number of hospitalizations (278 vs. 129, p <0.001) and in the total number of surgeries (231 vs. 111, p < 0.001). One of the 88 preoperative COVID-19 tests of asymptomatic patients was positive. No member of the staff got infected.
DISCUSSION AND CONCLUSION: Although there is a decrease in the number of patients in the 2020 period, the increase in the qualitative characteristics of the head and neck oncological procedures performed causes an increase in the difficulties / risks that health professionals face even though they do not work for pandemic services.

GÝRÝÞ ve AMAÇ: Çalýþmamýzda kolon kanseri tanýlý hastalarda radyolojik ve histopatolojik lenf nodu evresini kýyaslayarak preoperatif bilgisayarlý tomografi (BT) ile taramanýn lenf nodu durumunu belirlemedeki deðerini belirlemeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2014 ve Aralýk 2018 tarihleri arasýnda kolon kanseri tanýsý almýþ olan hastalarýn preoperatif BT taramalarý alanýnda deneyimli bir radyolog tarafýndan geriye dönük olarak incelendi. Görüntülerde bölgesel lenf nodu yayýlýmýnýn göstergesi olarak 1cm’den büyük lenf nodu, ≥3 kümelenmiþ lenf nodlarý veya her ikisinin de mevcut olmasý kabul edilmiþtir. Sonuçlar histopatolojik lenf nodu evresi ile kýyaslandý. Ardýndan, pozitif prediktif deðer (PPD), negatif prediktif deðer (NPD), sensitivite, spesifisite ve doðruluk deðerleri hesaplandý.
BULGULAR: Çalýþmamýza 184 hasta dahil olmuþtur. Bölgesel lenf nodu metastazýnýn tespitinde tespit edilen PPD, NPD, sensitivite, spesifisite ve doðruluk deðerleri sýrasýyla %65.6, %75, %58.3, %80.3 ve %71.7% idi. Acil ve tümör yerleþimi gibi altgruplarda BT ile lenf nodunun deðerlendirilmesinde ise BT’nin orta düzey sensitivite, spesifisite ve doðruluða sahip olduðu görüldü.
TARTIÞMA ve SONUÇ: Çalýþmamýz daha önceden yapýlmýþ olan çalýþmalara göre nispeten daha çok hasta içermesi ve daha homojen yapýda olmasýna raðmen, kolon kanseri hastalarýnýn preoperatif BT ile lenf nodu durumunu deðerlendirilmesinde tatmin edici sonuçlara ulaþýlamamýþtýr. BT görüntülemedeki lenf nodunu görünümüne göre tedaviye yön vermede tanýsal doðruluðu arttýracak ince aksiyal kesitler ve üç-boyutlu rekonstruksiyon yöntemleri gibi güçlü geliþmelere gereksinim vardýr.

INTRODUCTION: Our aim is to determine the value of a pre-operative Computed Tomography (CT) scan for the assessment of lymph node status in patients diagnosed with colon cancer by comparing between radiological N-stage and histopathological N-stage.
METHODS: After approving by local ethics committee, an experinced radiologist reviewed all pre-operative CT scans of patients diagnosed with colon cancer retrospectively, between January 2014 and December 2018. The CT scans were examined for any signs of regional lymphatic spread which was defined as lymph nodes exceeding 1 cm, clusters of ≥3 lymph nodes or a combination of the two. The results were compared with the histopathological N-stage. The diffrences in comparison were eveluated statistically and positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and accuracy were calculated.
RESULTS: We included 184 patients in our study. The statistical values of PPV, NPV, sensitivity, specificity, and accuracy of detecting regional lymph nodes metastases were 65.6%, 75%, 58.3%, 80.3% and 71.7%, respectively. The assessment of lymph node status with CT resulted in a moderate sensitivity, specificity and accuracy for both subgroups, defined as emergency and tumor localization subgroups.
DISCUSSION AND CONCLUSION: Although our study group is relatively large and homogeneous compared to previous studies, the obtained results in the evaluation of patients with colon cancer with preoperative CT does not seem to be satisfactory. Before making the treatment decisions according to the appearance of lymph nodes in colon cancer patients on CT images, the diagnostic accuracy needs strong improvement, such as thinner axial slices and three-dimensional reconstruction methods.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý malign meme lezyonu olan hastalarýn lateral torasik arter (LTA) ve internal torasik arter (ÝTA) power doppler ultrason inceleme sonuçlarýnýn prediktif özelliðini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Bu çalýþma, 2018-2020 yýllarý arasýnda ultrasonografi ve mamografi ile þüpheli lezyonlarý saptanan ve patolojik invaziv meme kanseri tanýsý konan 47 hastanýn üçüncü basamak bir hastanede dahil edildiði prospektif bir vaka kontrol çalýþmasýdýr. Ayný hastanýn invaziv karsinom tanýsý alan memede ve saðlýklý memede power doppler ultrasonografi ile LTA ve ÝTA ile deðerlendirildi. Saðlýklý meme kontrol grubuydu.
BULGULAR: Tanýsal istatistiksel testlerde; LTA Peak systolic flow (PSF) deðeri için optimum cut-off deðeri 19,6 cm/s, bu deðerin duyarlýlýðý %81,3 ve özgüllüðü %95.8'dir. LTA resistive index (RI) deðeri için optimal cut-off deðeri 0.805, bu deðerin duyarlýlýðý %91.7 ve özgüllüðü %95.8 idi. Karþý memede invaziv meme kanseri tespiti için ITA peak diastolic flow (PDF)' nýn 8.35'in altýndaki duyarlýlýðý %77,1, özgüllüðü %79,2'dir.
TARTIÞMA ve SONUÇ: Bildiðimiz kadarýyla, bu çalýþma dahili ITA ve LTA'nýn akýþ modellerini birlikte inceleyen ilk yayýndýr. Bu çalýþma, meme kanserini tespit etmek için kullanýlabilecek, kolay eriþilebilir, uygulanabilir, yüksek duyarlýlýk ve özgüllüðe sahip yeni kantitatif taný testleri sunmaktadýr.

INTRODUCTION: The aim of this study is to investigate the predictive feature of lateral thoracic artery (LTA) and internal thoracic artery (ITA) power doppler ultrasound examination results of patients with malignant breast lesions.
METHODS: This is a prospective case-control study in which 47 patients with suspicious lesions detected by ultrasonography and mammography and diagnosed with pathologically invasive breast carcinoma between 2018-2020 were included in a tertiary hospital. The breast with invasive carcinoma and the intact breast of the same patient were evaluated with LTA and ITA by power doppler ultrasonography. Healthy breast was the control group.
RESULTS: In the diagnostic statistical tests; the optimum cut-off value for LTA Peak systolic flow (PSF) value is 19.6 cm / s, sensitivity of this value is 81.3% and specificity is 95.8%. The optimal cut-off value for LTA resistive index (RI) value was 0.805, sensitivity of this value was 91.7% and specificity was 95.8%. For the detection of invasive breast carcinoma in the contralateral breast, the sensitivity of peak diastolic flow (PDF) below 8.35 is 77.1% and the specificity is 79.2%.
DISCUSSION AND CONCLUSION: To the best of our knowledge, this study is the first publication to examine the flow patterns of internal ITA and LTA together. This study presents new quantitative diagnostic tests that can be used to detect breast cancer, are easily accessible, applicable, and have high sensitivity and specificity.

GÝRÝÞ ve AMAÇ: 18F-fluorodeoksiglukoz (18F-FDG) pozitron emisyon tomografi-bilgisayarlý tomografide (PET/BT) malignite kuþkulu lezyonlara ilaveten, benign karakterdeki bulgularýn raporlanmasý da hasta yönetiminde önemlidir. Bazý pulmoner bulgular benign olsa bile hayati tehlike oluþturan ciddi sonuçlara yol açabilir. Bu çalýþmanýn amacý, ekstrapulmoner malign neoplazm tanýsý ile PET/BT çekilmiþ olan yaþlý hastalarda benign yada malign pulmoner bulgularýn sýklýðýný araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Üçüncü basamak saðlýk kuruluþu nükleer týp bölümüne Kasým 2017-Nisan 2018 tarihleri arasýnda baþvuran 65 yaþ ve üzeri hastalar retrospektif deðerlendirildi. Demografik verileri, klinik bilgileri ve PET/BT görüntüleri hastane kayýtlarýndan elde edildi. Bulgular SPSS 22 kullanýlarak analiz edildi.
BULGULAR: Toplam 112 hasta (yaþ ortalamasý 72.8±7.0; %58.9’ u kadýn olan) çalýþmaya dahil edildi. Hastalarýn %38.4’ ü aktif, %39.2’ si pasif sigara içicisiydi. En sýk PET/BT çekimi endikasyonu, tedavi sonrasý yanýt deðerlendirme (%42.9) ve evreleme (%35.7) idi. Tanýlarýn çoðunluðunu gastrointestinal sistem (%26.8), meme (%26.8) ve ürogenital sistem (%17) maligniteleri oluþturmaktaydý. Hastalarýn çoðunda toraks kesitlerinde benign yada malign pulmoner bulgulara rastlanýrken, sadece 24 hastada (%21.4) hiçbir anormal pulmoner bulgu izlenmedi. En sýk saptanan bulgular; amfizem (%39.3), metastatik nodül (%27.7), bronþ duvarý kalsifikasyonu (%14.3) ve hava hapsi/kisti (%9.8) idi.
TARTIÞMA ve SONUÇ: Bu çalýþma, ekstrapulmoner malign neoplazm tanýsý ile PET/BT çekilen yaþlý hastalarýn %78.6’ sýnda en az bir anormal pulmoner bulgunun olduðunu gösterdi. Bu bulgularýn çoðu iyi huylu olmakla birlikte, bunlarýn raporlanmasý malignitesi olan hastalarýn yönetimi ve klinik gidiþatýnda önemlidir.

INTRODUCTION: Reporting thorax imaging findings on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is important for patient management. Even if some pulmonary findings are benign, they can have serious life-threatening consequences. This study aimed to investigate the frequency of benign or malignant pulmonary findings, which were simultaneously detected in PET/CT scans, of elderly patients with extrapulmonary malignant neoplasms.
METHODS: Patients aged ≥65 years, applying to nuclear medicine department of a tertiary level health unit between November 2017 and April 2018 were retrospectively evaluated. Demographic and clinical information and PET/CT scans were obtained from their previous hospital records. Data obtained were analyzed using the SPSS version 22.
RESULTS: A total of 112 patients (mean age, 72.8 ± 7.0; females, 58.9%) were included in the study. In total, 38.4% of the patients had a smoking history, and 39.2% were exposed to second-hand smoke. The most common indications for PET/CT imaging were post-treatment evaluation (42.9%) and staging (35.7%). Predominantly diagnosed malignancies were cancers of the gastrointestinal system (26.8%), breast (26.8%), and urogenital system (17%). While most patients had benign or malign pulmonary findings in thoracic images, no abnormal pulmonary findings were observed in only 24 patients (21.4%). The most common findings were emphysema (39.3%), metastatic nodules (27.7%), bronchial wall calcifications (14.3%), and air trapping/cysts (9.8%).
DISCUSSION AND CONCLUSION: This study revealed that 78.6% of elderly patients with extrapulmonary malignant neoplasms undergoing PET/CT scans had at least one pathologic lung finding. Although most of these findings are benign, reporting of them is important in the management and clinical outcomes of patients with malignancy.

GÝRÝÞ ve AMAÇ: Hodgkin Lenfoma hastalarýnda taný anýnda evrelemede kullanýlan PET/BT tetkikinin kemik iliði tutulumunu belirlemedeki yerini saptamak
YÖNTEM ve GEREÇLER: Saðlýk Bilimleri Üniversitesi Ankara Dýþkapý Yýldýrým Beyazýt Eðitim ve Araþtýrma Hastanesi Hematoloji kliniðinde 2009-2019 yýllarý arasýnda takip edilen Hodgkin lenfoma tanýlý hastalarýn dosyalarý retrospektif olarak incelendi. Bu hastalar arasýnda taný anýnda hem kemik iliði biyopsisi yapýlan, hem de PET/BT çekilen toplam 46 hasta çalýþmaya dahil edildi.
BULGULAR: Toplam 46 hastanýn yaþ ortalamasý 40,0 [19,0-80,0] idi. Hastalarýn kemik iliði tutulum durumlarý incelendiðinde kemik iliði biyopsisinde 3 hastada tutulum saptanýrken, taný anýnda yapýlan PET/BT'de 14 hastada tutulum olduðu görülmüþtür. PET/BT sonuçlarýnýn kemik iliði biyopsi sonuçlarýna göre deðerlendirildiðinde duyarlýlýðýnýn % 100 (3/3), özgüllüðünün ise % 74,4 (32/43) olduðu görüldü.
TARTIÞMA ve SONUÇ: Hodgkin lenfoma hastalarýnda kemik iliði tutulumunu saptamada non invaziv bir test olan PET/BT'nin duyarlýlýðý çok yüksektir. Ancak özgüllüðünün düþük olmasý sebebi ile yanlýþ pozitif hasta evrelemesine sebep olabileceðinden þüphe halinde invaziv de olsa kemik iliði biyopsisi yapýlmasý daha uygun olacaktýr.

INTRODUCTION: This study was conducted to determine the predictive value of positron emission tomography (PET/CT) used in staging Hodgkin Lymphoma (HL) at the time of diagnosis in determining bone marrow (BM) involvement.
METHODS: The patients diagnosed with Hodgkin lymphoma in our hematology department between 2009-2019 were analyzed retrospectively. The study included a total of 46 patients who underwent both BM biopsy and PET / CT for staging at the time of diagnosis.
RESULTS: The mean age of the 46 patients was 40.0 years [19.0-80.0]. BM involvement was determined in 3 patients from BM biopsy and in 14 patients from PET / CT performed at the time of diagnosis. When PET / CT results were analyzed according to BM biopsy results, it was found that the sensitivity was 100% (3/3) and the specificity was 74.4% (32/43).
DISCUSSION AND CONCLUSION: The sensitivity of PET / CT is very high in detecting BM involvement in HL patients, and is a non-invasive test. However, in doubtful cases it may be more appropriate to perform a BM biopsy, even though it is invasive, as PET/CT may cause false positive patient staging due to its low specificity.

GÝRÝÞ ve AMAÇ: Malign mezotelyoma (MM) sýklýkla ileri evrede taný alan kötü prognozlu nadir bir hastalýktýr. Sistemik inflamatuar indeksler (SII) kanserde prognostik deðerlere sahip olabilir. Albümin, negatif bir akut faz reaktanýdýr. Sunulan çalýþmada MM takibinde SII ve albüminin globulin oranýnýn (AGO) prognostik önemini deðerlendirdik
YÖNTEM ve GEREÇLER: Merkezimizde dahil edilme kriterlerini karþýlayan 56 MM hastasý çalýþmaya dahil edildi. 18 yaþ üstü, patolojik olarak doðrulanmýþ malign plevral ve peritoneal mezotelyoma olan sekonder malignitesi olmayan hastalar çalýþmaya dahil edildi. Taný anýnda SII ve AGR laboratuvar parametreleri veri tabanýndan retrospektif oalrak kaydedildi.Bu parametreleri etkileyebilecek aktif enfeksiyonu olanlar, steroid kullaným öyküsü olanlar çalýþma dýþý býrakýldý.
BULGULAR: Medyan takip süresi 13,5 aydý. Hastalarýn çoðunluðu (%58.9) kadýndý. Medyan genel saðkalým (OS) 13 aydý. Median OS, plevral mezotelyoma grubunda 16 ay ve peritoneal mezotelyoma grubunda 9 aydý (p=0.982). OS, trombosit sayýsý, nötrofil/lenfosit oraný (NLR) ve trombosit/lenfosit oraný (PLR) ile negatif korelasyon gösterdi (p1= 0,015, p2=0,009 p3=0,004;sýrasýyla).Öte yandan OS, lenfosit sayýsý, albümin ve AGR ile pozitif korelasyon gösterdi (sýrasýyla p1=0,032, p2<0,001, p3=0,004;). Ortalama OS, albümin düzeyi yüksek (>3,5 g/dL) hastalarda 22 ay iken, albümin düzeyi düþük olanlarda ( ≤3,5 g/dL) sýrasýyla 9 aydý (p=0,03). Çok deðiþkenli Cox regresyon analizinde trombosit sayýsý, lenfosit sayýsý, NLR, PLR, albümin ve AGR, OS için baðýmsýz prognostik faktörler olarak belirlendi (p1<0,001, p2=0,001, p3=0,026, p4<0,001, p5=0,03, p6= 0.008; sýrasýyla)
TARTIÞMA ve SONUÇ: Çalýþmada albümin, AGO, NLR, PLR, trombosit ve lenfosit sayýlarýnýn MM'de OS için baðýmsýz prognostik faktörler olduðu gösterilmiþtir.

INTRODUCTION: Malignant mesothelioma (MM) is rare with poor prognosis and often diagnosed at advanced stage. Systemic inflammatory indices (SII) may have prognostic value in cancer. Albumin is a negative acute phase reactant. We evaluated the prognostic significance of SII and albumin to globulin ratio (AGR) in MM followed-up at a single institute
METHODS: Fifty-six MM patients who met the inclusion criteria at our oncology cenrter were included in the study. Patients aged over 18 years with pathologically confirmed malignant pleural and peritoneal mesothelioma and no secondary malignancy followed up at our center were included in the study. Laboratory parameters for estimation of SII and AGR at diagnosis were obtained from database. Those with active infection, which might affect these parameters, those with a medical history of steroid use were excluded from the study.
RESULTS: Median follow-up was 13.5 months. Most of the patients were female (58.9%). Median overall survival (OS) was 13 months. Median OS was 16 months in the pleural mesothelioma group and 9 months in the peritoneal mesothelioma group (p=0.982).OS was negatively correlated with platelet count, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) (p1=0.015, p2=0.009 p3=0.004;respectively).On the other hand, OS was positively correlated with lymphocyte count, albumin and AGR (p1=0.032, p2<0.001, p3=0.004; respectively). Median OS was 22 months in patients with higher albumin level ( >3.5 g/dL) while it was 9 months in others with lower albumin level ( ≤3.5 g/dL), respectively (p=0.03). In multivariate Cox regression analysis, platelet count, lymphocyte count, NLR, PLR, albumin and AGR were determined as independent prognostic factors for OS (p1<0.001, p2=0.001, p3=0.026, p4<0.001, p5=0.03, p6=0.008;respectively)
DISCUSSION AND CONCLUSION: It has been demonstrated that albumin, AGR, NLR, PLR, platelet and lymphocyte counts are independent prognostic factors for OS in MM.

Primer infundibular kraniofarenjiyoma, konumu nedeniyle nispeten nadir görülen ve genellikle geç taný alan bir hastalýktýr. Farklý zamanlarda norolojik muayenelerinde bitemporal hemianopsi tespit edilen iki hasta MRG incelemesi için radyoloji kliniðine refere edildi. Her iki hastada da MRG ile infindubüler yerleþimli lezyonlar tespit edildi ve kraniofaranjiyom birincil taný olarak düþünüldü. Her iki kitle de ameliyat edildi ve kraniofaranjiyom tanýsý patolojik olarak doðrulandý.

Primary infundibular craniopharyngioma is a relatively unusual disease due to its location, which usually results in late diagnosis. Two female patients are referred to the radiology clinic because of bitemporal hemianopsia detected in visual assessment at different times.
Infindubular lesions were detected with MRI both patients and craniopharangioma was considered as the primary diagnosis. Both masses are operated and the diagnosis of craniopharangioma is proven pathologically.