Browsing by Author "Soran, Atilla"

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Aso visual abstract: Intervention for hepatic and pulmonary metastases in breast cancer patients-prospective, multi-institutional registry study: Imet; protocol mf 14-02
(Springer, 2022-08-06) Soran, Atilla; Özbaş, S.; Özcınar, B.; Isık, A.; Doğan, L.; Dağ, A.; Karanlık, H.; Aytaç, O.; Karadeniz Çakmak, G.; Dalcı, K.; Doğan, M.; Sezer, Y. A.; Özyar, E.; Sezgin, E.; GÖKGÖZ, MUSTAFA ŞEHSUVAR; Senol, Kazım; ŞENOL, KAZIM; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.
Placement technique and the early complications of balloon breast brachytherapy - magee-womens hospital experience
(Lippincott Williams & Wilkins, 2007-04-01) Soran, Atilla; Beriwal, Sushil; Mogus, Robert; Keenan, Donald; Kelley, Joseph L.; Balkan, Mujdat; Harlak, Ali; Bonaventura, Marguerite A.; Johnson, Ronald; Falk, Jeffrey S.; Evrensel, Türkkan; EVRENSEL, TÜRKKAN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Onkoloji Anabilim Dalı.; 0000-0002-3398-7230; 0000-0002-9015-5617; AAJ-1027-2021
Backgrounds and Objectives: Open (OT) and percutaneous closed (PCT) techniques have been described for placement of the MammoSite catheter to deliver accelerated partial breast brachytherapy. We report early complications of both techniques.Methods: A total of 125 patients underwent catheter placement for MammoSite high-dose rate brachytherapy, with 108 patients successfully completing treatment. The OT was used in 85 patients and PCT in 40 patients. The mean distance between the balloon surface and breast skin was 1.44 cm and 1.31 cm, respectively. Average skin dose was 278 cGy in the OT group and 295 cGy in the PCT group (P > 0.05). Average gross specimen size was 43.16 cm(3) in the OT group and 62.19 cm(3) in the PCT group. Median follow-up was I I months for the OT group and 5 months for the PCT group.Results: In 17 cases, the catheter was subsequently removed without the patient completing treatment. Two of the patients in the OT group (3%) developed a delayed abscess. The overall incidence of persistent seroma (>6 months) was 20% with all occurring in the OT group, 30% of those patients. There were no acute skin toxicities higher than grade 2. The overall cosmesis is excellent or good in 95% of patients.Conclusion: Despite short follow-up and a small sample size in this study, it seems that the MammoSite brachytherapy was well tolerated by patients with early stage breast cancer when using either the OT or PCT.
The predicted probability of having positive non-sentinel lymph nodes in patients who received neoadjuvant chemotherapy for large operable breast cancer
(Wiley, 2008-09) Johnson, Ronald; Ahrendt, Gretchen; Bonaventura, Marguerite; Falk, Jeffrey; Keenan, Donald; Soran, Atilla; Evrensel, Türkkan; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Onkoloji Anabilim Dalı.; 0000-0002-9732-5340; AAJ-1027-2021; 6603942124
The accuracy of the nomogram in women with positive sentinel nodes following neoadjuvant chemotherapy (NCT) is unknown. The aim of this study was to evaluate the accuracy of the nomogram in patients receiving NCT. Between December 1999 and December 2005, we identified 233 patients who had a positive sentinel lymph node biopsy (SLNB) and complete axillary lymph node dissection at Magee-Womens Hospital of University of Pittsburgh Medical Center. Thirty-two patients (14%) had presented with clinically N0 breast cancer (BC) for which NCT was administered. The computerised BC nomogram was used to calculate the probability of non-sentinel node metastases utilising tumour size before NCT and after NCT for the same patient. The discrimination of the nomogram was assessed by calculating the area under (AUC) the receiver operating characteristic curve (ROC). The median patient age was 51.5 (range: 39-66) years in the NCT group of patients. Twelve patients (37%) had positive axillary non-sentinel lymph nodes (NSLNs). The nomogram was first validated in our institution for 201 patients without NCT and the predicted accuracy of the nomogram by the AUC was 0.73. The area under the ROC was identical regardless of whether pre- or posttreatment tumour size was used to determine predicted probability of NSLN metastases (0.66). The predictive accuracy of the nomogram was found to have less power for patients receiving NCT (0.66) than the non-NCT group of patients.
Primary surgery in patients with de novo stage IV BC; finalizing the protocol MF07-01 randomized clinical trial
(American Association for Cancer Research, 2020-02-15) Soran, Atilla; Özmen, Vahit; Özbaş, Serdar; Karanlık, Hasan; Müslümanoğlu, Mahmut; İğci, Abdullah; Cantürk, Zafer; Utkan, Zafer; Özaslan, Cihangir; Uras, Cihan; Aksaz, Erol; Soyder, Aykut; Uğurlu, Ümit; Çöl, Cavit; Cabıoğlu, Neslihan; Erdem, Ergün; Gürleyik, Günay; Sezgin, Efe; Evrensel, Türkkan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Dahili Tıp Bilimleri/İç Hastalıkları.; 0000-0002-9732-5340; AAJ-1027-2021
Background. The MF07-01 trial is a multicenter randomized study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone in de novo Stage IV breast cancer (BC) patients. Aim: To evaluate and finalize the survival data of LRT in patients with the diagnosis of de novo Stage IV BC. Methods. At initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. Continuous and categorical variable differences between LRT and ST groups were analyzed using t-test and Chi-square test, respectively. Overall survival (OS) and 5-year survival rates were compared using Kaplan-Meier log-rank tests. Univariate and multivariate Cox models were used to estimate hazard ratios, and logistic regession model used to estimate odds ratio. Results. During more than 10 years follow-up, 23% of patients in LRT group and 8% of patients in ST group were alive. Median survival was 46 months for LRT (n=134) and 35 months for ST (n=131) [HR:0.71, 95%CI;0.59-0.86, p=0.0004]. Solitary bone metastasis patients’ median survival was 14 months longer in LRT group comparing ST group [HR:0.55, 95%CI; 0.35-0.86, p=0.008]; 16% of solitary bone metastasis patients in the LRT group were alive, but all patients died in the ST group. Patients younger than 55 lived longer compared the patients older than 55 [HR:0.67, 95%CI; 0.52-0.87, p=0.002], and 26% of hormone receptor positive patients were still alive in the LRT group comparing 10% in the ST group [HR:0.71, 95%CI; 0.58-0.88, p=0.002]. Regarding the patients who lived at least 5 years since randomization, LRT (p=0.003), hormone receptor positivity (p=0.004), Triple negative status (p=0.02), hormonotherapy (p=0.0001), bisphosphonates usage (p=0.03), and 2 or more organ metastases (p=0.004) were associated with OS in univariant analyses. However, in the multivariate model with significant baseline and clinical characteristics only LRT [OR= 1.58, p=0.03] was found to be significantly related with over 5 years of survival. Conclusion. In the current analysis, patients at the diagnosis of de novo stage IV BC who underwent LRT followed by ST had a 58% higher chance to live at least 5 years compared to the patients who received only ST. Longer follow-up of the study discloses that LRT should be presented to patients when discussing treatment options.
Primary surgery with systemic therapy in patients with de novo stage IV breast cancer: 10-year follow-up; protocol MF07-01 randomized clinical trial
(Elsevier Inc., 2021-12) Soran, Atilla; Özmen, Vahit; Özbaş, Serdar; Karanlık, Hasan; Müslümanoğlu, Mahmut; İğci, Abdullah; Cantürk, Nuh Zafer; Utkan, Zafer; Sezgin, Efe; Özaslan, Cihangir; Uras, Cihan; Aksaz, Erol; Soyder, Aykut; Çöl, Cavit; Cabioğlu, Neslihan; Güllüoğlu, Bahadır M.; Erdem, Ergün; Evrensel, Türkkan; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Bölümü.; EXZ-0745-2022; 6603942124
BACKGROUND: The aim of this randomized clinical trial was to evaluate the overall survival (OS) data of patients diagnosed with de novo stage IV breast cancer (BC) who received locoregional treatment (LRT) over a 10-year follow-up. STUDY DESIGN: The MF07-01 is a 1:1 multicenter, randomized clinical trial comparing the LRT with systemic therapy (ST), where ST was given to all patients either immediately after randomization or after surgical resection of the intact primary tumor. RESULTS: A total of 278 patients were randomized and 265 patients were in the final analysis. At 10-year follow-up, survivals were 19% (95% CI 13%-28%) and 5% (95% CI 2%-12%) in the LRT group and ST group, respectively. Median survival was 46 months for the LRT group and 35 months for the ST group, and hazard of death was 29% lower in the LRT group compared with the ST group (hazard ratio [HR] 0.71; 95% CI 0.59-0.86; p = 0.0003). CONCLUSIONS: Patients with a diagnosis of de novo stage IV BC who underwent LRT followed by ST had a 14% higher chance of OS by the end of the 10-year follow-up compared with the patients who received only ST. The longer study follow-up revealed that LRT should be presented to patients when discussing treatment options.
Randomized trial comparing resection of primary tumor with no surgery in stage IV breast cancer at presentation: Protocol MF07-01
(Springer, 2018-10-24) Soran, Atilla; Ozmen, Vahit; Ozbas, Serdar; Karanlık, Hasan; Muslumanoglu, Mahmut; Igci, Abdullah; Canturk, Zafer; Utkan, Zafer; Ozaslan, Cihangir; Uras, Cihan; Aksaz, Erol; Soyder, Aykut; Ugurlu, Umit; Col, Cavit; Cabioglu, Neslihan; Bozkurt, Betül; Uzunkoy, Ali; Koksal, Neset; Gulluoglu, Bahadir M.; Ünal, Bülent; Atalay, Can; Yildirim, Emin; Erdem, Ergun; Salimoglu, Semra; Sezer, Atakan; Koyuncu, Ayhan; Gurleyik, Gunay; Alagol, Haluk; Ulufi, Nalan; Berberoglu, Ugur; Dulger, Mustafa; Cengiz, Omer; Sezgin, Efe; Johnson, Ronald; Evrensel, Türkkan; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; 0000-0002-9732-5340; AAJ-1027-2021; 6603942124
The MF07-01 trial is a multicenter, phase III, randomized, controlled study comparing locoregional treatment (LRT) followed by systemic therapy (ST) with ST alone for treatment-na < ve stage IV breast cancer (BC) patients. At initial diagnosis, patients were randomized 1:1 to either the LRT or ST group. All the patients were given ST either immediately after randomization or after surgical resection of the intact primary tumor. The trial enrolled 274 patients: 138 in the LRT group and 136 in the ST group. Hazard of death was 34% lower in the LRT group than in the ST group (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.49-0.88; p = 0.005). Unplanned subgroup analyses showed that the risk of death was statistically lower in the LRT group than in the ST group with respect to estrogen receptor (ER)/progesterone receptor (PR)(+) (HR 0.64; 95% CI 0.46-0.91; p = 0.01), human epidermal growth factor 2 (HER2)/neu(-) (HR 0.64; 95% CI 0.45-0.91; p = 0.01), patients younger than 55 years (HR 0.57; 95% CI 0.38-0.86; p = 0.007), and patients with solitary bone-only metastases (HR 0.47; 95% CI 0.23-0.98; p = 0.04). In the current trial, improvement in 36-month survival was not observed with upfront surgery for stage IV breast cancer patients. However, a longer follow-up study (median, 40 months) showed statistically significant improvement in median survival. When locoregional treatment in de novo stage IV BC is discussed with the patient as an option, practitioners must consider age, performance status, comorbidities, tumor type, and metastatic disease burden.
The role of loco-regional treatment in long-term quality of life in de novo stage IV breast cancer patients: Protocol MF07-01Q
(Springer, 2021-07) Soran, Atilla; Soyder, Aykut; Özbaş, Serdar; Özmen, Vahit; Karanlık, Hasan; İğci, Abdullah; Müslümanoğlu, Mahmut; Cantürk, Zafer; Utkan, Zafer; Özaslan, Cihangir; Uras, Cihan; Uğurlu, Ümit; Col, Cavit; Cabioğlu, Neslihan; Uzunköy, Ali; Güllüoğlu, Bahadır M.; Erdem, Ergün; Konca, Can; Sezgin, Efe; Evrensel, Türkkan; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Onkoloji Anabilim Dalı.; 0000-0002-9732-5340; AAJ-1027-2021; 6603942124
Background/objective Since more solid evidence has emerged supporting the effectiveness of loco-regional treatment (LRT), clinicians consider LRT a treatment option for selected de novo stage IV breast cancer (BC) patients. This is the first report on long-term quality of life (QoL) in a cohort of patients who were randomized to receive either LRT and then systemic treatment (ST) or ST alone in the protocol MF07-01. We aimed to evaluate QoL in patients living at least 3 years since randomization using scores from the SF-12 health survey. Methods SF-12 (V2) forms were completed during visits of patients who were living 36 months after the randomization. We first calculated PCS-12 (Physical Health Composite Scale) and MCS-12 (Mental Health Composite Scale) scores from de novo stage IV BC patients and compared them with the scores of patients diagnosed with stage I-III BC who lived more than 3 years. Further, PCS-12 and MCS-12 scores were compared between the LRT and ST groups with de novo stage IV BC. Additionally, general health, physical functioning, role functioning, bodily pain, vitality, mental health, and social functioning were evaluated and compared between the groups. Considering age-related changes in QoL, we also compared PCS-12 and MCS-12 scores of patients below or above 55 and 65 years of age. Responses to four additional questions (compare your physical health, mental health, daily activities, and energy currently vs. at diagnosis of BC) were recorded, considering cultural differences. Results There were 81 patients in this analysis; 68% of patients (n = 55) had LRT, and 32% (n = 26) received ST. General health was good or very good in 62% (n = 34) in the LRT group and 66% (n = 17) in the ST-only group (p = 0.63). Mean PCS-12 score was 40.8 + 1.6, and mean MCS-12 score was 43.4 + 2.0 (p = 0.34 and p = 0.54, respectively). PCS-12 and MCS-12 score difference was lower than that of the general Turkish population (PCS-12 = 49.3 + 12.8 and MCS-12 = 46.8 + 13.0) and stage I-III BC patients (PCS-12 = 51.1 +/- 0.5, MCS-12 = 45.7 +/- 0.6). PCS-12 and MCS-12 scores were similar between the LRT and ST-only groups in patients younger and older than 55 and 65, but QoL scores were much better in stage I-III BC patients younger than 65 when compared to the scores of those with de novo stage IV BC. Although treatment with or without LRT did not affect physical health, mental health, daily activities, and energy at 3 years vs. at diagnosis of BC in de novo stage IV BC patients (p > 0.05), these variables were significantly better in stage I-III BC patients (p < 0.001). Conclusion The current MF07-01Q study demonstrates that patient who had LRT has similar physical and mental health outcomes compared to ST only in a cohort of patients who lived longer than 3 years. Trial registration This study is registered on clinicaltrials.gov with identifier number NCT00557986.
The predictive probability of two different breast cancer nomograms for non sentinel axillary lymph node metastasis in positive sentinel lymph node biopsy
(Aves, 2008-07-01) Gür, Akif Serhat; Ünal, Bülent; Johnson, Ronald; Ahrendt, Gretchen; Bonaventura, Marguerite; Evrensel, Türkkan; Soran, Atilla; EVRENSEL, TÜRKKAN; Uludağ Üniversitesi/Tıp Fakültesi/Medikal Onkoloji Anabilim Dalı.; 0000-0002-9732-5340; AAJ-1027-2021
INTRODUCTION: Non sentinel axillary lymph node metastasis (NSLNM) occurs in 35-50% of breast cancer (BC) patients having positive sentinel lymph nodes (SLN). A nomogram which includes 8 variables was developed at Memorial Sloan Kettering Cancer Center (MSKCC) in 2003 and it has been validated at sources outside that institution. The Stanford University group recently reported their nomogram which evaluated 3 variables. AIM: The aim of this study is to evaluate the predictability of two different scoring systems wherein 3 or 8 variables are used in the same patient groups.MATERIALS and METHODS: We identified 201 patients who had a positive SLN biopsy and completion axillary lymph node dissection at Magee-Womens Hospital of UPMC over a 5 year period. The computerized BC nomograms developed by MSKCC and Stanford University were used to calculate the probability of non-sentinel lymph node metastases. Area Under (AUC) Receiver Operating Characteristics Curve (ROC) was calculated for each nomogram and the values more than 0.70 have been accepted that presents considerable discrimination.RESULTS: Sixty-six of 201 patients (32.8%) had positive axillary NSLNM. The mean predicted probability of positive NSLNM was 25.4% (3-93), and 66.3% (7-100) for the MSKCC and Stanford nomograms, respectively. The AUC values were 0.73 and 0.67 for MSKCC and Stanford nomograms, respectively.DISCUSSION and CONCLUSION: Nomograms for predicting the probability of NSLNM in BC patients have been in use for 5 years. It is clear there are discrepancies in the results of nomograms among the studies using the same scoring system. Notwithstanding the Stanford nomogram is easier to implement as it considers only 3 variables in our study, we found the MSKCC nomogram to be more predictive than the Stanford nomogram Nomograms developed at outside institutions should be used with caution when counseling patients regarding the risk of additional nodal disease.
Validation of breast cancer nomograms for predicting the non-sentinel lymph node metastases after a positive sentinel lymph node biopsy in a multi-center study
(Elsevier, 2010-01) Gür, Serhat; Ünal, Bülent; Özbek, Umut; Özmen, Vahit; Aydoğan, Fatih; Güllüoğlu, Bahadır Mahmut; Aksaz, Erol; Özbaş, Serdar Mustafa; Başkan, Semih; Koyuncu, Ayhan; Soran, Atilla; Gökgöz, Şehsuvar; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; 6603238737
Objective: In the study, our aim was to evaluate the predictability of four different nomograms on non-sentinel lymph node metastases (NSLNM) in breast cancer (BC) patients with positive sentinel lymph node (SLN) biopsy in a multi-center study. Methods: We identified 607 patients who had a positive SLN biopsy and completion axillary lymph node dissection (CALND) at seven different BC treatment centers in Turkey. The BC nomograms developed by the Memorial Sloan Kettering Cancer Center (MSKCC), Tenon Hospital, Cambridge University, and Stanford University were used to calculate the probability of NSLNM. Area under (AUC) Receiver Operating Characteristics Curve (ROC) was calculated for each nomogram and values greater than 0.70 were accepted as demonstrating good discrimination. Results: Two hundred and eighty-seven patients (287) of 607 patients (47.2%) had a positive axillary NSLNM. The AUC values were 0.705, 0.711, 0.730, and 0.582 for the MSKCC, Cambridge, Stanford, and Tenon models, respectively. On the multivariate analysis; overall metastasis size (OMS), lymphovascular invasion (LVI), and proportion of positive SLN to total SLN were found statistically significant. We created a formula to predict the NSLNM in our patient population and the AUC value of this formula was 0.8023. Conclusions: The MSKCC, Cambridge, and Stanford nomograms were good discriminators of NSLNM in SLN positive BC patients in this study. A newly created formula in this Study needs to be validated in prospective studies in different patient populations. A nomogram to predict NSLNM in patients with positive SLN biopsy developed at one institution should be used with caution.
Validation of breast cancer nomograms for predicting the non-sentinel lymph node metastases after a positive sentinel lymph node biopsy in a multi-center study (vol 36, pg 30, 2010)
(Elsevier, 2011-05) Gür, Serhat; Ünal, Bülent; Özbek, Umut; Özmen, Vahit; Aydoǧan, Fatih; Güllüoǧlü, Bahadır Mahmut; Aksaz, Erol; Özbaş, Serdar Mustafa; Başkan, Semih; Koyuncu, Ayhan; Soran, Atilla; Gökgöz, Şehsuvar; Uludağ Üniversitesi/Tıp Fakültesi/Genel Cerrahi Anabilim Dalı.; 6603238737
What is the predicted probability of having positive non-sentinel lymph nodes in patients who received neoadjuvant chemotherapy (NCT) for locally advanced breast cancer?
(Elsevier, 2006) Soran, Atilla; Ahrendt, Gretchen; Koçer, Belma; Bonaventura, Marguerite; Falk, Jeffrey; Keenan, Donald; Johnson, Ronald; Evrensel, Türkkan; Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Onkoloji Anabilim Dalı.; 0000-0002-9732-5340; AAJ-1027-2021