Journal of Advances in Medicine and Medical Research
A significant contributor to cancer-related morbidity and mortality worldwide is head and neck ca... more A significant contributor to cancer-related morbidity and mortality worldwide is head and neck cancer (HNC). Depending on the affected site, its etiology may include risk factors like geographic differences, genetic predisposition, gender, age, type of diet, smoking and/or alcohol consumption habits, and sexual preferences. Dysbiosis, or disruption of the oral microbiota balance, is another proposed causative factor for HNC. The oral microbiota is home to over 1,000 microbial species, including pathogenic and commensal strains. Disruption of the healthy balance of the oral cavity microbiota triggers the carcinogenic mechanisms by inducing chronic inflammation in the affected site, which acts as a pro-carcinogenic factor by inducing an immune-suppressed microenvironment that induces cell proliferation and inhibits apoptosis. Recent studies have also found that members of the human microbiome are strongly linked to a wide range of cancer types, with well-established associations betwe...
Purpose Effects of antibiotic administration on patients’ microbiome may negatively influence can... more Purpose Effects of antibiotic administration on patients’ microbiome may negatively influence cancer outcomes, and adverse prognoses after antibiotic application have been demonstrated for cancer patients receiving immune checkpoint inhibitors. While the microbiome may play an important role also in head-and-neck squamous cell carcinoma (HNSCC), the prognostic value of antibiotic treatment here is largely unknown. We therefore analyzed whether antibiotic prescription is associated with impaired oncological outcomes of HNSCC patients undergoing definitive (chemo)radiation. Methods A cohort of 220 HNSCC patients undergoing definitive (chemo)radiation between 2010 and 2019 was analyzed. The influence of antibiotic administration on locoregional control, progression-free survival (PFS) and overall survival (OS) was determined using Kaplan–Meier and Cox analyses. Results A total of 154 patients were treated with antibiotics within 30 days before (chemo)radiation (pretherapeutic) or durin...
Asian Journal of Research in Medical and Pharmaceutical Sciences
With 500,000 new cases diagnosed each year, head and neck cancers (HNC) are among the most preval... more With 500,000 new cases diagnosed each year, head and neck cancers (HNC) are among the most prevalent cancers in the world. The most effective organ-sparing therapy for patients with locally advanced HNC is concurrent chemoradiotherapy (C-CRT). Many HNC patients lose multiple teeth and develop soft and hard tissue defects over the course of the disease and treatment, leading to functional limitations and cosmetic deformity. Such devastating effects harm the patient's ability to eat, chew, and swallow as well as their psychological, financial, and social well-being. Additionally, multiple tooth losses and subpar oral rehabilitation services can cause cachexia, rapid weight loss, and weakened immunity. The use of conventional prostheses to address tooth losses may not be permitted due to detrimental changes in the structure of the oral cavity. Conventional prostheses may aggravate the harmful side effects of radiotherapy, including xerostomia, mucositis, and a deterioration of bone...
Journal of Advances in Medicine and Medical Research
A significant contributor to cancer-related morbidity and mortality worldwide is head and neck ca... more A significant contributor to cancer-related morbidity and mortality worldwide is head and neck cancer (HNC). Depending on the affected site, its etiology may include risk factors like geographic differences, genetic predisposition, gender, age, type of diet, smoking and/or alcohol consumption habits, and sexual preferences. Dysbiosis, or disruption of the oral microbiota balance, is another proposed causative factor for HNC. The oral microbiota is home to over 1,000 microbial species, including pathogenic and commensal strains. Disruption of the healthy balance of the oral cavity microbiota triggers the carcinogenic mechanisms by inducing chronic inflammation in the affected site, which acts as a pro-carcinogenic factor by inducing an immune-suppressed microenvironment that induces cell proliferation and inhibits apoptosis. Recent studies have also found that members of the human microbiome are strongly linked to a wide range of cancer types, with well-established associations betwe...
Stereotactic radiosurgery (SRS) has been utilized broadly for brain metastases not only for intac... more Stereotactic radiosurgery (SRS) has been utilized broadly for brain metastases not only for intact ones but as well as of late for the postoperative cavity of metastases after surgery, due to the advantages of SRS to preserve neurocognitive functions, maintain local control and prescribe the treatment in a short time frame. Randomized trials have proven the safety and efficacy of cavity SRS compared to observation. As WBRT offers no survival advantage in comparison to SRS and frequent monitorization with brain MRIs for early salvage upon failure, there has been a revolution in clinical approach for patients with limited intact brain metastases to treat with SRS only and omit WBRT. Likewise, the postoperative cavity SRS for brain metastases has gained a growing reputation. In this review, we summarize the proof for evidence-based optimization in the postoperative setting of the surgically removed brain metastases.
ObjectiveThe significance of pre‐hemoglobin‐to‐platelet ratio (HPR) in predicting the occurrence ... more ObjectiveThe significance of pre‐hemoglobin‐to‐platelet ratio (HPR) in predicting the occurrence of radiation‐induced trismus (RIT) in locally advanced nasopharyngeal carcinoma patients (LA‐NPC) who received concurrent chemoradiotherapy (C‐CRT).MethodsThe records of LA‐NPC patients with oral examination before and after C‐CRT were analyzed. Maximum mouth openings (MMO) were measured before and after C‐CRT to confirm RIT status, with an MMO of ≤35 mm defined as RIT. HPR values were calculated on the first day of C‐CRT. The relationship between the HPR values and RIT status was discovered using the receiver operating characteristic curve analysis.ResultsA total of 43 patients RIT cases among 198 individuals were diagnosed. The optimal HPR cutoff that stratified the patients into two groups was 0.54. RIT incidence was found to be significantly higher in the HPR ≤0.54 group than its HPR >0.54 counterpart(p < 0.001). Univariately T3‐4 stage, mean masticator apparatus dose>57.2Gy...
Osteoradionecrosis of the jaws (ORNJ) is a severe radiotherapy (RT) complication that occurs in 2... more Osteoradionecrosis of the jaws (ORNJ) is a severe radiotherapy (RT) complication that occurs in 2% to 22% of individuals with head and neck cancers (HNC) who are treated with RT or concurrent chemo-RT. The accurate diagnosis of ORNJ is crucial for appropriate and prompt management. On the other hand, various ORNJ stages can resemble osteomyelitis, medication-related osteonecrosis of the jaw (MRONJ), and tumor recurrences. This challenging situation is primarily due to the clinical and radiologic similarities between ORNJ and these non-RT-related conditions. Image analysis techniques such as panoramic imaging (PI), computed tomography (CT), magnetic resonance imaging (MRI), bone scintigraphy, positron emission tomography (PET), and single photon emission CT (SPECT) might help to avoid diagnostic obstacles. Despite the fact that the general characteristics of ORNJ have been reported in the literature, there is no clear consensus on its definitive diagnosis. Therefore, the current revi...
Journal of Advances in Medicine and Medical Research
One of the most serious and debilitating complications of radiation therapy (RT) for patients wit... more One of the most serious and debilitating complications of radiation therapy (RT) for patients with head and neck cancer (HNC) is osteoradionecrosis of the jaws (ORNJ). ORNJ is defined as radiation-induced ischemic bone necrosis with soft tissue necrosis in the absence of primary tumor, recurrence, or metastatic disease. Even though the incidence of ORNJ has dropped from about 20% to 2–8% as a result of recent advancements in RT techniques, this serious complication is still very challenging to predict, prevent, and treat. It is beyond dispute that ORNJ has detrimental effects on patients' quality of life (QoL). Pain, halitosis, taste disturbance, dysesthesia or anesthesia, trismus, difficulty chewing, swallowing, feeding, and speaking, fistula formation, pathological fracture, and localized or systemic infections are the most frequent symptoms of ORNJ that have an impact on the victim's QoL measures. However, ORNJ-specific QoL studies are scarce in this patient group despite...
Head and neck cancers (HNC) account for 10–15% of all cancers globally. Curative radiation therap... more Head and neck cancers (HNC) account for 10–15% of all cancers globally. Curative radiation therapy (RT) and concurrent chemoradiotherapy (CCRT) with or without surgery are widely accepted standard treatment modalities for these patients. Radiation-induced fibrosis is one of the side effects of these treatments, and it causes degeneration, inflammation, pain, and atrophy of the masticatory muscle fibers and the temporomandibular joint, resulting in trismus. Trismus, also known as hypomobility of the mouth, is defined as a restricted opening of the mouth. Radiation-induced trismus (RIT) can occur within the first three months of treatment or up to 12–48 months later during the follow-up period. It has a significant negative influence on daily activities and vital oral functions, including speech problems, difficulty eating or drinking, psychological problems, malnutrition, dehydration, and difficulty with oral hygiene, reducing the quality of life (QoL). Given the underappreciated nat...
Aim: We intended to survey the prognostic utility of pretreatment neutrophil-to-lymphocyte ratio ... more Aim: We intended to survey the prognostic utility of pretreatment neutrophil-to-lymphocyte ratio (NLR) as a novel prognostic index in recurrent glioblastoma multiforme (R-GBMs) treated with bevacizumab plus irinotecan (BEVIRI). Patients & methods: The present retrospective investigation incorporated the R-GBMs patients who underwent BEVIRI. The pre-BEVIRI NLR was calculated for each patient by utilizing the complete blood count tests obtained on the first day of BEVIRI. Results: The data of a total of 103 patients were analyzed. The ideal cutoff was identified at 3.04 (area under the curve: 60%; sensitivity: 60.3%; specificity 60%) for the pre-BEVIRI NLR. Low-NLR group had significantly longer overall survival times than the high-NLR group (15.8 vs 9.3 months; p = 0.015). Conclusion: NLR might be utilized as a novel biomarker in the prognostic stratification of the R-GBMs treated with BEVIRI.
Brain metastases (BMs) represent the commonest intracranial tumours which occur approximately 30%... more Brain metastases (BMs) represent the commonest intracranial tumours which occur approximately 30% of all adult patients presenting with solid cancers. The BMs do not only reduce the survival expectations but negatively alter the quality of life measures as well. For decades, surgery and whole-brain radiotherapy (WBRT) constituted the traditional treatment options with limited efficacy for the BMs. However, the unsatisfactory local control and ultimate survival outcomes led to a paradigm change, and stereotactic radiosurgery (SRS) has been executed as an alternative to surgery and WBRT or to augment the outcomes of each treatment when used in conjunction with them. In spite of the impressive improvements in the local control rates, yet the desired survival Review Article Kucuk et al.; IRJO, 3(1): 9-19, 2020; Article no.IRJO.55909 10 results were not achieved with SRS mainly due to the deaths ascribed to the extracranial systemic disease progression or unavoidably fatal distant brain ...
Amac: T1N0M0 glottik larenks kanseri (GLK) nedeniyle radyoterapi almis hastalarda sagkalim ve uz... more Amac: T1N0M0 glottik larenks kanseri (GLK) nedeniyle radyoterapi almis hastalarda sagkalim ve uzun donem toksisite sonuclarimiz ve iliskili faktorlerin arastirilmasi. Gerec ve Yontem: Ocak 2007-Mayis 2017 arasinda 64,4 Gy (2,3 Gy/fx) radyoterapi alan 90 hasta geriye donuk olarak analiz edilmistir. Sagkalim analizleri radyoterapi son gunu ve son kontrol/olay tarihi temel alinarak Kaplan Meire yontemiyle hesaplanmis olup gec yan etkiler Radiation Therapy Oncology Group’un (RTOG) kriterlerine gore degerlendirilmistir. Bulgular: Ortanca takip suresi 57 ay (0-129 ay) olup 12 (%13,3) hastada relaps gelismistir: %11,1 lokal, %1,1 lokal-bolgesel ve %1,1 lokal-bolgesel-uzak seklindedir. Takipte 14 hasta olmus ve olum nedenleri 7 (%50) larenks kanser (LK), 5 (%35,7) ikinci primer kanser (IPK) ve 2 (%14,3) kanser disi sebeplerdir. Relaps gelisen 12 hastanin 7’si (%58,3) LK, 1’i (%8,3) IPK ve 1’i (%8,3) kanser disi sebeplerden kaybedilmistir. Genel, hastaliga ozgu ve lokal relapssiz 5-yillik...
Journal of Advances in Medicine and Medical Research
A significant contributor to cancer-related morbidity and mortality worldwide is head and neck ca... more A significant contributor to cancer-related morbidity and mortality worldwide is head and neck cancer (HNC). Depending on the affected site, its etiology may include risk factors like geographic differences, genetic predisposition, gender, age, type of diet, smoking and/or alcohol consumption habits, and sexual preferences. Dysbiosis, or disruption of the oral microbiota balance, is another proposed causative factor for HNC. The oral microbiota is home to over 1,000 microbial species, including pathogenic and commensal strains. Disruption of the healthy balance of the oral cavity microbiota triggers the carcinogenic mechanisms by inducing chronic inflammation in the affected site, which acts as a pro-carcinogenic factor by inducing an immune-suppressed microenvironment that induces cell proliferation and inhibits apoptosis. Recent studies have also found that members of the human microbiome are strongly linked to a wide range of cancer types, with well-established associations betwe...
Purpose Effects of antibiotic administration on patients’ microbiome may negatively influence can... more Purpose Effects of antibiotic administration on patients’ microbiome may negatively influence cancer outcomes, and adverse prognoses after antibiotic application have been demonstrated for cancer patients receiving immune checkpoint inhibitors. While the microbiome may play an important role also in head-and-neck squamous cell carcinoma (HNSCC), the prognostic value of antibiotic treatment here is largely unknown. We therefore analyzed whether antibiotic prescription is associated with impaired oncological outcomes of HNSCC patients undergoing definitive (chemo)radiation. Methods A cohort of 220 HNSCC patients undergoing definitive (chemo)radiation between 2010 and 2019 was analyzed. The influence of antibiotic administration on locoregional control, progression-free survival (PFS) and overall survival (OS) was determined using Kaplan–Meier and Cox analyses. Results A total of 154 patients were treated with antibiotics within 30 days before (chemo)radiation (pretherapeutic) or durin...
Asian Journal of Research in Medical and Pharmaceutical Sciences
With 500,000 new cases diagnosed each year, head and neck cancers (HNC) are among the most preval... more With 500,000 new cases diagnosed each year, head and neck cancers (HNC) are among the most prevalent cancers in the world. The most effective organ-sparing therapy for patients with locally advanced HNC is concurrent chemoradiotherapy (C-CRT). Many HNC patients lose multiple teeth and develop soft and hard tissue defects over the course of the disease and treatment, leading to functional limitations and cosmetic deformity. Such devastating effects harm the patient's ability to eat, chew, and swallow as well as their psychological, financial, and social well-being. Additionally, multiple tooth losses and subpar oral rehabilitation services can cause cachexia, rapid weight loss, and weakened immunity. The use of conventional prostheses to address tooth losses may not be permitted due to detrimental changes in the structure of the oral cavity. Conventional prostheses may aggravate the harmful side effects of radiotherapy, including xerostomia, mucositis, and a deterioration of bone...
Journal of Advances in Medicine and Medical Research
A significant contributor to cancer-related morbidity and mortality worldwide is head and neck ca... more A significant contributor to cancer-related morbidity and mortality worldwide is head and neck cancer (HNC). Depending on the affected site, its etiology may include risk factors like geographic differences, genetic predisposition, gender, age, type of diet, smoking and/or alcohol consumption habits, and sexual preferences. Dysbiosis, or disruption of the oral microbiota balance, is another proposed causative factor for HNC. The oral microbiota is home to over 1,000 microbial species, including pathogenic and commensal strains. Disruption of the healthy balance of the oral cavity microbiota triggers the carcinogenic mechanisms by inducing chronic inflammation in the affected site, which acts as a pro-carcinogenic factor by inducing an immune-suppressed microenvironment that induces cell proliferation and inhibits apoptosis. Recent studies have also found that members of the human microbiome are strongly linked to a wide range of cancer types, with well-established associations betwe...
Stereotactic radiosurgery (SRS) has been utilized broadly for brain metastases not only for intac... more Stereotactic radiosurgery (SRS) has been utilized broadly for brain metastases not only for intact ones but as well as of late for the postoperative cavity of metastases after surgery, due to the advantages of SRS to preserve neurocognitive functions, maintain local control and prescribe the treatment in a short time frame. Randomized trials have proven the safety and efficacy of cavity SRS compared to observation. As WBRT offers no survival advantage in comparison to SRS and frequent monitorization with brain MRIs for early salvage upon failure, there has been a revolution in clinical approach for patients with limited intact brain metastases to treat with SRS only and omit WBRT. Likewise, the postoperative cavity SRS for brain metastases has gained a growing reputation. In this review, we summarize the proof for evidence-based optimization in the postoperative setting of the surgically removed brain metastases.
ObjectiveThe significance of pre‐hemoglobin‐to‐platelet ratio (HPR) in predicting the occurrence ... more ObjectiveThe significance of pre‐hemoglobin‐to‐platelet ratio (HPR) in predicting the occurrence of radiation‐induced trismus (RIT) in locally advanced nasopharyngeal carcinoma patients (LA‐NPC) who received concurrent chemoradiotherapy (C‐CRT).MethodsThe records of LA‐NPC patients with oral examination before and after C‐CRT were analyzed. Maximum mouth openings (MMO) were measured before and after C‐CRT to confirm RIT status, with an MMO of ≤35 mm defined as RIT. HPR values were calculated on the first day of C‐CRT. The relationship between the HPR values and RIT status was discovered using the receiver operating characteristic curve analysis.ResultsA total of 43 patients RIT cases among 198 individuals were diagnosed. The optimal HPR cutoff that stratified the patients into two groups was 0.54. RIT incidence was found to be significantly higher in the HPR ≤0.54 group than its HPR >0.54 counterpart(p < 0.001). Univariately T3‐4 stage, mean masticator apparatus dose>57.2Gy...
Osteoradionecrosis of the jaws (ORNJ) is a severe radiotherapy (RT) complication that occurs in 2... more Osteoradionecrosis of the jaws (ORNJ) is a severe radiotherapy (RT) complication that occurs in 2% to 22% of individuals with head and neck cancers (HNC) who are treated with RT or concurrent chemo-RT. The accurate diagnosis of ORNJ is crucial for appropriate and prompt management. On the other hand, various ORNJ stages can resemble osteomyelitis, medication-related osteonecrosis of the jaw (MRONJ), and tumor recurrences. This challenging situation is primarily due to the clinical and radiologic similarities between ORNJ and these non-RT-related conditions. Image analysis techniques such as panoramic imaging (PI), computed tomography (CT), magnetic resonance imaging (MRI), bone scintigraphy, positron emission tomography (PET), and single photon emission CT (SPECT) might help to avoid diagnostic obstacles. Despite the fact that the general characteristics of ORNJ have been reported in the literature, there is no clear consensus on its definitive diagnosis. Therefore, the current revi...
Journal of Advances in Medicine and Medical Research
One of the most serious and debilitating complications of radiation therapy (RT) for patients wit... more One of the most serious and debilitating complications of radiation therapy (RT) for patients with head and neck cancer (HNC) is osteoradionecrosis of the jaws (ORNJ). ORNJ is defined as radiation-induced ischemic bone necrosis with soft tissue necrosis in the absence of primary tumor, recurrence, or metastatic disease. Even though the incidence of ORNJ has dropped from about 20% to 2–8% as a result of recent advancements in RT techniques, this serious complication is still very challenging to predict, prevent, and treat. It is beyond dispute that ORNJ has detrimental effects on patients' quality of life (QoL). Pain, halitosis, taste disturbance, dysesthesia or anesthesia, trismus, difficulty chewing, swallowing, feeding, and speaking, fistula formation, pathological fracture, and localized or systemic infections are the most frequent symptoms of ORNJ that have an impact on the victim's QoL measures. However, ORNJ-specific QoL studies are scarce in this patient group despite...
Head and neck cancers (HNC) account for 10–15% of all cancers globally. Curative radiation therap... more Head and neck cancers (HNC) account for 10–15% of all cancers globally. Curative radiation therapy (RT) and concurrent chemoradiotherapy (CCRT) with or without surgery are widely accepted standard treatment modalities for these patients. Radiation-induced fibrosis is one of the side effects of these treatments, and it causes degeneration, inflammation, pain, and atrophy of the masticatory muscle fibers and the temporomandibular joint, resulting in trismus. Trismus, also known as hypomobility of the mouth, is defined as a restricted opening of the mouth. Radiation-induced trismus (RIT) can occur within the first three months of treatment or up to 12–48 months later during the follow-up period. It has a significant negative influence on daily activities and vital oral functions, including speech problems, difficulty eating or drinking, psychological problems, malnutrition, dehydration, and difficulty with oral hygiene, reducing the quality of life (QoL). Given the underappreciated nat...
Aim: We intended to survey the prognostic utility of pretreatment neutrophil-to-lymphocyte ratio ... more Aim: We intended to survey the prognostic utility of pretreatment neutrophil-to-lymphocyte ratio (NLR) as a novel prognostic index in recurrent glioblastoma multiforme (R-GBMs) treated with bevacizumab plus irinotecan (BEVIRI). Patients & methods: The present retrospective investigation incorporated the R-GBMs patients who underwent BEVIRI. The pre-BEVIRI NLR was calculated for each patient by utilizing the complete blood count tests obtained on the first day of BEVIRI. Results: The data of a total of 103 patients were analyzed. The ideal cutoff was identified at 3.04 (area under the curve: 60%; sensitivity: 60.3%; specificity 60%) for the pre-BEVIRI NLR. Low-NLR group had significantly longer overall survival times than the high-NLR group (15.8 vs 9.3 months; p = 0.015). Conclusion: NLR might be utilized as a novel biomarker in the prognostic stratification of the R-GBMs treated with BEVIRI.
Brain metastases (BMs) represent the commonest intracranial tumours which occur approximately 30%... more Brain metastases (BMs) represent the commonest intracranial tumours which occur approximately 30% of all adult patients presenting with solid cancers. The BMs do not only reduce the survival expectations but negatively alter the quality of life measures as well. For decades, surgery and whole-brain radiotherapy (WBRT) constituted the traditional treatment options with limited efficacy for the BMs. However, the unsatisfactory local control and ultimate survival outcomes led to a paradigm change, and stereotactic radiosurgery (SRS) has been executed as an alternative to surgery and WBRT or to augment the outcomes of each treatment when used in conjunction with them. In spite of the impressive improvements in the local control rates, yet the desired survival Review Article Kucuk et al.; IRJO, 3(1): 9-19, 2020; Article no.IRJO.55909 10 results were not achieved with SRS mainly due to the deaths ascribed to the extracranial systemic disease progression or unavoidably fatal distant brain ...
Amac: T1N0M0 glottik larenks kanseri (GLK) nedeniyle radyoterapi almis hastalarda sagkalim ve uz... more Amac: T1N0M0 glottik larenks kanseri (GLK) nedeniyle radyoterapi almis hastalarda sagkalim ve uzun donem toksisite sonuclarimiz ve iliskili faktorlerin arastirilmasi. Gerec ve Yontem: Ocak 2007-Mayis 2017 arasinda 64,4 Gy (2,3 Gy/fx) radyoterapi alan 90 hasta geriye donuk olarak analiz edilmistir. Sagkalim analizleri radyoterapi son gunu ve son kontrol/olay tarihi temel alinarak Kaplan Meire yontemiyle hesaplanmis olup gec yan etkiler Radiation Therapy Oncology Group’un (RTOG) kriterlerine gore degerlendirilmistir. Bulgular: Ortanca takip suresi 57 ay (0-129 ay) olup 12 (%13,3) hastada relaps gelismistir: %11,1 lokal, %1,1 lokal-bolgesel ve %1,1 lokal-bolgesel-uzak seklindedir. Takipte 14 hasta olmus ve olum nedenleri 7 (%50) larenks kanser (LK), 5 (%35,7) ikinci primer kanser (IPK) ve 2 (%14,3) kanser disi sebeplerdir. Relaps gelisen 12 hastanin 7’si (%58,3) LK, 1’i (%8,3) IPK ve 1’i (%8,3) kanser disi sebeplerden kaybedilmistir. Genel, hastaliga ozgu ve lokal relapssiz 5-yillik...
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