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Publication Open Access Prognostic Value of Pretreatment Systemic Immune-Inflammation Index in Glioblastoma Multiforme Patients Undergoing Postneurosurgical Radiotherapy plus Concurrent and Adjuvant Temozolomide(Hindawi Limited 410 Park Avenue, 15th Floor, 287 pmb New York NY 10022, 2020) Topkan, Erkan; Beşen, Ali Ayberk; Özdemir, Yurday; Kucuk, Ahmet; Mertsoylu, Hüseyin; Pehlivan, Berrin; Selek, Uǧur; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Beşen, Ali Ayberk, Department of Medical Oncology, Başkent Üniversitesi, Ankara, Turkey; Özdemir, Yurday, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Kucuk, Ahmet, Radiation Oncology Clinics, Mersin City Hospital, Mersin, Turkey; Mertsoylu, Hüseyin, Department of Medical Oncology, Başkent Üniversitesi, Ankara, Turkey; Pehlivan, Berrin, Department of Radiation Oncology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Selek, Uǧur, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey, Department of Radiation Oncology, University of Texas Health Science Center at Houston, Houston, United StatesObjectives. To evaluate the potential prognostic utility of pretreatment systemic immune-inflammation index (SII) in newly diagnosed glioblastoma multiforme (GBM) patients who underwent postneurosurgical radiotherapy and concurrent plus adjuvant temozolomide. Methods. The retrospective data of GBM patients who underwent postneurosurgical radiotherapy and concurrent plus adjuvant temozolomide were analyzed. For each patient, SII was calculated using the platelet, neutrophil, and lymphocyte measures obtained on the first day of treatment: SII=platelets×neutrophils/lymphocytes. The receiver operating characteristic (ROC) curve analysis was utilized for the evaluation of optimal cut-off values for SII those linked with the outcomes. Primary and secondary endpoints constituted the overall (OS) and progression-free survival (PFS) per conveyance SII group. Results. A total of 167 patients were included. The ROC curve analysis identified the optimum SII cut-off at a rounded 565 value that significantly interacted with the PFS and OS and stratified patients into two groups: low-SII (SII<565, n=71) and high-SII (SII≥565, n=96), respectively. Comparative survival analyses exhibited that the high-SII cohort had significantly shorter median PFS (6.0 versus 16.6 months, P<0.001) and OS (11.1 versus 22.9 months, P<0.001) than the low-SII cohort. The relationship between the high-SII and poorer PFS (P<0.001) and OS (P<0.001) further retained its independent significance in multivariate analysis, as well. Conclusions. The outcomes displayed here qualified the pretreatment SII as a novel independent prognostic index for predicting survival outcomes of newly diagnosed GBM patients undergoing postneurosurgical radiotherapy and concurrent plus adjuvant temozolomide. © 2020 Elsevier B.V., All rights reserved.Publication Open Access Systemic Inflammation Response Index Predicts Survival Outcomes in Glioblastoma Multiforme Patients Treated with Standard Stupp Protocol(Hindawi Limited, 2020) Topkan, Erkan; Kucuk, Ahmet; Özdemir, Yurday; Mertsoylu, Hüseyin; Beşen, Ali Ayberk; Sezen, Duygu; Bölükbaşı, Yasemin; Pehlivan, Berrin; Selek, Uǧur; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Kucuk, Ahmet, Radiation Oncology Clinics, Mersin City Hospital, Mersin, Turkey; Özdemir, Yurday, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Mertsoylu, Hüseyin, Department of Medical Oncology, Başkent Üniversitesi, Ankara, Turkey; Beşen, Ali Ayberk, Department of Medical Oncology, Başkent Üniversitesi, Ankara, Turkey; Sezen, Duygu, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey; Bölükbaşı, Yasemin, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey, Department of Radiation Oncology, University of Texas Health Science Center at Houston, Houston, United States; Pehlivan, Berrin, Department of Radiation Oncology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Selek, Uǧur, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey, Department of Radiation Oncology, University of Texas Health Science Center at Houston, Houston, United StatesObjectives. We endeavored to retrospectively assess the prognostic merit of pretreatment systemic immune response index (SIRI) in glioblastoma multiforme (GBM) patients who underwent postoperative partial brain radiotherapy (RT) and concurrent plus adjuvant temozolomide (TMZ), namely, the Stupp protocol. Methods. The records of 181 newly diagnosed GBM patients who received the postoperative Stupp protocol were retrospectively analyzed. The SIRI value for each eligible patient was calculated by utilizing the platelet, neutrophil, and lymphocyte measures obtained on the first day of treatment: SIRI=Neutrophils×Monocytes/Lymphocytes. The ideal cutoff values for SIRI connected with the progression-free- (PFS) and overall survival (OS) results were methodically searched through using the receiver operating characteristic (ROC) curve analysis. Primary and secondary end-points constituted the potential OS and PFS distinctions among the SIRI groups, respectively. Results. The ROC curve analysis labeled the ideal SIRI cutoffs at 1.74 (Area under the curve (AUC): 74.9%, sensitivity: 74.2%, specificity: 71.4%) and 1.78 (AUC: 73.6%, sensitivity: 73.1%, specificity: 70.8%) for PFS and OS status, individually. The SIRI cutoff of 1.78 of the OS status was chosen as the common cutoff for the stratification of the study population (Group 1: SIRI≤1.78 (N=96) and SIRI>1.78 (N=85)) and further comparative PFS and OS analyses. Comparisons between the two SIRI cohorts manifested that the SIRI≤1.78 cohort had altogether significantly superior median PFS (16.2 versus 6.6 months, P<0.001) and OS (22.9 versus 12.2 months, P<0.001) than its SIRI>1.78 counterparts. The results of multivariate Cox regression analyses ratified the independent and significant alliance between a low SIRI and longer PFS (P<0.001) and OS (P<0.001) durations, respectively. Conclusions. Present results firmly counseled the pretreatment SIRI as a novel, sound, and independent predictor of survival outcomes in newly diagnosed GBM patients intended to undergo postoperative Stupp protocol. © 2021 Elsevier B.V., All rights reserved.Publication Open Access Postchemoradiotherapy Neutrophil-to-Lymphocyte Ratio Predicts Distant Metastasis and Survival Results in Locally Advanced Pancreatic Cancers(NLM (Medline), 2022) Topkan, Erkan; Selek, Uǧur; Haksöyler, Veysel; Kucuk, Ahmet; Kiliç Durankuş, Nülifer; Sezen, Duygu; Bölükbaşı, Yasemin; Pehlivan, Berrin; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Selek, Uǧur, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States; Haksöyler, Veysel, Department of Medical Oncology, Medline Hospital, Adana, Turkey; Kucuk, Ahmet, Clinic of Radiation Oncology, Mersin City Education and Research Hospital, Mersin, Turkey; Kiliç Durankuş, Nülifer, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey; Sezen, Duygu, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey; Bölükbaşı, Yasemin, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States; Pehlivan, Berrin, Department of Radiation Oncology, Bahçeşehir Üniversitesi, Istanbul, TurkeyMaterials and Methods: Our retrospective research included a sum of 126 LAPAC patients who received CCRT. The NLR was calculated for each patient based on the complete blood count test results obtained on the last day of the CCRT. The availability of optimal cutoff(s) that might dichotomize the whole cohort into two groups with significantly different clinical outcomes was searched using receiver operating characteristic (ROC) curve analysis. Primary and secondary endpoints were the potential association between the post-CCRT NLR measures and distant metastasis-free survival (DMFS) and overall survival (OS) outcomes. Results: The median follow-up duration was 14.7 months (range: 2.4-94.5). The median and 3-year OS and DMFS rates for the whole group were 15.3 months (95% confidence interval: 12.4-18.2) and 14.5%, and 8.7 months (95% CI: 6.7-10.7) and 6.3% separately. The ROC curve analysis findings separated the patients into two groups on a rounded NLR cutoff of 3.1 (area under the curve (AUC): 75.4%, sensitivity: 74.2%, specificity: 73.9%) for OS and DMFS: NLR <3.1 (N = 62) and NLR ≥3.1 (N = 64), respectively. Comparisons between the NLR groups displayed that the median OS (11.4 vs. 21.4 months, P < 0.001) and DMFS (6.0 vs. 16.0 months, P < 0.001) lengths were significantly shorter in the NLR ≥3.1 group than its NLR <3.1 counterparts, as well as the 3-year actuarial DM rate (79.7% vs. 50.0%, P=0.003). The N1-2 nodal stage, CA 19-9>90 U/mL, and NLR >3.1 were found to be independent predictors of poor prognosis in the multivariate analysis. Conclusion: The present study found that the posttreatment NLR ≥3.1 was independently linked with a higher risk of DM and subsequent degraded survival outcomes in unresectable LAPAC patients managed with exclusive CCRT. This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of MedicinePublication Open Access A high pan-immune-inflammation value before chemoradiotherapy indicates poor outcomes in patients with small-cell lung cancer(SAGE Publications Inc., 2023) Kucuk, Ahmet; Topkan, Erkan; Ozkan, Emine Elif; Öztürk, Duriye; Pehlivan, Berrin; Selek, Uǧur; Kucuk, Ahmet, Clinic of Radiation Oncology, Mersin City Education and Research Hospital, Mersin, Turkey; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Ozkan, Emine Elif, Department of Radiation Oncology, Süleyman Demirel Üniversitesi, Isparta, Turkey; Öztürk, Duriye, Department of Radiation Oncology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey; Pehlivan, Berrin, Department of Radiation Oncology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Selek, Uǧur, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United StatesObjectives: The objective of our study was to assess the prognostic significance of the Pan-Immune-Inflammation Value (PIV) before concurrent chemoradiation (C-CRT) and prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (SCLC). Methods: The medical records of LS-SCLC patients who underwent C-CRT and PCI between January 2010 and December 2021 were retrospectively analyzed. PIV values were calculated using the peripheral blood samples obtained within the past 7 days before the initiation of treatment: PIV = [neutrophils × platelets × monocytes] ÷ lymphocytes. Using receiver operating characteristic (ROC) curve analysis, the optimal pretreatment PIV cutoff values that can partition the study population into two groups with substantially distinct progression-free survival (PFS) and overall survival (OS) outcomes were determined. The relationship between PIV values and OS outcomes was the primary outcome measure. Results: Eighty-nine eligible patients were divided into two PIV groups at an optimal cutoff of 417 [Area under curve (AUC): 73.2%, sensitivity: 70.4%, specificity: 66.7%]: Group 1: PIV < 417 (N = 36) and Group 2: PIV ≥ 417 (N = 53). Comparative analyses revealed that patients with PIV < 417 had significantly longer OS (25.0 vs 14.0 months, p <.001) and PFS (18.0 vs 8.9 months, p =.004) compared to patients with PIV ≥ 417. The outcomes of the multivariate analysis have verified the independent significance of pretreatment PIV concerning PFS (p <.001) and OS (p <.001) outcomes. Conclusion: The findings of this retrospective study indicate that the pretreatment PIV is a reliable and independent prognostic biomarker for patients with LS-SCLC who were treated with C-CRT and PCI. © 2023 Elsevier B.V., All rights reserved.Publication Metadata only Letter to the Editor: Radiotherapy Increases aMMP-8 Levels and Neutrophil/Lymphocyte Ratio Rapidly in Head and Neck Cancer Patients: A Pilot Study(SAGE Publications Ltd, 2023) Yilmaz, Busra; Topkan, Erkan; Pehlivan, Berrin; Selek, Uǧur; Yilmaz, Busra, Department of Oral and Maxillofacial Surgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Pehlivan, Berrin, Department of Radiation Oncology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Selek, Uǧur, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey[No abstract available]Publication Metadata only Pre-chemoradiotherapy low hemoglobin levels indicate increased osteoradionecrosis risk in locally advanced nasopharyngeal cancer patients(Springer Science and Business Media Deutschland GmbH, 2023) Yilmaz, Busra; Somay, Efsun; Topkan, Erkan; Pehlivan, Berrin; Selek, Uǧur; Yilmaz, Busra, Department of Oral and Maxillofacial Surgery, Başkent Üniversitesi, Ankara, Turkey; Somay, Efsun, Department of Oral and Maxillofacial Surgery, Başkent Üniversitesi, Ankara, Turkey; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Pehlivan, Berrin, Department of Radiation Oncology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Selek, Uǧur, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United StatesPurpose: We aimed to determine whether pretreatment hemoglobin (Hb) levels can predict the risk of osteoradionecrosis (ORN) in patients receiving concurrent chemoradiotherapy (CCRT) for locally advanced nasopharyngeal carcinoma (LA-NPC). Methods: ORN cases were identified from the records of LA-NPCs who had oral exams before and after CCRT. All Hb measurements were obtained on the first day of treatment. Receiving operating characteristic curve analysis was used to determine the relationship between Hb levels and ORN rates. The relationship between pretreatment Hb levels and ORN rates served as the primary endpoint, and secondary endpoints included the discovery of additional potential ORN risk factors. Results: Among the 263 eligible LA-NPCs, we identified 8.7% ORN cases. The ideal cutoff Hb before CCRT was 10.6 g/dL. It was revealed that HPR ≤ 10.6 group had a significantly higher ORN rate (32.5% vs. 1.5% for Hb > 10.6, P < 0.001). The mandibular V59.8 ≥ 36% Gy, pre-CCRT ≥ 4 tooth extractions, the presence of post-CCRT tooth extractions, and the time of post-CCRT tooth extractions > 8 months were the other factors associated with significantly increased ORN rates (P < 0.05 for each). Conclusion: Low pre-CCRT Hb levels appeared to be independently linked to significantly higher ORN rates. Pretreatment Hb levels may be used to establish preventive measures and predict ORN. © 2023 Elsevier B.V., All rights reserved.Publication Metadata only Comment on: Planned dose of intensity modulated proton beam therapy versus volumetric modulated arch therapy to tooth-bearing regions(Elsevier Ltd, 2023) Yilmaz, Busra; Topkan, Erkan; Yilmaz, Busra, Department of Oral and Maxillofacial Surgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey[No abstract available]Publication Metadata only The predictive usefulness of the novel combined hemoglobin-to-platelet ratio and maximum mouth opening index on prevalence of radiation induced trismus in patients with nasopharyngeal cancer(John Wiley and Sons Inc, 2023) Somay, Efsun; Yilmaz, Busra; Topkan, Erkan; Kucuk, Ahmet; Pehlivan, Berrin; Selek, Uǧur; Somay, Efsun, Department of Oral and Maxillofacial Surgery, Başkent Üniversitesi, Ankara, Turkey; Yilmaz, Busra, Department of Oral and Maxillofacial Surgery, Başkent Üniversitesi, Ankara, Turkey; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Kucuk, Ahmet, Department of Radiation Oncology, Mersin City Hospital, Mersin, Turkey; Pehlivan, Berrin, Department of Radiation Oncology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Selek, Uǧur, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United StatesObjectives: To explore how well a unique combination of hemoglobin-to-platelet ratio (HPR) and pretreatment maximum mouth opening (MMO) predicts the prevalence of radiation-induced trismus (RIT). Patients and methods: HPR and MMO cutoff values (0.54 and 40.7 mm) divided patients into two groups. To develop the novel HPR-MMO index, four combinations of these factors were tested for predictive power: Group 1: HPR > 0.54 and MMO > 40.7 mm, Group 2: HPR ≤ 0.54 but MMO > 40.7 mm, Group 3: HPR > 0.54 but MMO ≤ 40.7 mm, Group 4: HPR ≤ 0.54 and MMO ≤ 40.7 mm. Results: Data of 198 patients with LA-NPC was analyzed retrospectively. RIT rates for Groups 1 to 4 were 10.2%, 15.2%, 25%, and 59.4%. Groups 2 and 3 were merged to generate HPR-MMO index because of statistically equivalent RIT rates: Low-risk: HPR > 0.54 and MMO > 40.7 mm, Intermediate-risk: HPR ≤ 0.54 but MMO > 40.7 mm or, HPR > 0.54 but MMO ≤ 40.7 mm, High-risk: HPR ≤ 0.54 and MMO ≤ 40.7 mm. It was revealed that the low-, high-, and intermediate-risk group's RIT rates, 10.2%, 59.4%, and 19.2%, respectively. Conclusion: The novel HPR-MMO index may to classify LA-NPC patients into low, intermediate, and high-risk RIT groups. © 2023 Elsevier B.V., All rights reserved.Publication Metadata only Hemoglobin-to-platelet ratio in predicting the incidence of trismus after concurrent chemoradiotherapy(John Wiley and Sons Inc, 2023) Somay, Efsun; Yilmaz, Busra; Topkan, Erkan; Kucuk, Ahmet; Haksöyler, Veysel; Pehlivan, Berrin; Selek, Uǧur; Araz, Kenan; Somay, Efsun, Department of Oral and Maxillofacial Surgery, Başkent Üniversitesi, Ankara, Turkey; Yilmaz, Busra, Department of Dentomaxillofacial Radiology, Başkent Üniversitesi, Ankara, Turkey; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Kucuk, Ahmet, Department of Radiation Oncology, Mersin City Hospital, Mersin, Turkey; Haksöyler, Veysel, Department of Medical Oncology, Medline Hospital, Adana, Turkey; Pehlivan, Berrin, Department of Radiation Oncology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Selek, Uǧur, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States; Araz, Kenan, Department of Oral and Maxillofacial Surgery, Başkent Üniversitesi, Ankara, TurkeyObjective: The 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). Methods: The 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. Results: A 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, and pre-C-CRT MMO ≤40.7 mm were found as the other significant correlates of increased RIT rates(p < 0.05). All four variables seemed to be independently connected to greater RIT incidence in multivariate analysis (p < 0.05, for each). Conclusion: The risk of post-C-CRT RIT may be significantly increased when pre-treatment HPR levels are low. © 2023 Elsevier B.V., All rights reserved.Publication Metadata only Letter to the Editor regarding Radiologic findings of osteonecrosis, osteoradionecrosis, osteomyelitis and jaw metastatic disease with cone beam CT(Elsevier Ireland Ltd, 2023) Yilmaz, Busra; Topkan, Erkan; Yilmaz, Busra, Department of Oral and Maxillofacial Surgery, Bahçeşehir Üniversitesi, Istanbul, Turkey; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey[No abstract available]