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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 Prognostic Value of C-Reactive Protein to Albumin Ratio in Glioblastoma Multiforme Patients Treated with Concurrent Radiotherapy and Temozolomide(Hindawi Limited 410 Park Avenue, 15th Floor, 287 pmb New York NY 10022, 2020) Topkan, Erkan; Beşen, Ali Ayberk; Mertsoylu, Hüseyin; Kucuk, Ahmet; 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; Mertsoylu, Hüseyin, Department of Medical Oncology, Başkent Üniversitesi, Ankara, Turkey; Kucuk, Ahmet, Radiation Oncology Clinics, 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, University of Texas Health Science Center at Houston, Houston, United StatesObjective. We investigated the prognostic impact of C-reactive protein to albumin ratio (CRP/Alb) on the survival outcomes of newly diagnosed glioblastoma multiforme (GBM) patients treated with radiotherapy (RT) and concurrent plus adjuvant temozolomide (TMZ). Methods. The pretreatment CRP and Alb records of GBM patients who underwent RT and concurrent plus adjuvant TMZ were retrospectively analyzed. The CRP/Alb was calculated by dividing serum CRP level by serum Alb level obtained prior to RT. The availability of significant cutoff value for CRP/Alb that interacts with survival was assessed with the receiver-operating characteristic (ROC) curve analysis. The primary endpoint was the association between the CRP/Alb and the overall survival (OS). Results. A total of 153 patients were analyzed. At a median follow-up of 14.7 months, median and 5-year OS rates were 16.2 months (95% CI: 12.5-19.7) and 9.5%, respectively, for the entire cohort. The ROC curve analysis identified a significant cutoff value at 0.75 point (area under the curve: 74.9%, sensitivity: 70.9%, specificity: 67.7%, P<0.001) for CRP/Alb that interacts with OS and grouped the patients into two: CRP/Alb <0.75 (n = 61) and ≥0.75 (n = 92), respectively. Survival comparisons revealed that the CRP/Alb <0.75 was associated with a significantly superior median (22.5 versus 15.7 months, P<0.001) and 5-year (20% versus 0%) rates than the CRP/Alb ≥0.75, which retained its independent significance in multivariate analysis (P<0.001). Conclusion. Present results suggested the pretreatment CRP/Alb as a significant and independent inflammation-based index which can be utilized for further prognostic lamination of GBM patients. © 2020 Elsevier B.V., All rights reserved.Publication Open Access Low Systemic Inflammation Response Index Predicts Good Prognosis in Locally Advanced Pancreatic Carcinoma Patients Treated with Concurrent Chemoradiotherapy(Hindawi Limited 410 Park Avenue, 15th Floor, 287 pmb New York NY 10022, 2020) Topkan, Erkan; Mertsoylu, Hüseyin; Kucuk, Ahmet; Beşen, Ali Ayberk; Sezer, Ahmet; Sezen, Duygu; Bölükbaşı, Yasemin; Selek, Uǧur; Pehlivan, Berrin; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Mertsoylu, Hüseyin, Department of Medical Oncology, Başkent Üniversitesi, Ankara, Turkey; Kucuk, Ahmet, Radiation Oncology Clinics, Mersin City Training and Research Hospital, Mersin, Turkey; Beşen, Ali Ayberk, Department of Medical Oncology, Başkent Üniversitesi, Ankara, Turkey; Sezer, Ahmet, 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; Selek, Uǧur, 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, TurkeyBackground. We investigated the prognostic significance of pretreatment systemic inflammation response index (SIRI) in locally advanced pancreatic carcinoma (LAPC) patients treated with concurrent chemoradiotherapy (CRT). Methods. Present retrospective cohort analysis investigated consecutive 154 LAPC patients who received radical CRT. The SIRI was defined as: SIRI=neutrophil×monocyte/lymphocyte counts. Ideal SIRI cutoff(s) influencing overall survival (OS) and progression-free survival (PFS) results were sought by using receiver operating characteristic (ROC) curve analysis. The primary endpoint was the interaction between the SIRI and OS results. Results. The median follow-up, PFS, and OS durations were 14.3 (range: 2.9-74.6), 7.9 [%95 confidence interval (CI): 5.7-10.1), and 14.7 months (%95 CI: 11.4-18.0) for the entire cohort, respectively. ROC curve analyses determined the ideal SIRI cutoff that exhibiting a significant link with OS and PFS outcomes at the rounded 1.6 point (AUC: 74.3%, sensitivity: 73.8%, specificity: 70.1%).The SIRI <1.6 patients (N=58) had significantly superior median PFS (13.8 versus 6.7 months, P<0.001) and OS (28.6 versus 12.6 months, P<0.001) lengths than SIRI ≥1.6 patients (N=96), respectively. Although the N0 (versus N1, P<0.05) and CA 19-9 ≤90 U/mL (versus >90 U/mL) appeared as the other significant associates of better OS and PFS in univariate analyses, yet the results of multivariate analyses confirmed the SIRI <1.6 as the independent indicator of superior OS and PFS (P<0.001 for each). Conclusion. Pretreatment SIRI is a novel independent prognosticator that may further enhance the conventional tumor-node-metastases staging system in a more precise prediction of the OS and PFS outcomes of LAPC patients after radical CRT. © 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 The Influence of Systemic Inflammation Response Index on Survival Outcomes of Limited-Stage Small-Cell Lung Cancer Patients Treated with Concurrent Chemoradiotherapy(Hindawi Limited, 2020) Kucuk, Ahmet; Ozkan, Emine Elif; Oztep Eskici, Sukran; Mertsoylu, Hüseyin; Pehlivan, Berrin; Selek, Uǧur; Topkan, Erkan; Kucuk, Ahmet, Clinic of Radiation Oncology, Mersin City Training and Research Hospital, Mersin, Turkey; Ozkan, Emine Elif, Department of Radiation Oncology, Süleyman Demirel Üniversitesi, Isparta, Turkey; Oztep Eskici, Sukran, Clinic of Radiation Oncology, Mersin City Training and Research 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 States; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, TurkeyBackground. Recent studies have indicated that the systemic inflammation response index (SIRI) can efficiently predict survival outcomes in various tumor types. Thusly, in absence of comparable investigations in limited-stage small-cell lung cancers (LS-SCLCs), we aimed to retrospectively evaluate the prognostic utility of SIRI in LS-SCLC patients treated with concurrent chemoradiotherapy (CRT). Patients and Methods. Present multi-institutional retrospective analysis incorporated LS-SCLC patients treated with CRT at three academic radiation oncology centers between January 2007 and December 2018. The SIRI was calculated by using the peripheral blood neutrophil (N), monocyte (M), and lymphocyte (L) counts acquired in the last ≤7 days before the commencement of the CRT: SIRI = N × M/L. Accessibility of pretreatment SIRI cutoff that may stratify the study population into two gatherings with distinctive overall survival (OS) results was evaluated by utilizing the receiver operating characteristic (ROC) curve analysis. Primary objective was the association between the SIRI values and the OS results. Results. Search for the availability of an ideal SIRI cutoff that may stratify the entire patients' population into two particular groups with distinctive OS outcomes identified the 1.93 value (area under the curve (AUC): 72.9%, sensitivity: 74.6%, specificity: 70.1%): Group 1: SIRI <1.93 (N = 71) and Group 2: SIRI ≥1.93 (N = 110), respectively. At a median follow-up of 17.9 (95% CI: 13.2-22.6) months, 47 (26.0%) patients were still alive (47.9% for SIRI <1.93 versus 18.3% for SIRI ≥1.93, p<0.001). Kaplan-Meier comparisons between the two SIRI groups showed that the SIRI <1.93 cohort had significantly longer median OS (40.5 versus 14.2 months, p<0.001) than the SIRI ≥1.93 cohort. Similarly, the 3-(54% versus 12.6%) and 5-year (33% versus 9.9%) OS rates were also numerically superior in the SIRI <1.93 cohort. Results of the multivariate analyses uncovered that the prognostic significance of the SIRI on OS outcomes was independent of the other confounding variables. Conclusions. The results of this retrospective multi-institutional cohort analysis suggested that a pre-CRT SIRI was a strong and independent prognostic biomarker that reliably stratified LS-SCLC patients into two cohorts with significantly different OS outcomes. © 2021 Elsevier B.V., All rights reserved.Publication Open Access Prechemoradiotherapy Systemic Inflammation Response Index Stratifies Stage IIIB/C Non-Small-Cell Lung Cancer Patients into Three Prognostic Groups: A Propensity Score-Matching Analysis(Hindawi Limited, 2021) Topkan, Erkan; Selek, Uǧur; Kucuk, Ahmet; Haksöyler, Veysel; Özdemir, Yurday; Sezen, Duygu; Mertsoylu, Hüseyin; Beşen, Ali Ayberk; Bölükbaşı, Yasemin; Özyılkan, Özgür; 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; Kucuk, Ahmet, Radiation Oncology Clinics, Mersin City Hospital, Mersin, Turkey; Haksöyler, Veysel, Department of Medical Oncology, Medline Hospital, Adana, Turkey; Özdemir, Yurday, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Sezen, Duygu, Department of Radiation Oncology, Koç Üniversitesi, Istanbul, Turkey; Mertsoylu, Hüseyin, Department of Medical Oncology, Başkent Üniversitesi, Ankara, Turkey; Beşen, Ali Ayberk, Department of Medical Oncology, Başkent Üniversitesi, Ankara, 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; Özyılkan, Özgür, Department of Medical Oncology, Medline Hospital, Adana, TurkeyPurpose. We explored the prognostic influence of the systemic inflammation response index (SIRI) on the survival outcomes of stage IIIB/C non-small-cell lung cancer (NSCLC) patients who underwent concurrent chemoradiotherapy. Methods. Present propensity score-matching (PSM) analysis comprised 876 stage IIIB/C NSCLC patients who received 1-3 cycles of platinum-based doublets concurrent with thoracic radiotherapy from 2007 to 2017. The primary and secondary objectives were the relationships between the SIRI values and overall (OS) and progression-free survival, respectively. Propensity scores were calculated for SIRI groups to adjust for confounders and to facilitate well-balanced comparability between the SIRI groups by creating 1: 1 matched study groups. Results. The receiver operating characteristic curve analysis identified an optimal SIRI cutoff at 1.9 for OS (AUC: 78.8%, sensitivity: 73.7%, specificity: 70.7%) and PFS (AUC: 80.5%, sensitivity: 75.8%, specificity: 72.9%) and we grouped the patients into two PSM cohorts: SIRI < 1.9 (N = 304) and SIRI ≥ 1.9 (N = 304), respectively. The SIRI ≥ 1.9 cohort had significantly worse median OS (P<0.001) and PFS (P<0.001) than their SIRI < 1.9 companions. The further combination of SIRI with disease stage exhibited that the SIRI-1 (IIIB and SIRI < 1.9) and SIRI-3 (IIIC and SIRI ≥ 1.9) cohorts had the best and worst outcomes, respectively, with SIRI-2 cohort (IIIB and SIRI ≥ 1.9 or IIIC and SIRI < 1.9) being remained in between (P<0.001 for OS and PFS, separately). In multivariate analysis, the two- and three-laddered stratifications per the 1.9 cutoffs and SIRI groups retained their independent significance, individually. Conclusions. The SIRI ≥ 1.9 independently prognosticated significantly worse OS and PFS results and plated the stage IIIB/C patients into three fundamentally distinct prognostic groups. © 2021 Elsevier B.V., All rights reserved.Publication Metadata only The prognostic significance of novel pancreas cancer prognostic index in unresectable locally advanced pancreas cancers treated with definitive concurrent chemoradiotherapy(Dove Medical Press Ltd, 2021) Topkan, Erkan; Selek, Uǧur; Pehlivan, Berrin; Kucuk, Ahmet; Haksöyler, Veysel; Kiliç Durankuş, Nülifer; Sezen, Duygu; Bölükbaşı, Yasemin; 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; Pehlivan, Berrin, Department of Radiation Oncology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kucuk, Ahmet, Radiation Oncology Clinics, Mersin City Hospital, Mersin, Turkey; Haksöyler, Veysel, Department of Medical Oncology, Medline Hospital, Adana, 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 StatesPurpose: We evaluated the prognostic quality of the novel pancreas cancer prognostic index (PCPI), a combination of CA 19-9 and systemic inflammation response index (SIRI), on the outcomes of locally advanced pancreas adenocarcinoma (LAPAC) patients who received concurrent chemoradiotherapy (C-CRT). Methods: This retrospective analysis covered 152 unresectable LAPAC patients treated from 2007 to 2019. Receiver operating characteristic (ROC) curve analysis was used to define ideal cutoff thresholds for the pretreatment CA 19-9 and SIRI measurements, indivi-dually. The associations between the PCPI groups and progression-free-(PFS) and overall survival (OS) comprised the respective primary and secondary endpoints. Results: The ROC curve analysis distinguished the respective rounded optimal cutoffs at 91 U/m/ L (< versus ≥90) and 1.8 (< versus ≥1.8) for CA 19-9 and SIRI, arranging the study cohort into two significantly different survival groups for each, with resultant four likely groups: Group-1: CA 19-9<90 U/m/L and SIRI<1.8, Group-2: CA 19-9<90 U/m/L but SIRI≥1.8, Group-3: CA 19-9≥90 U/ m/L but SIRI<1.8, and Group-4: CA 19-9≥90 U/m/L and SIRI≥1.8. Since the PFS (P=0.79) and OS (P=0.86) estimates of the groups 2 and 3 were statistically indistinct, we merged them as one group and created the novel three-tiered PCPI: PCPI-1: CA 19-9<90 U/m/L and SIRI<1.8, PCPI-2: CA 19-9<90 U/m/L but SIRI≥1.8 or CA 19-9≥90 U/m/L but SIRI<1.8, and PCPI-3: CA 19-9≥90 U/m/L and SIRI≥1.8, respectively. Comparative analyses unveiled that the PCPI-1 and PCPI-3 groups had the respective best and worst PFS (17.0 versus 7.5 versus 4.4 months, P<0.001) and OS (26.1 versus 15.1 versus 7.4 months, P<0.001) outcomes, while the PCPI-2 group posed in between. The multivariate analysis outcomes confirmed the novel three tired PCPI’s independent prognostic significance on either of the PFS [HR: 5.38 (95% confidence interval (CI): 4.96-5.80), P<0.001)] and OS [HR: 5.67 (95% CI: 5.19-6.15), P<0.001] endpoints, separately. Conclusion: The new PCPI introduced here can be used as an independent and reliable prognostic indicator to divide LAPAC patients into three subgroups with discrete survival results. © 2021 Elsevier B.V., All rights reserved.Publication Open Access Theoretical Bases of the Influence of Radiation-induced Abscopal Effects on the Cardiovascular System(Istanbul Tip Fakultesi, 2022) Topkan, Erkan; Pehlivan, Berrin; Kucuk, Ahmet; Selek, Uǧur; Topkan, Erkan, Department of Radiation Oncology, Başkent Üniversitesi, Ankara, Turkey; Pehlivan, Berrin, Department of Radiation Oncology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Kucuk, Ahmet, Department of Radiation Oncology, Mersin City Training and Research Hospital, Mersin, 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 StatesSUMMARY Radiation therapy (RT) has been recognized as an efficient treatment modality commonly utilized in the curative or palliative management of many cancers for more than a century. Cytotoxic effects of RT are principally eventuated by its direct infield physical DNA damage or indirect insults from reactive oxygen species, dependent on the radiation source in use. On the contrary, radiation-induced abscopal effect (RIAE) refers to the distant non-targeted either profitable anti-tumoral or deleterious actions of radiation on a particular tissue, organ system, or the entire body. Although it is quite challenging to comment robustly on the precise RIAE mechanisms, yet, it is broadly acknowledged that the non-tar-geted distant effects of RIAE are chiefly mediated by the cytokines secreted from the tumor or bystander cells into the blood circulation or by the radiation-induced systemic immunity. The present brief review focuses principally on the rarely addressed, but likely, consequences of RIAE on the cardiovascular system in the light of accessible proof for the proposed RIAE mechanisms. © 2022 Elsevier B.V., All rights reserved.Publication Metadata only High Measures of Pre-Chemoradiotherapy Platelet-to-Albumin Ratio Indicates Poor Prognosis in Locally Advanced Pancreatic Cancer Patients(Dove Medical Press Ltd, 2022) Kucuk, Ahmet; Topkan, Erkan; Selek, Uǧur; Haksöyler, Veysel; Mertsoylu, Hüseyin; Beşen, Ali Ayberk; Pehlivan, Berrin; Kucuk, Ahmet, Department of Radiation Oncology, Mersin City Training and Research Hospital, Mersin, Turkey; 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; Mertsoylu, Hüseyin, Department of Medical Oncology, Başkent Üniversitesi, Ankara, Turkey; Beşen, Ali Ayberk, Department of Medical Oncology, Başkent Üniversitesi, Ankara, Turkey; Pehlivan, Berrin, Department of Radiation Oncology, Bahçeşehir Üniversitesi, Istanbul, TurkeyPurpose: In a lack of similar research, we meant to retrospectively investigate the prognostic significance of pre-chemoradiotherapy (C-CRT) platelet-to-albumin ratio (PAR) on the survival results of locally advanced unresectable pancreatic adenocarcinoma (LAPC) patients. Patients and Methods: The present analysis included 139 LAPC patients who received C-CRT in total. The utility of pre-C-CRT cutoff(s) reshaping survival data was explored using receiver operating characteristic (ROC) curve analysis. The primary and secondary objectives were the associations between PAR levels and overall survival (OS) and progression-free survival (PFS) outcomes. Results: At a median follow-up of 15.7 months (95% CI: 11.6–19.8), the overall cohort’s median and 5-year OS rates were 14.4 months (95% CI: 11.8–17) and 14.7%, respectively, while the corresponding PFS rates were 7.8 months (95% CI: 6.5–9.1) and 11.2%. Because the ROC curve analysis found 4.9 as the optimal PAR cutoff for both OS and PFS [area under the curve (AUC): 75.4%, sensitivity: 72.4%, specificity: 70.3%], we divided the patients into two PAR cohorts: PAR<4.9 (N=60) and PAR≥4.9 (N=79). Comparative analysis per PAR group exhibited significantly worse OS (11.2 vs 18.6 months, and 9.8% vs 20.9% at 5 years, P=0.003) and DFS (7 vs 14.3 months, and 7.6% vs 16.2% at 5 years, P=0.001) with PAR≥4.9 versus PAR<4.9, respectively. In multivariate analysis, the N0 nodal status, CA 19–9≤90 U/mL, and PAR<4.9 were found to be independent predictors of improved OS and PFS. Conclusion: The pre-C-CRT high PAR (≥4.9) robustly and independently prognosticated significantly worse OS and PFS results in inoperable LAPC patients who underwent definitive C-CRT. © 2022 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. 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