GÝRÝÞ ve AMAÇ: Polisitemi vera (PSV), esansiyel trombositoz (ET) ve primer miyelofibroz (PMF), BCR/ABL negatif olan kronik miyeloproliferatif hastalýklardýr (KMPH). Bu hastalýklarda hematopoietik hücrelerde anormal klonal proliferasyon sonucu artmýþ tromboz, kanama, lösemik transformasyon riski yaný sýra hayat kalitesinde bozulmalar görülmektedir. Hastalýklarýn tedavisinde kök hücre nakli tek küratif seçenek iken semptomatik tedaviler ön plana çýkmaktadýr. Bu çalýþmada amaç, merkezimizde ruksolitinib ile tedavi edilen KMPH hastalarýnýn sonuçlarýný deðerlendirmektir.


YÖNTEM ve GEREÇLER: Bu retrospektif kohort çalýþmada Ocak 2013 ile Ocak 2022 tarihleri arasýnda merkezimizde ruksolitinib ile tedavi edilen 18 hastanýn (altý hasta PSV ve on iki hasta PMF) verileri analiz edildi.
BULGULAR: Ruksolitinib alan altý PSV hastasý çalýþmaya alýndý. Ruksolitinib öncesinde splenomegalisi olan üç hastada, ortanca 6 aylýk tedavi süresince dalak hacmi yanýtý gözlendi. Ortanca 6 aylýk (2-52 aralýðýnda) ruksolitinib tedavisi boyunca hematolojik veya hematolojik olmayan yan etkiler, trombolitik veya kardiyovasküler komplikasyonlar veya lösemik transformasyon görülmedi.
PMF tanýsý ile ruksolitinib kullanan on iki hasta çalýþmaya dahil edildi. Altý hastada (%50) ortanca 12 aylýk takipte dalak hacmi yanýtý gözlenirken, dokuz hastada (%75) medyan 15,5 aylýk ruksolitinib tedavisi sýrasýnda semptomatik yanýt alýndýðý gözlendi. Trombolitik veya kardiyovasküler komplikasyon gözlenmedi.

TARTIÞMA ve SONUÇ: Hematopoietik kök hücre nakli için aday olmayan hastalarda ruksolitinib uygun ve güvenli bir tedavi seçeneðidir.

INTRODUCTION: Polycythemia vera (PSV), essential thrombocytosis (ET), and primary myelofibrosis (PMF) are BCR/ABL negative chronic myeloproliferative neoplasms (CMPNs). As a result of abnormal clonal proliferation of hematopoietic cells, these disorders have a higher risk of thrombosis, bleeding, leukemic transformation, and worsening in quality of life. While stem cell transplantation is the sole curative option for CMPNs, symptomatic therapies gain importance. The purpose of this study is to assess the results of patients with CMPNs treated with ruxolitinib at our center.
METHODS: The data from eighteen patients (six patients with PSV and twelve patients with PMF) who were treated with ruxolitinib at our center between January 2013 and January 2022 were analyzed in this retrospective cohort study.
RESULTS: Six PSV patients who received ruxolitinib were included in the study. Three patients with splenomegaly previous to ruxolitinib, had a response of spleen volume, median of 6 months. There were no hematological or non-hematological adverse effects, thrombolytic or cardiovascular complications, or leukemic transformation throughout a median of 6 (range 2-52) months of ruxolitinib treatment.
Twelve patients with PMF used ruxolitinib were included in the study. Spleen volume response was observed in six patients (50%) at a median follow-up of 12 months, while symptomatic response was observed in nine patients (75%) during a median of 15.5 months of ruxolitinib treatment. Any thrombolytic or cardiovascular complications were observed.
DISCUSSION AND CONCLUSION: Ruxolitinib is an appropriate and safe treatment option for patients who are not candidates for hematopoietic stem cell transplantation.

GÝRÝÞ ve AMAÇ: Ýlaç endüstrisinin hýzlý geliþimi, özellikle onkoloji pratiðinde geniþ bir týbbi tedavi yelpazesine yol açmýþtýr. Amerika Birleþik Devletleri'nde 2005 ile 2011 yýllarý arasýnda reçete edilen ilaç deðiþimleri üç kat arttý. Ayrýca artan ilaç sayýlarý, onkoloji çaðýnda bu dönemde ikiye katlanan ilaç kýtlýðýna yol açtý. Bu çalýþmada onkoloji pratisyenlerinin gözünden onkoloji kliniklerinin geçen yýlki ilaç arzýný deðerlendirmeye çalýþtýk.
YÖNTEM ve GEREÇLER: Türkiye'de onkologlarýn geçtiðimiz yýl yaþadýðý ilaç kýtlýðý ile ilgili Google Forms üzerinden online bir anket gerçekleþtirdik. Çalýþmamýz kesitsel bir çalýþmadýr. Ýstatistiksel analiz için SPSS 25 programý kullanýldý. Tanýmlayýcý istatistikler frekans daðýlýmý olarak sunuldu Bu çalýþmada, iki yönlü istatistiksel analizler yapýldý ve p<0.05 istatistiksel olarak anlamlý kabul edildi
BULGULAR: Katýlýmcýlarýn yüzde seksen dokuzu geçen yýl ilaç sýkýntýsý yaþadýklarýný beyan ettiler. En çok etkilenen ilaç gruplarý kemoterapötikler (%61,4), biyolojik ajanlar (%56,8), immünolojik ilaçlar (%54,5) ve destekleyici ilaçlar (%42) idi. Onkologlarýn yüzde 61'i hastalarýný ilaç sýkýntýsýndan kurtulmak için baþka kliniklere yönlendiriyor. En sýk nedenler tedarik sorunu (%70), döviz kurundan kaynaklanan ilaç firmalarý kaygýsý (%68), hastane bütçe sorunlarý (%48) ve bürokratik iþlemler (%47) idi. Ýlaç sýkýntýsý ile katýlýmcýlarýn hastaneleri arasýnda anlamlý bir fark vardý. Ayrýca, üniversite hastanelerinde açýk önemli ölçüde daha uzun sürmüþtür.
TARTIÞMA ve SONUÇ: : Çalýþmamýz, ilaç türlerinden baðýmsýz olarak geçen yýl onkoloji kliniklerinde yaygýn bir ilaç sýkýntýsý olduðunu gösterdi. Üniversite hastaneleri, diðer kuruluþlara kýyasla daha kötü sonuçlar bildirmiþti. Ýlaç kýtlýðýnýn ve onkolojik ilaçlarýn mevcudiyetinin ve bu fenomenin prognostik etkisinin daha fazla deðerlendirilmesine acil bir ihtiyaç vardýr.

INTRODUCTION: The rapid development of the drug industry led to a great spectrum of medical treatment, especially in oncology practice. The prescribed drug alternations increased three times in the United States. Also, the increased drug numbers led to drug shortages, which doubled during this period in the oncology era. In this study, we try to evaluate the oncology clinics' drug supply last year in the eyes of oncology practitioners.
METHODS: We conducted an online questionnaire via Google Forms on the drug shortages which are faced last year by oncologists in Turkey. Our study is a cross-sectional study.The SPSS 25 software was used for statistical analysis.
RESULTS: Eighty-nine percent of the participants declared they had a drug shortage last year. The most affected drug groups were chemotherapeutics (61,4%), biologic agents (anti-VEGF, anti-EGFR agents, etc.) (56,8%), immunologic drugs (available anti-PD1 drugs) (54,5%), and supportive medicines (Folinic acid, GCSF, etc.) (42%). 61 percent of the oncologists referred their patients to other clinics to get over the drug shortage. The most common reasons were supply problems (70%), drug company-related concerns due to exchange rates (68%), hospital budget problems (48%), and bureaucratic procedures (47%). There was a significant difference between drug shortage and participants' hospitals. Also, the shortage has significantly lasted longer in university hospitals.
DISCUSSION AND CONCLUSION: Our study showed an extensive drug shortage in oncology clinics last year independent of drug types. University hospitals had reported worse results compared with other organizations. There is an urgent need for further evaluation of drug shortages and the availability of oncologic drugs and the prognostic effect of this phenomenon.

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, erken evre kolon kanseri tanýsý almýþ yaþlý hastalarda geriatrik beslenme risk indeksinin (GNRI) prognostik önemini retrospektif olarak deðerlendirmektir.
YÖNTEM ve GEREÇLER: Küratif cerrahi uygulanan ve kemoterapi alan kolon kanseri tanýlý 114 yaþlý hastanýn týbbi kayýtlarý incelendi. GNRI, serum albümin düzeyi ve vücut aðýrlýðý kullanýlarak hesaplandý. Hastalar düþük GNRI (GNRI: <98) ve yüksek GNRI (GNRI: ≥98) kategorilerine ayrýlarak kýyaslandý.
BULGULAR: Düþük GNRI grubunun 5 yýllýk genel saðkalým oraný, yüksek GNRI grubundan anlamlý derecede düþüktü (%65.7'ye karþýlýk %91.1, p= 0.002). Ýki grubun 5 yýllýk nükssüz saðkalým oranlarýnda da istatistiksel olarak anlamlý bir fark vardý (%66,7'ye karþý %90,8, p <0,001). Yapýlan çok deðiþkenli Cox regresyon analizi, yalnýzca tümör tarafý (p= 0.038) ve GNRI'yi (p = 0.042) genel sað kalým için baðýmsýz prognostik faktörler olarak tanýmladý.
TARTIÞMA ve SONUÇ: GNRI, erken evre kolon kanseri tanýsý almýþ yaþlý hastalarda genel sað kalým için kolay uygulanabilir ve deðerli bir prognostik faktördür. Araþtýrmamýz, düþük bir GNRI'nin azalmýþ genel sað kalým ile iliþkili olduðunu göstermektedir.

INTRODUCTION: The aim of this retrospective study was to assess the prognostic significance of the geriatric nutritional risk index (GNRI) for elderly patients diagnosed with early-stage colon cancer.
METHODS: Medical records of 114 elderly patients diagnosed with colon cancer who underwent curative surgery and received chemotherapy were analyzed. The calculation of the GNRI was derived from the measurement of serum albumin levels and the assessment of body weight. Patients were divided into two nutritional risk categories: low-GNRI (GNRI: <98), and high-GNRI (GNRI: ≥98) and compared.
RESULTS: The 5-year overall survival (OS) rate of the low-GNRI group was significantly lower than that of the high-GNRI group (65.7% vs. 91.1%, p= 0.002). There was also a statistically significant difference in the 5-year recurrence-free survival (RFS) rate of the two groups (66.7% vs. 90.8%, p <0.001). The multivariate Cox regression analysis identified tumor sidedness (p= 0.038) and GNRI (p = 0.042) as independent prognostic factors for only OS.
DISCUSSION AND CONCLUSION: The GNRI is an easily applicable and valuable prognostic factor for OS in elderly patients diagnosed with early-stage colon cancer. The current investigation indicates that a low-GNRI was correlated with poor OS.

GÝRÝÞ ve AMAÇ: Lokal ileri özofagus kanserinde neoadjuvan kemoradyoterapi/radyoterapi (neo-KRT/RT)+cerrahi ve definitif kemoradyoterapi (def-KRT) yaklaþýmlarýnýn sonuçlarýný araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Ocak 2012 ile Aralýk 2021 tarihleri arasýnda iki merkezde lokal ileri özofagus kanseri tanýsý ile def-KRT veya neo-KRT/RT alan hastalar retrospektif olarak incelendi. Olgular tedavi yanýtý, genel saðkalým, hastalýksýz saðkalým ve lokal nüks açýsýndan deðerlendirildi.
BULGULAR: Toplamda elli vaka çalýþmaya dahil edildi. Medyan takip süresi 10 (2-26) ay’dý. Def-KRT grubunda; Bir yýllýk ve iki yýllýk genel saðkalým sýrasýyla %67 ve %32; bir yýllýk ve iki yýllýk hastalýksýz saðkalým sýrasýyla %62 ve %32 idi. Neo-KRT grubunda; bir yýllýk genel saðkalým %81 ve bir yýllýk hastalýksýz %73 idi. Takip süresince lokal nüks oraný, def-KRT grubunda %12.1 ve neo-KRT grubunda %11.8 idi. Ýki tedavi kolu arasýnda, genel saðkalým (p=0,404), hastalýksýz saðkalým (p=0,593) ve lokal nüks (p=0,670) açýsýndan anlamlý fark yoktu. Neo-KRT grubu ameliyat zamanýna göre deðerlendirildiðinde, 8 haftadan sonra ameliyat edilen hastalarda istatistiksel anlamlýlýða ulaþýlamasa da daha fazla mortalite saptandý.
TARTIÞMA ve SONUÇ: Cerrahinin morbidite ve mortalitesi göz önüne alýndýðýnda, tedaviye yanýtý tam yanýt olarak kabul edilen seçilmiþ olgularda def-KRT, neoadjuvan+cerrahi tedaviye bir alternatif olabilir. Bu hastalarda nükse kadar bekleyip ardýndan salvaj cerrahi düþünülebilir.

INTRODUCTION: The aim of this study is to investigate the results of neoadjuvant chemoradiotherapy /radiotherapy (neo-CRT/RT)+surgery and definitive chemoradiotherapy (def-CRT) approaches in locally advanced esophageal cancer
METHODS: Between January 2012 and December 2021, in two centers, patients who received def-CRT or neo-CRT/RT with the diagnosis of locally advanced esophageal cancer, were retrospectively analyzed. Cases were evaluated for treatment response, overall survival (OS), disease-free survival (DFS), and local recurrence (LR).
RESULTS: In total, fifty cases were included. The median follow-up was 10 months (range 2-26). In the def-CRT group; OS at one year, and two years were 67 % and 32 %, respectively; DFS at one year, and two years were 62 % and 32 % respectively. In the neo-CRT group; OS at one year was 81 % and DFS at one year was 73 %. In the follow-up time, LR was 12.1% in def-CRT and 11.8% in the neo-CRT group. For two treatment arms, there were no significant differences in OS (p=0.404), DFS (p=0.593) and LR (p=0.670). The neo-CRT group was evaluated according to the time of surgery, more mortality was found in patients who underwent surgery after 8 weeks, although statistical significance was not reached.
DISCUSSION AND CONCLUSION: Considering the morbidity and mortality of surgery, def-CRT may be an alternative to neoadjuvant-surgical treatment in selected cases whose treatment response is considered a complete response. In these patients, waiting until recurrence and then salvage surgery can be considered.

Memenin desmoid tip fibromatozisi nadir görülen, lokal agresif bir stromal tümördür. Bu lezyon tüm meme tümörlerinin %0,2'sinde görülür, sýklýkla 25-45 yaþlarý arasýnda ortaya çýkar ve erkek: kadýn oraný 1: 2'dir. Bu olgu sunumunda, meme kanserini taklit eden meme fibromatozisi olan 57 yaþýnda bir kadýn hastayý sunuyoruz. Fizik muayenede sol meme üst dýþ kadranda göðüs duvarýna fikse yaklaþýk 3x2 cm boyutlarýnda düzensiz þekilli kitle lezyonu izlendi. Mamografide sol meme dýþ orta kýsmýnda fibroglandüler doku ile örtülü opaklýkta artýþ izlendi. Ultrason muayenesinde sol meme üst dýþ kadranda 32x10mm boyutlarýnda, sýnýrlarý düzensiz, iç ekosu olan, yer yer mikrokalsifikasyonlu, heterojen hipoekoik solid lezyon izlendi. (BIRADS 4). Tru-cut biyopside fibromatozis benzeri metaplastik meme karsinomu ile desmoid fibromatozis ayýrt edilemediðinden genel anestezi altýnda eksizyonel biyopsi gerçekleþtirildi. Pozitif cerrahi sýnýrlar nedeniyle geniþ lokal eksizyon uygulandý. Sonuç olarak, desmoid tip fibromatosis nonspesifik fizik muayene bulgularý ve radyolojik görüntüleme bulgularýna sahiptir ve malignite ile karýþtýrýlmaktadýr. Bu lezyonun primer tedavisi negatif cerrahi sýnýr ile eksizyondur.

Desmoid-type fibromatosis of the breast is a rare, locally aggressive stromal tumor. This lesion is observed in 0.2% of all breast tumors, often occurs between the ages of 25 and 45 and the sex ratio is 1: 2 (male: female). In this study, we report a case of a 57-year-old woman with breast fibromatosis, which has been mimicking breast carcinoma. On physical examination, there was an irregularly shaped mass lesion of approximately 3x2 cm fixed to the chest wall in the upper outer quadrant of the left breast. On mammography, an increase in opacity covered by fibroglandular tissue was observed in the outer middle part of the left breast. On ultrasound examination, a heterogeneous hypoechoic solid lesion with microcalcifications in places and 32x10mm in size with irregular borders and internal echoes were observed in the upper outer quadrant of the left breast. (BIRADS 4). Since the tru-cut biopsy could not differentiate between Fibromatosis-like Metaplastic Breast Carcinoma and Desmoid Fibromatosis, an excisional biopsy was performed under general anaesthesia. Wide local excision was performed due to positive surgical margins. In conclusion, desmoid-type fibromatosis has nonspecific physical examination findings and radiological imaging and is confused with malignancy. The primary treatment of this lesion is excision with a negative surgical margin

Kolanjiokarsinomlar intrahepatik ve ekstrahepatik safra kanallarýnýn epitel hücrelerinden kaynaklanan kanserlerdir. Çoðu prezente olduðunda lokal olarak ilerlemiþ lezyonlardýr. Genellikle sarýlýk, abdominal aðrý ve anormal karaciðer biyokimyasal testleri ile prezente olurlar.
Sað femurda karsinom metastazý saptanýp prýmerýne yonelýk tetkýk ettiðimiz 49 yasýndaký kadýn hastanýn sað gözünde proptozis geliþti. Hastanýn lakrimal bez biyopsisi kolanjýiokarsinom metastazý ile uyumlu saptandý. Kolanjiokarsinomda nörooptalmolojýk komplikasyonlar oldukça nadir olup literatürde 10 vaka bildirimiþtir.

Cholangiocarcinomas are cancers arising from epithelial cells of the intrahepatic and extrahepatic bile ducts. Most are locally advanced lesions when present. They usually present with jaundice, abdominal pain, and abnormal liver biochemical tests.
Proptosis developed in the right eye of a 49-year-old female patient who was diagnosed with carcinoma metastasis in the right femur and we examined for the primary one. Lacrimal gland biopsy of the patient was found to be compatible with cholangiocarcinoma metastasis. Neuroopthalmologic complications in cholangiocarcinoma are very rare and 10 cases have been reported in the literature.