ÖzAkupunktur, farklı yöntemlerle vücudun belirli noktaları ve buralardan geçen sinirlerin uyarıldığı ve birtakım semptomlarda rahatlama sağlandığı bir tamamlayıcı ve alternatif tıp yöntemidir. Geleneksel Çin Tıbbı'nda akupunkturun etki mekanizması, enerji akımı gibi bilimsel olmayan temellere dayandırılsa da; yapılan çalışmalarla akupunkturun etkisinin sinirlerin uyarılmasıyla salınan maddeler ve plasebo etkisine dayandığı gösterilmiştir. Akupunktur, kanser hastalarının da sıkça başvurduğu bir yöntemdir. Ancak akupunkturun kanserde tek başına etkin bir tedavi yöntemi olduğuna dair bilimsel bir kanıt yoktur. Kanser hastaları, akupunktur yöntemini kansere ve/veya kanser tedavisine bağlı belirtilerde azalma sağlamak amacıyla, standart tedaviye ek olarak tamamlayıcı bir tedavi yöntemi olarak kullanabilir. Yapılan çalışmalarla; akupunkturun kanser hastalarında ağrı, halsizlik, bulantı, kusma, psikolojik problemler, ağız kuruluğu, lenfödem, lökopeni, sıcak basmaları, duyu bozuklukları, nefes darlığı semptomlarında rahatlama sağlayabileceğine yönelik bulgular elde edilse de, yeterli değildir. Akupunkturun kanser hastalarındaki etkileri ve kullanım alanlarına dair, yapılacak kapsamlı ve iyi tasarlanmış çalışmalara ihtiyaç vardır.Anahtar Sözcükler: Akupunktur, Kanser, Alternatif tıp, Tamamlayıcı tıp AbStrActAcupuncture is a complementary and alternative medical method, helpful in relieving certain symptoms, that involves stimulating certain points on the body as well as nerves passing though those points, with the use of various techniques. Although the mechanism of action of acupuncture is based on some unscientific foundations such as energy flow in Traditional Chinese Medicine, studies have shown that the effect of acupuncture is based on the placebo effect and the substances released in consequence of the stimulation of the nerves. Acupuncture is a method that is often tried by cancer patients. However, there is no scientific evidence showing that acupuncture alone is an effective treatment for cancer. Cancer patients should use acupuncture technique as a complementary treatment in addition to the standard treatment, with intent to ensure a reduction in symptoms caused by cancer and/or cancer treatment. Some findings obtained from studies have suggested that acupuncture can provide relief from some symptoms such as pain, fatigue, nausea, vomiting, psychological problems, dryness of the mouth (xerostomia), lymphedema, leukopenia, hot flashes, sensory impairment, and shortness of breath in cancer patients; however, these findings are not adequate. Comprehensive and well-designed studies to be carried out on the effects of acupuncture in cancer patients as well as its areas of use are needed.

ÖzD vitamini, esas olarak kemik sağlığı için gerekli olmakla birlikte vücutta birçok olayda rol oynayan, yağda çözünen vitaminler grubundan bir bileşiktir. Güneşten gelen ultraviyole ışınlarına maruziyet sonucu vücutta endojen olarak üretilebilen D vitamini, aynı zamanda bazı besinlerde doğal olarak bulunmakta veya D vitamini takviyelerinden elde edilebilmektedir. D vitamini uzun yıllardır bilinen görevlerinin yanı sıra, son yıllarda kanser, diyabet, kalp hastalıkları gibi bazı hastalıklardan korunmadaki etkisiyle de sıkça gündeme gelmektedir. Yapılan bazı araştırmalarda; güneşe maruziyetin az olduğu bölgelerde bazı kanser türlerinin daha sık görüldüğünün gözlenmesi, D vitamininin kanserden korunmada etkili olduğu düşüncesini doğurmuştur. Yapılan laboratuvar çalışmalarında, D vitamininin kanserden korunmada etkili olabileceğine dair güçlü kanıtlar elde edilse de; randomize klinik çalışmaların sonuçları çelişkilidir. D vitamini; hangi dozlarda yararlı, hangi dozlarda zararlı, hangi kanser türlerinde etkili, net olarak bilinmemektedir. Bu noktada, iyi tasarlanmış kapsamlı çalışmalara ihtiyaç vardır. Yapılacak çalışmalar için anahtar; bazı kanser türlerinin riskini azaltan, ancak diğerlerinin riskini artırmayan ideal D vitamini miktarının belirlenmesi olacaktır. Anahtar Sözcükler: D vitamini, Kanser, Kanserden korunma, Kemoprevensiyon AbStrActVitamin D is essential for bone health, and is a compound in the group of fat-soluble vitamins, which plays a role in many events in the body. Vitamin D can be produced as an endogenous substance in the body as a result of exposure to ultraviolet radiation coming from the sun and is also available in certain natural foods or can be obtained from vitamin D supplements. Besides its duties that have been known for years, Vitamin D has been of interest in recent years due to its role in protection against some diseases such as cancer, diabetes, and heart disease. The idea that vitamin D is effective in protection against cancer was born as a result of the fact that certain types of cancer were observed to be more commonly encountered in regions where sun exposure was low in some studies. Although strong evidence has been obtained that vitamin D is likely to be effective in protection from cancer, the results of randomized clinical studies are inconsistent. Vitamin Dʼs beneficial and harmful doses, and the types of cancer on which it is effective, are not clearly known. At this point, well-designed comprehensive studies are needed. The key for the further studies will be the determination of the ideal amount of vitamin D that will reduce the risk of some cancers but will not increase the risk of some others.

Background: The 21-gene Oncotype DX assay is accepted as an important predictive factor in the adjuvant treatment of node negative, estrogen receptor (ER) positive and HER2 (-) breast cancer. The test is not widely available for Turkish physicians as itÕs currently not reimbursed.We performed a prospective analysis to find the impact of the Recurrence Score result (RS) on treatment decisions. Methods: Ten centers across Turkey participated in this prospective trial. Consecutive breast cancer patients with pT1-3, pN0-N1mic, ER(+) , and HER2 (-) tumors were identified and adjuvant treatment decisions were made at breast tumor boards. The pre assay treatment decision was recorded on a questionnaire form. Cases were discussed at tumor boards again when the RS was available and investigators filled the post-assay questionnaire forms with the final decision. Results: 165 patients were enrolled. Mean age was 49.8 (SD±10.3) years. 108(65.5%) patients had pT1 tumors. Mean RS was 18.8±14.0. RS was low in 56.8%, intermediate in in 35.2% and high in 8.5%. There was an overall treatment decision change in 33% of patients with a reduction of chemotherapy (CT) from 56% to 35% overall and a 48% reduction in patients originally recommended CT. Among the patients with low and intermediate results, the decision changed from CT to Òhormonal therapy (HT) aloneÓ in 36 (85.7%) and 7 (36.8%) patients, respectively. Conclusions: The 21-gene assay has a significant impact on treatment decisions at specialty tumor boards in Turkish hospitals. Our initial findings warrant further consideration for the use of this genomic assay in patients with early stage breast cancer in Turkey. Health economic analysis will be reported separately in the near future.

ÖZSistemik sarkoidoz bulguları olmaksızın, epiteloid non-kazeifiye granülomların görülmesi halinde, bu duruma sarkoid benzeri reaksiyon adı verilmektedir. Bu granülomlar esas olarak tümör veya tümörü drene eden lenf nodlarında görülmekte ve PET/BT gibi görüntüleme yöntemleriyle de maligniteden ayırt edilememektedir. Bu durum, lezyonların yanlışlıkla metastaz olarak değerlendirilmesine yol aça-bilmekte ve hastalığın tanı, evreleme ve tedavisinde ciddi hatalara yol açarak telafisi mümkün olmayan sonuçlar doğurabilmektedir. Bu yüzden bu çalışmada; supraklavikular, paratrakeal ve subkarinal lenf nodu tutulumunun gözlendiği sarkoid reaksiyonlu, lokal ileri evre meme kanseri bir olgu sunulmuş ve PET/BT ile teşhiste oluşabilecek yanılgılar adına farkındalık yaratılmaya çalışılmıştır.Anahtar Sözcükler: Sarkoid benzeri reaksiyon, Sarkoidoz, Granülom, Lenfadenopati, Meme kanseri ABSTRACTThe condition involving the appearance of epithelioid non-classified granulomas, without signs of systemic sarcoidosis, is called sarcoid-like reaction. These granulomas are basically seen in the tumor or the lymph nodes that drain the tumor, and cannot be distinguished from malignancy by means of imaging techniques such as PET/CT. Such a condition may cause lesions to be considered as metastatic lesions in consequence of a misevaluation, and may lead to mistakes in the diagnosis, staging and treatment of the disease. In this study, a locally advanced breast cancer case, which involved the detection of a sarcoid-like reaction, is presented with the aim of increasing awareness regarding any potential mistakes that might occur during the diagnostic PET/CT processes.