Background Access to cancer care is a problem that continues to plague refugees displaced from their home countries. The turbulent political crisis in Syria, which has led to millions of refugees seeking asylum in Turkey, merits further attention. We aimed to study the rate of utilization of radiation therapy among Syrian refugees with cancer living in Turkey in an attempt to identify the contributing factors predictive of non-compliance with prescribed RT. Methods In this retrospective review of 14 institutional databases, Syrian refugee patients in Turkey with a cancer diagnosis from January 2015 to December 2019 who were treated with RT were identified. The demographic data, treatment compliance rates, and toxicity outcomes in these patients were surveyed. Variable predictors of noncompliance such as age, sex, diagnosis, treatment length, and toxicity were studied. The association between these variables and patient noncompliance was determined. Results We identified 10,537 patients who were diagnosed with cancer during the study period, of whom 1010 (9.6%) patients were treated with RT. Breast cancer (30%) and lung cancer (14%) were the most common diagnoses with up to 68% of patients diagnosed at an advanced stage (Stage III, IV). 20% of the patients were deemed noncompliant. Treatment with concurrent chemoradiotherapy (OR 1.61, 95% CI 1.06–2.46, p = 0.023) and living in a refugee camp (OR 3.62, 95% CI 2.43–5.19, p < 0.001) were associated with noncompliance. Age, sex and treatment length were not significantly associated with noncompliance. Conclusions Noncompliance with radiotherapy among Syrian refugees in Turkey remains an area of concern with a multitude of factors contributing to these alarming numbers. Further studies to better ascertain the finer nuances of this intricately complex problem and a global combination of efforts can pave the way to providing a solution.

Malignant pleural mesothelioma (MPM) is a rare disease with a poor prognosis. The main therapeutic options for MPM include surgery, chemotherapy, and radiation therapy (RT). Although multimodality therapy has been reported to improve survival, not every medically operable patient is able to undergo all recommended therapy. With improvements in surgical techniques and systemic therapies, as well as advancements in RT, there has been a potential new paradigm in the management of this disease. In this review, we discuss the current literature on MPM management and propose a functional treatment algorithm.

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ÖZET Amaç:Rezidü ve/ veya nüks hipofiz adenomlarının tedavisinde stereotaktik radyocerrahi alternatif bir tedavi seçeneğidir. Bu yazıda kliniğimizde Cyberknife® stereotaktik radyocerrahi (SRC) uyguladığımız hipofiz adenomlu hastaların tedaviye yanıtlarının değerlendirilmesi amaçlanmıştır. Yöntemler: Dr. A.Y. Ankara Onkoloji Eğitim ve Araştırma Hastanesi Radyasyon Onkolojisi Kliniğinde, Ocak 2010-Haziran 2013 tarihleri arasında beşi fonksiyonel ve ikisi non-fonksiyonel olmak üzere toplamda yedi hipofiz adenomlu olguya SRC uygulandı. Olgularda ortanca yaş 36 (aralık, 30-60) ve olguların %71'i (n=5) erkek idi. Hemofili hastalığı olan bir hasta dışındaki tüm olgulara cerrahi uygulanmış idi. Fonksiyonel adenomlu dört olgu medikal tedaviye yanıtsız idi ve yinelemiş tümörlerinin olması nedeni ile radyocerrahi kararı alındı. İki olgu ise cerrahi sonrası kalıntı tümör nedeni ile, bir olguda cerrahi yapılamadığı için primer olarak SRC uygulandı. Reçete edilen ortanca doz, 22 Gy (aralık, 20-25 Gy), 3-5 fraksiyonda, ortanca %84 (aralık, %80-%93) izodoz ile uygulandı. Bulgular: Ortanca takip zamanı 18 ay (aralık, 14-55 ay) idi. Bir olgu (non-fonksiyonel) 55 aylık izleminde klinik ve radyolojik olarak tam yanıt gösterirken, bir fonksiyonel hipofiz adenomlu olgu ise progrese oldu. Yedi olgunun 6'sında (%86) radyolojik olarak tümör kontrolü sağlandı. Sonuç: Rezidü ve/ veya nüks hipofiz adenomlarının tedavisinde stereotaktik radyocerrahi etkin ve güvenli bir tedavi seçeneği olabilir. Anahtar Kelimeler: Cyberknife; Stereotaktik radyocerrahi; Hipofiz adenomu ABSTRACT Objective: Stereotactic radiosurgery is an alternative treatment option in recurrent or residual pituitary adenomas. In this study, pituitary adenoma patients' response to the stereotactic radiosurgery (SRS) with Cyberknife® were evaluated. Methods:, Totally 7 patients (5 functional and 2 non-functional adenoma) with pituitary adenomas underwent SRS in Dr. A.Y. Ankara Oncology Training and Research Hospital from January 2010 to June 2013. Median age was 36 (range, 30-60) and 71% of cases (n=5) were male. Surgery was applied to all patients except one who has hemophilia. SRS was applied to 4 cases with recurrent functioning adenomas that unresponsive to medical treatment,. Radiosurgery were performed in two cases due to residual tumor after surgery and one case that surgery cannot be done. The median prescribed dose was 22 Gy (range, 20-25 Gy), in 3 and 5 fractions, with median 84% isodose line (range, 80%-93%). Results: The median follow-up time was 18 months (14 to 55 months). One patient (non-functioning pituitary adenoma) showed clinical and radiological complete response after 55 months follow-up. One patient with a functioning pituitary adenoma was progressing. In 6 of the seven patients (86%) radiological tumor control were achieved. Conclusion: Stereotactic radiosurgery may be a safe and effective treatment option in the treatment of recurrent or residual pituitary adenomas.

BackgroundAccess to cancer care is a problem that continues to plague refugees displaced from their home countries. The turbulent political crisis in Syria, which has led to millions of refugees seeking asylum in Turkey, merits further attention. We aimed to study the rate of utilization of radiation therapy among Syrian refugees with cancer living in Turkey in an attempt to identify the contributing factors predictive of non-compliance with prescribed RT.MethodsIn this retrospective review of 14 institutional databases, Syrian refugee patients in Turkey with a cancer diagnosis from January 2015 to December 2018 who were treated with RT were identified. The demographic data, treatment compliance rates, and toxicity outcomes in these patients were surveyed. Variable predictors of noncompliance such as age, gender, diagnosis, geographic location, treatment length, and toxicity were studied. The association between these variables and patient noncompliance was determined.ResultsWe identified 10,537 patients who were diagnosed with cancer during the study period, of whom 1010 (9.6%) patients were treated with RT. Breast cancer (30%) and lung cancer (14%) were the most common diagnoses with up to 68% of patients diagnosed at an advanced stage (Stage III, IV). 20% of the patients were deemed noncompliant. Treatment with concurrent chemoradiotherapy (OR 1.61, 95% CI 1.06 – 2.46, p = 0.023) and living in a refugee camp (OR 3.62, 95% CI 2.43 – 5.19, p < 0.001) were associated with noncompliance. Age, gender and treatment length were not significantly associated with noncompliance.ConclusionsNoncompliance with radiotherapy among Syrian refugees in Turkey remains an area of concern with a multitude of factors contributing to these alarming numbers. Further studies to better ascertain the finer nuances of this intricately complex problem and a global combination of efforts can pave the way to providing a solution.