Objective To investigate the impact of cumulative cisplatin dose on clinical outcomes in locally advanced cervical cancer patients undergoing definitive chemoradiotherapy. Methods A retrospective analysis was conducted on 654 patients with stage IB3–IVA disease treated with definitive chemoradiotherapy. Radiotherapy was applied as external beam pelvic with or without para-aortic radiotherapy and brachytherapy. Concomitant chemotherapy was in the form of weekly or 3 weekly cisplatin. Data on demographics, treatment protocols, cumulative cisplatin dose, adverse effects, and survival outcomes were collected. Statistical analyses, including univariate and multivariate Cox regression models, were used to assess factors influencing progression free survival and overall survival. Results The median cumulative cisplatin dose was 210 mg (range 40–320), and ≥200 mg in 503 (76.9%) patients. Median follow-up was 35 months (range 1–150). The 5 year progression free survival and overall survival rates were 66.9% and 77.1%, respectively. Multivariate analysis identified poor performance status, non-squamous cell histology, presence of lymph node metastases, and hemoglobin <10 g/dL before chemoradiotherapy as poor prognostic factors for both progression free survival and overall survival in the whole group. When stage III cases were evaluated separately, the cumulative cisplatin dose 200 mg, particularly in patients with lymph node metastases, significantly improved overall survival. Factors such as anemia, toxicity related challenges, and comorbidities were identified as critical considerations in treatment planning. These findings emphasize the balance between maximizing therapeutic efficacy and managing toxicity, guiding personalized treatment approaches for locally advanced cervical cancer.

Objective: In the current classification of brain tumors of the World Health Organization, various tumor histologies have been categorized under the main heading of glial tumors. The subgroup of low-grade gliomas comprises grade 2 diffuse astrocytic and oligodendroglial tumors. Methods: The primary treatment of low-grade gliomas is surgery. Safe maximal resection is the widest possible resection without causing additional neurological damage. It increases survival and reduces existing neurological symptoms. Maximal safe resection may not be achieved because of tumor infiltration or proximity to sensitive motor/sensory function areas. Although radio diagnostic and surgical technique advancements have improved, residual tumors are detected in the majority of patients. Results: Adjuvant treatment of residual low-grade gliomas is controversial. The European Organisation for Research and Treatment of Cancer (EORTC) study showed that early radiotherapy after surgery extended progression-free survival for 2 years without an overall survival benefit. After this study, it has been adopted in clinical practice that high-risk patients receive early radiotherapy and low-risk groups receive radiotherapy after progression. Certain risk factors have been determined from Radiation Therapy Oncology Group (RTOG) and EORTC studies. The high-risk factors are age over 40 years, partial resection, tumor size over 5 cm, not having isocitrate dehydrogenase mutation, and tumor progression or recurrence. Adjuvant radiotherapy and concurrent chemotherapy are recommended achieving improved progression-free survival and overall survival in patients with high-risk factors. In the low-risk group, radiotherapy may be delayed until progression. Conclusions: Low-grade gliomas are slow progressing tumors. To detect progression in follow-up, it is recommended to compare follow-up magnetic resonance images with the initial reference magnetic resonance images, not with the previous control. Cite this article as: Dağdelen M, Demir E, Uzel ÖE. Radiotherapy in the treatment of low-grade gliomas. Cerrahpaşa Med J. February 12, 2022. 46(1):1-5.

Radiation-induced cardiotoxicity (RIC) is a significant adverse effect of thoracic radiotherapy (RT), leading to oxidative stress, inflammation, endothelial dysfunction, myocardial fibrosis, vascular damage, and cardiac dysfunction. Melatonin (MLT), a potent antioxidant and radioprotective agent, has been suggested to mitigate these effects. This study aims to evaluate the optimal dosage of MLT for cardioprotection following RT in a rat model. Forty-five adult male Sprague-Dawley rats were divided into five groups. The control group received 1 mL saline solution and sham irradiation. The RT-only group received 12 Gy RT in a single fraction with saline. Three experimental groups received the same RT dose with MLT at 100 mg/kg, 50 mg/kg, or 5 mg/kg. Eight weeks post-irradiation, protein oxidation, lipid peroxidation, glycoxidation, non-enzymatic redox homeostasis biomarkers, and histological changes in heart tissues were examined. In MLT-treated groups, 5 mg/kg dose was found to be more effective in preventing protein oxidation and lipid peroxidation. The levels of advanced glycation end products were significantly lower in 5 mg/kg and 50 mg/kg MLT groups compared to the RT only group, whereas no difference was found at the high dose (100 mg/kg). When Cu-Zn superoxide dismutase activity, iron ion reducing antioxidant power and total thiol groups were evaluated, we found that 5 mg/kg MLT caused a significant increase in these antioxidant parameters, while 50 mg/kg and 100 mg/kg dose caused significant increase in superoxide dismutase. Evaluation heart tissues showed that the RIC was significantly lower in all MLT-treated groups. 5 mg/kg melatonin reduces oxidative markers and RIC in rats, indicating its potential as a low-dose cardioprotective agent after RT.

Objective: We aimed to evaluate the usage patterns, awareness, and trust in artificial intelligence (AI) technologies among radiation oncology patients and their caregivers. Materials and Methods: A total of 83 radiation oncology patients or caregivers were surveyed using a 17-item questionnaire. The survey assessed participant demographics, AI awareness, usage patterns, trust, verification behaviors, and concerns. Statistical analyses were conducted using Chi-square and Fisher’s exact tests. Results: Of 83 participants, 40 (48.2%) were patients and 43 (51.8%) were caregivers. The most common uses of AI were learning about disease (42.1%), treatment options (28.9%), receiving support (16.8%), and appointment-related processes during radiation therapy (12.0%). 82.1% of participants verified AI-generated information by consulting a radiation oncologist. 53.0% of participants expressed concerns about misinformation, 37.3% about the privacy of health data, and 30.1% about reduced human interaction. Higher educational level was significantly associated with AI use (p < 0.001). Conclusions: Radiation oncology patients and their caregivers frequently use AI to access health-related information, but they have concerns about reliability, privacy, and the preservation of human-centered care.

Objective: The aim was to evaluate the relationship between the G-8 geriatric screening score and clinical outcomes in elderly lung cancer patients treated with radiotherapy (RT) ± chemotherapy (CT). Methods: This retrospective study analyzed data from 80 lung cancer patients aged ≥65 years who underwent RT ± CT between 2010 and 2020. All patients were assessed using the G-8 screening tool. Survival analyses were performed using the Kaplan–Meier method, and toxicities were graded according to the Common Terminology Criteria for Adverse Events version 4. Prognostic factors for survival were evaluated using the log-rank test and Cox regression analysis. Results: The median age was 69 years, and 72.5% of patients had non–small cell lung cancer (NSCLC). The median progression-free survival (PFS) and overall survival (OS) were 11.5 and 17.5 months, respectively. Grade ≥3 toxicity occurred in 12.5% of patients, with higher rates among those with NSCLC and those receiving concurrent CT. Frail patients (92%, G-8 ≤14) showed no significant differences in survival or toxicity compared with non-frail patients (P = .652). While the conventional cutoff of 14 was not an independent prognostic factor for PFS or OS, a cutoff value of 10 was prognostic for PFS (P = .037) in the patient population. Conclusion: Most of the lung cancer patients aged ≥65 years were frail according to the G-8 score. The conventional cutoff of 14 did not correlate with treatment outcomes or toxicity; however, a cutoff value of 10 was prognostic for PFS. These findings highlight the need for improved assessment tools to better predict treatment-related toxicity and mortality in geriatric lung cancer patients. Cite this article as: Demir E, Yıldırım HC, Demirel İF, Bölükbaş D, Öner Dinçbaş F. The impact of G-8 frailty scores on oncological outcomes in elderly lung cancer patients. Cerrahpaşa Med J. 2025, 49, 0071, doi:10.5152/cjm.2025.25071.