Browsing by Author "Binici, Serhat"

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Addressing Radiotherapy-Induced Fibrosis: the Potential of Platelet-Rich Plasma and Infliximab for Improved Breast Cancer Management
(Springer, 2024) Binici, Serhat; Guven, Mustafa; Ozdemir, Abdulselam; Ilik, Zehra Akman; Demirhan, Birhan; Uygur, Serhat; Iliklerden, Umit Haluk
Breast cancer treatment encompasses various therapeutic modalities, including surgery, radiotherapy, and chemotherapy. Breast-conserving surgery has been an integral part of breast cancer management. However, radiotherapy, an important component of breast cancer management, can lead to complications, particularly fibrosis, affecting reconstructive surgery outcomes. We conducted an in vivo study using 48 female Wistar Albino rats, employing segmental mastectomy and radiotherapy to simulate post-mastectomy conditions. The rats were divided into six groups: control, mastectomy, mastectomy + radiotherapy, mastectomy + platelet-rich plasma (PRP) + radiotherapy, mastectomy + infliximab + radiotherapy, and mastectomy + infliximab + PRP + radiotherapy. Edema, hyperemia, inflammation, and fibrosis were assessed as indicators of tissue response. Histopathological analysis revealed that mastectomy + infliximab and mastectomy + infliximab + PRP groups showed significant reductions in fibrosis compared to other groups. Edema, hyperemia, and inflammation were also less severe in these groups compared to the control group. Radiotherapy-induced fibrosis is a major concern in breast reconstruction. Our study suggests that local PRP application and systemic infliximab administration, either alone or in combination, could mitigate the adverse effects of radiotherapy. This approach has the potential to improve reconstructive outcomes in patients undergoing or having the possibility to undergo radiotherapy. This is the first study showing the effectiveness of infliximab and PRP combination on wound healing. The provided experimental rat model might offer guidance for further research. This study provides insights into optimizing outcomes in reconstructive breast surgery, paving the way for further research and clinical studies.
The Effect of Prp (platelet Reach Plasma) and Tnf-Α (tumor Necrosis Factor Α) on Radiotherapy-Associated Fibrosis Applied After Breast Conserving Surgery in Rats
(2022) Binici, Serhat; İliklerden, Ümit Haluk
Malign meme hastalıklarında meme koruyucu cerrahi sonrası küratif tedavi amacıyla yapılan radyoterapi uygulaması günümüzde standart tedavi haline gelmiştir. Radyoterapinin (RT) sağkalımı uzattığı ispat edilmekle beraber uygulanan alanda ciddi fibrozis ve yara kontraktürü oluşturmaktadır. Özellikle meme cerrahisi sonrası rekonstrüksiyon planlanan hastalarda elastikiyetin zayıflaması nedeniyle rekonstrüksiyon zorlaşmaktadır. Bu çalışmamızda ratlarda meme cerrahisi sonrası uygulanan RT ile ilişkli fibrozis yoğunluğu üzerine lokal PRP (platelet rich plasma) ve sistemik TNF-α (tümor nekroz faktör-alfa) inhibitörü olan infliximab'ın yara iyileşmesine etkisini araştırmayı amaçladık. Gereç ve Yöntem: Çalışmamızda ortalama vücut ağırlıkları 250- 290 gr olan daha önce herhangi bir çalışmada kullanılmamış, hiçbir ilaca maruz kalmamış 48 adet dişi, 3 aylık Wistar Albino rat kullanıldı. Tüm gruplar; etkin meme dokusu volümü sağlanabilmesi amacıyla emzirmeden henüz kesilmiş, kendi içerisinde çiftleştirilmiş ve en az 3 nesil yavru elde edilmiş yavru dişi ratlardan oluşturuldu. PRP hazırlamak için yine bu 3. nesle akraba ihtiyaç kadar rat sayısı kullanıldı. Ratlar, sham grubu ile birlikte cerrahi ve diğer işlemlerden oluşan 6 gruba (n:8) kuyrukları işaretlenerek gruplandırıldı. Gruplandırma; Grup: 1: Kontrol, Grup, 2: Sadece Cerrahi, Grup 3: Cerrahi + RT uygulaması, Grup 4: Cerrahi+lokal PRP+RT uygulaması, Grup 5: Cerrahi+ sistemik TNF-α inhibitörü +RT uygulaması, Grup 6: Cerrahi+lokal PRP+ sistemik TNF-α inhibitörü+RT uygulaması şeklinde oluşturuldu. Ratlara segmental mastektomi uygulandıktan 7 gün sonra tek doz tüm vücut 6,75 Gy iyonize radyasyon uygulandı. Radyoterapi uygulaması yapıldıktan sonra ratlar sakrifiye edilerek işlem yapılan meme total eksize edilerek histopatolojik inceleme için patolojiye verildi. Histopatolojik inceleme için hazırlanan preparatlar hematoksilen-eozin (HE) ile boyandı ve fibrozisteki kollajen birikimini göstermek amacıyla Masson Trikrom (MT) ile histokimyasal boyama yapıldı. Gruplar ödem, hiperemi, fibrozis ve inflamasyon parametrelerine göre karşılaştırıldı. Yara iyileşmesi histopatolojik bulgulara göre; 'yok (- ), hafif (+), orta (++) ve yaygın (+++)' olarak skorlanarak istatistiksel çalışmaları yapıldı. Bulgular: Cerrahi sonrası tüm gruplarda ödem tespit edildi. Segmental mastektominin (SM), ödem şiddetini etkilediği görüldü (p<0,001). Grup 5 ve 6'daki XIV prosedürlerin ödem şiddetini azalttığı belirlendi. Grup 4'deki yöntemin ise ödem şiddetini artırdığı izlendi. Cerrahi sonrası tüm gruplarda hiperemi tespit edildi. SM'nin, hiperemi şiddetini etkilediği görüldü (p = 0,009). Grup 5 ve 6'daki prosedürlerin hiperemi miktarını azalttığı belirlendi. Grup 3'deki prosedürün ratların %75'inde orta veya şiddetli hiperemiye neden olduğu belirlendi. Cerrahi sonrası tüm gruplarda fibrozis tespit edildi. SM'nin, fibrozis şiddetini etkilediği görüldü (p <0,001). Grup 5 ve 6'daki prosedürlerin belirgin biçimde fibrozis miktarını azalttığı belirlendi. Grup 2-4'deki prosedürün ratların %87,5'inde orta veya şiddetli fibrozis'e neden olduğu belirlendi. Cerrahi sonrası tüm gruplarda inflamasyon tespit edildi. SM'nin, inflamasyon şiddetini etkilediği görüldü (p <0,001). Tüm gruplarda inflamasyon seviyesinin ılımlı olduğu belirlendi. Sonuç: Çalışmamızda intraoperatif sistemik infliksimab ve lokal PRP uygulanmasının PMRT (Postmastectomy radiation therapy) sonrası fibrozisi, inflamasyonu, ödemi, hiperemiyi anlamlı olarak azalttığı görülmüş olup geç rekonstüriksiyon planlanan hastalarda onkoplastik cerrahinin istenmeyen tüm sonuçlarında azalma yaratacağı düşünülmektedir. Sonuç olarak bu hayvan modeli özgün olmakla beraber gelecekte yapılacak klinik çalışmalar için bu yönüyle yol gösterici olacaktır.
Impact of 18f-Fdg Pet/Ct in the Management Decisions of Breast Cancer Board on Early-Stage Breast Cancer
(Springer int Publ Ag, 2024) Ozdemir, Abdulselam; Guven, Mustafa; Binici, Serhat; Uygur, Serhat; Toktas, Osman
Purpose Breast cancer is the most common malignancy accounting for 11.7% of all cancer cases, with a rising incidence rate. Various diagnostic methods, including 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT), play a crucial role in breast cancer diagnosis and staging. However, the unnecessary use of advanced imaging techniques such as PET/CT in early-stage breast cancer can have negative effects on both economics and patients. We aimed to investigate the impact of PET/CT on the management decisions of early-stage breast cancer patients by the breast cancer tumor board.Methods A retrospective analysis was performed on a cohort of 81 patients with early-stage breast cancer who were evaluated by breast cancer tumor board from January 2015 to December 2020. Demographic, clinical, and radiographic data, along with surgical procedures and treatment options, were documented and analyzed.Results The results showed that 18F-FDG PET/CT had a moderate impact on treatment decisions of breast cancer tumor board, as only treatment decisions were changed in 14,86% of the patients. The surgical procedure decision of breast cancer tumor board changed in 12.35% of patients, while 87.65% of patients had consistent decisions before and after PET/CT. Pathological assessments revealed invasive ductal carcinoma as the most prevalent tumor type, and molecular subtypes were predominantly luminal B. PET/CT use had limited impact on surgical procedures and did not significantly alter treatment decisions of breast cancer tumor board in this early-stage breast cancer cohort.Conclusions In conclusion, this study highlights the importance of adherence to the guidelines and appropriate use of PET/CT in early-stage breast cancer management. PET/CT should be reserved for cases where it is clinically warranted, considering the potential economic burden and minimal impact on treatment decisions of breast cancer tumor board in this patient population.
Rare Liver Abscess Caused by Hepatogastric Fistula in a Case of Gastric Adenocarcinoma
(Elsevier Espana Slu, 2024) Ozgokce, Mesut; Binici, Serhat; Kotanb, Mehmet Cetin
Treatment of Idiopathic Granulomatous Mastitis: Local Steroid Administration Vs. Systemic (Oral) Steroid
(Springer india, 2023) Toktas, Osman; Toprak, Nursen; Elasan, Sadi; Calli, Iskan; Binici, Serhat
Idiopathic granulomatous mastitis is characterized by non-caseating granuloma and microabscess formation limited to mammary gland lobules. It is a form of chronic mastitis of unknown pathogenesis. In this study, the effectiveness of intralesional steroid injection with topical steroids is compared to systemic steroid therapy in the treatment of idiopathic granulomatous mastitis. Between June 2017 and December 2020, patients were collected and assessed. Idiopathic granulomatous mastitis was diagnosed histopathologically by tru-cut biopsy in patients with breast mass, pain, and erythema with suspicion of idiopathic granulomatous mastitis. Included in the study were one hundred and eleven patients who were diagnosed with idiopathic granulomatous mastitis and were treated with local or oral administration of corticosteroids, with at least 6 months of follow-up. The patients were divided into 2 groups: a local corticosteroid-treatment group (n = 57) and a peroral corticosteroid-treatment group (n = 54). Demographic characteristics, treatment responses, recurrence rates, side effects of the steroid, and the need for surgery were compared. The rate of smoking was 12.3% in the local corticosteroid-treatment group and 20.4% in the peroral corticosteroid-treatment group. There was no history of oral contraceptive use in either group. Previous steroid use was significantly lower in the local corticosteroid-treatment group (10.5%) compared to the peroral corticosteroid-treatment group (55.6%) (p = 0.001). Previous antibiotic use was significantly lower in the local corticosteroid-treatment group (75.4%) compared to the peroral corticosteroid-treatment group (100%) (p = 0.001). Those who responded after the first course of treatment were 96.5% in the local corticosteroid-treatment group versus 75.9% in the peroral corticosteroid-treatment group (p = 0.001). Complete responders after the third course of treatment was 98.2% in the local corticosteroid-treatment group versus 87.0% in the peroral corticosteroid-treatment group (p = 0.003). Recurrence had been 7% of the patients in the local corticosteroid-treatment group compared to 37% in the peroral corticosteroid-treatment group (p = 0.001). Steroid-related side effects were lower in the local corticosteroid-treatment group (0 compared to the peroral corticosteroid-treatment group (11.1%) (p = 0.010). Surgery was performed in 3.5% of the local corticosteroid-treatment group and in 57.3% of the peroral corticosteroid-treatment group (p = 0.001). A comparative open-label study in idiopathic granulamatous mastitis between local infiltration of corticosteroid compared to oral methyl prednisilone both used as single modality therapy has shown better and sustained response to local infiltration of corticosteroids.