Evaluation of Multimodality Imaging Based Vaginal Cuff Boost with Stereotactic Body Radiation Therapy (SBRT) for Endometrial Cancer: An Original Article Volume 56- Issue 2

Selcuk Demiral, Omer Sager*, Ferrat Dincoglan and Murat Beyzadeoglu

• Department of Radiation Oncology; University of Health Sciences, Gulhane Medical Faculty, Turkey

Received: March 12, 2024; Published: April 18, 2024

*Corresponding author: Omer Sager, Department of Radiation Oncology; University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey

DOI: 10.26717/BJSTR.2024.56.008813

Abstract PDF

Objective: Endometrial cancer is a significant public health concern for women with its critical incidence around the globe. The utilization of a vaginal cuff boost may be considered for patients deemed to be at a higher risk of vaginal recurrence. With improved stereotactic localization of well-defined targets under image guidance, Stereotactic Body Radiation Therapy (SBRT) offers a highly precise radiotherapeutic modality. More recently, SBRT has been used for vaginal cuff boost as an alternative to brachytherapy. Herein, we assess target definition for vaginal cuff SBRT with comparative analysis of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI).
Materials and Methods: In the context of this study, the endpoint has been targeting definition for vaginal cuff SBRT with comparative analysis of CT and MRI. All included patients were referred to the Department of Radiation Oncology at Gulhane Medical Faculty, University of Health Sciences for vaginal cuff SBRT. We undertook a comparative analysis of target definition by CT simulation images for SBRT planning and with MRI. CT simulations of the patients were carried out at CT-simulator (GE Lightspeed RT, GE Healthcare, Chalfont St. Giles, UK) available at our department. Also, MRI of patients were acquired and used for comparative evaluation.
Results: We found that CT and MRI defined target definition resulted in differences. Thus, we utilized fused CT and MRI for ground truth target volume definition for vaginal cuff SBRT.
Conclusion: From a radiation oncology perspective, our results may have implications for increased adoption of multimodality imaging-based target definition for vaginal cuff SBRT, nevertheless, the need for future studies to shed light on this critical issue may not be neglected.

Keywords: Endometrial Cancer; Vaginal Cuff; Stereotactic Body Radiation Therapy (SBRT); Target Definition

Abbreviations: SBRT: Stereotactic Body Radiation Therapy; CT: Computed Tomography; MRI: Magnetic Resonance Imaging; RT: Radiation Therapy; IGRT: Image Guided RT; ART: Adaptive RT; LINAC: Linear Accelerator

Endometrial cancer is a significant public health concern for women with its critical incidence around the globe [1]. Surgery, radiation therapy (RT), and systemic treatments may be used alone or in combination for management of endometrial cancer with respect to patient, disease, and treatment characteristics [2-7]. Recently, Stereotactic Body Radiation Therapy (SBRT) has emerged as a viable irradiation technique for management of a variety of cancers throughout the human body. The utilization of a vaginal cuff boost may be considered for patients deemed to be at a higher risk of vaginal recurrence. Cervical stromal invasion along with other factors including age, margin status, grade, extent of invasion, histology, and lower external beam RT doses may be regarded as critical issues to consider for optimal patient selection. Admittedly, recent years have witnessed critical advances in technology. Automatic segmentation techniques, molecular imaging methods, Image Guided RT (IGRT), Intensity Modulated RT (IMRT), stereotactic RT, and adaptive RT (ART) techniques have been introduced for improved radiotherapeutic management of patients [8-49]. With improved stereotactic localization of well-defined targets under image guidance, SBRT offers a highly precise radiotherapeutic modality. High doses of radiation may be delivered in a single fraction or with a limited number of fractions, and highly conformal treatment with steep dose gradients around the target may allow for optimal irradiation with an acceptable toxicity profile. More recently, SBRT has been used for vaginal cuff boost as an alternative to brachytherapy [7]. Herein, we assess target definition for vaginal cuff SBRT with comparative analysis of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI).

Department of Radiation Oncology at University of Health Sciences serves a tertiary cancer center for patients from Turkey and abroad. By using state of the art irradiation techniques, a plethora of benign and malignant tumors are irradiated here. In the context of this study, the endpoint has been target definition for vaginal cuff SBRT with comparative analysis of CT and MRI. All included patients were referred to the Department of Radiation Oncology at Gulhane Medical Faculty, University of Health Sciences for vaginal cuff SBRT. We undertook a comparative analysis of target definition by CT simulation images for SBRT planning and with MRI. CT simulations of the patients were carried out at CT-simulator (GE Lightspeed RT, GE Healthcare, Chalfont St. Giles, UK) available at our department. Also, MRI of patients were acquired and used for comparative evaluation. The Linear Accelerator (LINAC) with the capability of sophisticated IGRT techniques has been utilized for stereotactic irradiation. After rigid patient immobilization, planning CT images were acquired at CT-simulator for vaginal cuff SBRT planning. Thereafter, acquired SBRT planning images have been transferred to the delineation workstation via the network. Target volumes and normal tissues were contoured on these images and structure sets were generated. Also, target definition has also been performed on MRI for comparison purposes. All patients underwent vaginal cuff SBRT at Department of Radiation Oncology at Gulhane Medical Faculty, University of Health Sciences.

The current study has assessed target definition for vaginal cuff SBRT with comparative analysis of CT and MRI. Stereotactic irradiation procedures have been performed at our Radiation Oncology Department of Gulhane Medical Faculty at University of Health Sciences. Prior to vaginal cuff SBRT, all included patients have been individually evaluated by a multidisciplinary team of experts from surgical oncology, radiation oncology, and medical oncology. Critical goal of vaginal cuff SBRT planning has been to achieve optimal target coverage without violation of critical organ dose constraints. IGRT techniques such as kilovoltage cone beam CT was used, and vaginal cuff SBRT has been delivered by Synergy (Elekta, UK) LINAC. We found that CT and MRI defined target definition resulted in differences. Thus, we utilized fused CT and MRI for ground truth target volume definition for vaginal cuff SBRT.

Endometrial cancer is a significant public health concern for women with its critical incidence around the globe [1]. Surgery, radiation therapy (RT), and systemic treatments may be used alone or in combination for management of endometrial cancer with respect to patient, disease, and treatment characteristics [2-7]. Recently, SBRT has emerged as a viable irradiation technique for management of a variety of cancers throughout the human body. Admittedly, recent years have witnessed critical advances in technology. Automatic segmentation techniques, molecular imaging methods, IGRT, IMRT, stereotactic RT, and ART techniques have been introduced for improved radiotherapeutic management of patients [8-49]. With improved stereotactic localization of well-defined targets under image guidance, SBRT offers a highly precise radiotherapeutic modality. High doses of radiation may be delivered in a single fraction or with a limited number of fractions, and highly conformal treatment with steep dose gradients around the target may allow for optimal irradiation with an acceptable toxicity profile. More recently, SBRT has been used for vaginal cuff boost as an alternative to brachytherapy [7]. The utilization of a vaginal cuff boost may be considered for patients deemed to be at a higher risk of vaginal recurrence. Cervical stromal invasion along with other factors including age, margin status, grade, extent of invasion, histology, and lower external beam RT doses may be regarded as critical issue to consider for optimal patient selection.

In the context of radiation oncology, improved target definition and critical organ sparing should be considered among the pertinent aspects of optimal stereotactic irradiation. Determination of larger target volumes may lead to radiation induced toxicity, and definition of smaller than actual target volumes may result in decreased local control of the disease. It should be mentioned that adaptive irradiation approaches and multimodality imaging-based target definition may be suggested to improve radiotherapeutic results [50-106]. The current study has assessed target definition for vaginal cuff SBRT with comparative analysis of CT and MRI. Stereotactic irradiation procedures have been performed at our Radiation Oncology Department of Gulhane Medical Faculty at the University of Health Sciences. Prior to vaginal cuff SBRT, all included patients have been individually evaluated by a multidisciplinary team of experts from surgical oncology, radiation oncology, and medical oncology. The critical goal of vaginal cuff SBRT planning has been to achieve optimal target coverage without violation of critical organ dose constraints. IGRT techniques such as kilovoltage cone beam CT were used, and vaginal cuff SBRT has been delivered by Synergy (Elekta, UK) LINAC. We found that CT and MRI defined target definition resulted in differences. Thus, we utilized fused CT and MRI for ground truth target volume definition for vaginal cuff SBRT. From a radiation oncology perspective, our results may have implications for increased adoption of multimodality imaging- based target definition for vaginal cuff SBRT, nevertheless, the need for future studies to shed light on this critical issue may not be neglected.

1. Siegel RL, Giaquinto AN, Jemal A (2024) Cancer statistics, 2024. CA Cancer J Clin 74(1): 12-49.
2. Kim JH, Kim DY, Kim J, Noh JJ, Hwang WY, et al. (2024) Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology consensus statement. J Gynecol Oncol 35(2): e45.
3. Tubridy EA, Taunk NK, Ko EM (2024) Treatment of node-positive endometrial cancer: chemotherapy, radiation, immunotherapy, and targeted therapy. Curr Treat Options Oncol 25(3): 330-345.
4. Capozzi VA, Scarpelli E, De Finis A, Rotondella I, Scebba D, et al. (2023) Optimal Management for Stage IVB Endometrial Cancer: A Systematic Review. Cancers (Basel) 15(21): 5123.
5. Kuhn TM, Dhanani S, Ahmad S (2023) An Overview of Endometrial Cancer with Novel Therapeutic Strategies. Curr Oncol 30(9): 7904-7919.
6. Ladbury C, Sueyoshi MH, Brovold NM, Kumar R, Andraos TY, et al. (2023) Stereotactic Body Radiation Therapy for Gynecologic Malignancies: A Case-Based Radiosurgery Society Practice Review. Pract Radiat Oncol S1879-8500(23)00280-1.
7. Cilla S, Macchia G, Mattiucci G, Ianiro A, Romano C, et al. (2020) Optimized stereotactic volumetric modulated arc therapy as an alternative to brachytherapy for vaginal cuff boost. A dosimetric study. Med Dosim 45(4): 352-358.
8. Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, et al. (2023) Adaptive radiation therapy (art) for patients with limited-stage small cell lung cancer (LS-SCLC): A dosimetric evaluation. Indian J Cancer 60(1): 140-147.
9. Gamsiz H, Sager O, Uysal B, Dincoglan F, Demiral S, et al. (2023) Outcomes of Sterotactic Body Radiotherapy (SBRT) for pelvic lymph node recurrences after adjuvant or primary radiotherapy for prostate cancer. J Cancer Res Ther 19(Suppl 2): S851-S856.
10. Gamsiz H, Sager O, Uysal B, Dincoglan F, Demiral S, et al. (2022) Active breathing control guided stereotactic body ablative radiotherapy for management of liver metastases from colorectal cancer. Acta Gastroenterol Belg 85(3): 469-475.
11. Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, et al. (2022) Concise review of radiosurgery for contemporary management of pilocytic astrocytomas in children and adults. World J Exp Med12(3): 36-43.
12. Sager O, Dincoglan F, Demiral S, Gamsiz H, Uysal B, et al. (2022) Optimal timing of thoracic irradiation for limited stage small cell lung cancer: Current evidence and future prospects. World J Clin Oncol 13(12): 116-124.
13. Demiral S, Sager O, Dincoglan F, Uysal B, Gamsiz H, et al. (2021) Evaluation of breathing-adapted radiation therapy for right-sided early stage breast cancer patients. Indian J Cancer 58(12): 195-200.
14. Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, et al. (2021) Omission of Radiation Therapy (RT) for Metaplastic Breast Cancer (MBC): A Review Article. International Journal of Research Studies in Medical and Health Sciences 6(1): 10-15.
15. Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, et al. (2021) Concise review of stereotactic irradiation for pediatric glial neoplasms: Current concepts and future directions. World J Methodol 11(3): 61-74.
16. Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, et al. (2020) Adaptive radiation therapy of breast cancer by repeated imaging during irradiation. World J Radiol 12(5): 68-75.
17. Sager O, Beyzadeoglu M, Dincoglan F, Demiral S, Gamsiz H, et al. (2020) Multimodality management of cavernous sinus meningiomas with less extensive surgery followed by subsequent irradiation: Implications for an improved toxicity profile. J Surg Surgical Res 6: 056-061.
18. Beyzadeoglu M, Sager O, Dincoglan F, Demiral S, Uysal B, et al. (2020) Single Fraction Stereotactic Radiosurgery (SRS) versus Fractionated Stereotactic Radiotherapy (FSRT) for Vestibular Schwannoma (VS). J Surg Surgical Res 6: 062-066.
19. Dincoglan F, Beyzadeoglu M, Sager O, Demiral S, Uysal B, et al. (2020) A Concise Review of Irradiation for Temporal Bone Chemodectomas (TBC). Arch Otolaryngol Rhinol 6: 016-020.
20. Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, et al. (2019) Utility of Molecular Imaging with 2-Deoxy-2-[Fluorine-18] Fluoro-DGlucose Positron Emission Tomography (18F-FDG PET) for Small Cell Lung Cancer (SCLC): A Radiation Oncology Perspective. Curr Radiopharm 12(1): 4-10.
21. Dincoglan F, Sager O, Demiral S, Gamsiz H, Uysal B, et al. (2019) Fractionated stereotactic radiosurgery for locally recurrent brain metastases after failed stereotactic radiosurgery. Indian J Cancer 56(2): 151-156.
22. Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, et al. (2019) Breathing adapted radiation therapy for leukemia relapse in the breast: A case report. World J Clin Oncol 10(11): 369-374.
23. Dincoglan F, Sager O, Uysal B, Demiral S, Gamsiz H, et al. (2019) Evaluation of hypofractionated stereotactic radiotherapy (HFSRT) to the resection cavity after surgical resection of brain metastases: A single center experience. Indian J Cancer 56(3): 202-206.
24. Sager O, Dincoglan F, Uysal B, Demiral S, Gamsiz H, et al. (2018) Evaluation of adaptive radiotherapy (ART) by use of replanning the tumor bed boost with repeated computed tomography (CT) simulation after whole breast irradiation (WBI) for breast cancer patients having clinically evident seroma. Jpn J Radiol 36(6): 401-406.
25. Demiral S, Dincoglan F, Sager O, Uysal B, Gamsiz H, et al. (2018) Contemporary Management of Meningiomas with Radiosurgery. Int J Radiol Imaging Technol 80: 187-190.
26. Sager O, Dincoglan F, Uysal B, Demiral S, Gamsiz H, et al. (2017) Splenic Irradiation: A Concise Review of the Literature. J App Hem Bl Tran 1: 101.
27. Dincoglan F, Sager O, Demiral S, Uysal B, Gamsiz H, et al. (2017) Radiosurgery for recurrent glioblastoma: A review article. Neurol Disord Therap 1: 1-5.
28. Demiral S, Dincoglan F, Sager O, Gamsiz H, Uysal B, et al. (2016) Hypofractionated stereotactic radiotherapy (HFSRT) for who grade I anterior clinoid meningiomas (ACM). Jpn J Radiol 34(11): 730-737.
29. Dincoglan F, Beyzadeoglu M, Sager O, Demiral S, Gamsiz H, et al. (2015) Management of patients with recurrent glioblastoma using hypofractionated stereotactic radiotherapy. Tumori 101(2): 179-184.
30. Gamsiz H, Beyzadeoglu M, Sager O, Demiral S, Dincoglan F, et al. (2015) Evaluation of stereotactic body radiation therapy in the management of adrenal metastases from non-small cell lung cancer. Tumori 101(1): 98-103.
31. Sager O, Beyzadeoglu M, Dincoglan F, Demiral S, Uysal B, et al. (2015) Adaptive splenic radiotherapy for symptomatic splenomegaly management in myeloproliferative disorders. Tumori 101(1): 84-90.
32. Sager O, Dincoglan F, Beyzadeoglu M (2015) Stereotactic radiosurgery of glomus jugulare tumors: Current concepts, recent advances and future perspectives. CNS Oncol 4(2): 105-114.
33. Sager O, Beyzadeoglu M, Dincoglan F, Uysal B, Gamsiz H, et al. (2014) Evaluation of linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) for cerebral cavernous malformations: A 15-year single-center experience. Ann Saudi Med 34(1): 54-58.
34. Demiral S, Beyzadeoglu M, Sager O, Dincoglan F, Gamsiz H, et al. (2014) Evaluation of Linear Accelerator (Linac)-Based Stereotactic Radiosurgery (Srs) for the Treatment of Craniopharyngiomas. UHOD-Uluslararasi Hematoloji Onkoloji Dergisi 24(2): 123-129.
35. Sager O, Beyzadeoglu M, Dincoglan F, Gamsiz H, Demiral S, et al. (2014) Evaluation of linear accelerator-based stereotactic radiosurgery in the management of glomus jugulare tumors. Tumori 100(2): 184-188.
36. Ozsavaş EE, Telatar Z, Dirican B, Sager O, Beyzadeoğlu M (2014) Automatic segmentation of anatomical structures from CT scans of thorax for RTP. Comput Math Methods Med 2014: 472890.
37. Demiral S, Beyzadeoglu M, Sager O, Dincoglan F, Gamsiz H, et al. (2014) Evaluation of linear accelerator (linac)-based stereotactic radiosurgery (srs) for the treatment of craniopharyngiomas. UHOD - Uluslararasi Hematoloji-Onkoloji Dergisi 24: 123-129.
38. Gamsiz H, Beyzadeoglu M, Sager O, Dincoglan F, Demiral S, et al. (2014) Management of pulmonary oligometastases by stereotactic body radiotherapy. Tumori 100(2): 179-183.
39. Dincoglan F, Sager O, Gamsiz H, Uysal B, Demiral S, et al. (2014) Management of patients with ≥ 4 brain metastases using stereotactic radiosurgery boost after whole brain irradiation. Tumori 100(3): 302-306.
40. Sager O, Beyzadeoglu M, Dincoglan F, Demiral S, Uysal B, et al. (2013) Management of vestibular schwannomas with linear accelerator-based stereotactic radiosurgery: a single center experience. Tumori 99(5): 617-622.
41. Dincoglan F, Beyzadeoglu M, Sager O, Uysal B, Demiral S, et al. (2013) Evaluation of linear accelerator-based stereotactic radiosurgery in the management of meningiomas: A single center experience. J BUON 18(3): 717-722.
42. Dincoglan F, Beyzadeoglu M, Sager O, Oysul K, Kahya YE, et al. (2013) Dosimetric evaluation of critical organs at risk in mastectomized left-sided breast cancer radiotherapy using breath-hold technique. Tumori 99(1): 76-82.
43. Demiral S, Beyzadeoglu M, Uysal B, Oysul K, Kahya YE, et al. (2013) Evaluation of stereotactic body radiotherapy (SBRT) boost in the management of endometrial cancer. Neoplasma 60(3): 322-327.
44. Sager O, Beyzadeoglu M, Dincoglan F, Oysul K, Kahya YE, et al. (2012) Evaluation of active breathing control-moderate deep inspiration breath-hold in definitive non-small cell lung cancer radiotherapy. Neoplasma 59(3): 333-340.
45. Saǧer Ö, Dinçoǧlan F, Gamsiz H, Demiral S, Uysal B, et al. (2012) Evaluation of the impact of integrated [18f]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography imaging on staging and radiotherapy treatment volume definition of nonsmall cell lung cancer. Gulhane Med J 54: 220-227.
46. Sager O, Beyzadeoglu M, Dincoglan F, Oysul K, Kahya YE, et al. (2012) The Role of Active Breathing Control-Moderate Deep Inspiration Breath-Hold (ABC-mDIBH) Usage in non-Mastectomized Left-sided Breast Cancer Radiotherapy: A Dosimetric Evaluation. UHOD - Uluslararasi Hematoloji-Onkoloji Dergisi 22: 147-155.
47. Dincoglan F, Sager O, Gamsiz H, Uysal B, Demiral S, et al. (2012) Stereotactic radiosurgery for intracranial tumors: A single center experience. Gulhane Med J 54: 190-198.
48. Dincoglan F, Beyzadeoglu M, Sager O, Oysul K, Sirin S et al. (2012) Image-guided positioning in intracranial non-invasive stereotactic radiosurgery for the treatment of brain metastasis. Tumori 98(5): 630-635.
49. Sirin S, Oysul K, Surenkok S, Sager O, Dincoglan F, et al. (2011) Linear accelerator-based stereotactic radiosurgery in recurrent glioblastoma: A single center experience. Vojnosanit Pregl 68(11): 961-966.
50. Demiral S, Sager O, Dincoglan F, Uysal B, Gamsiz H, et al. (2018) Evaluation of Target Volume Determination for Single Session Stereotactic Radiosurgery (SRS) of Brain Metastases. Canc Therapy & Oncol Int J 12(5): 555848.
51. Beyzadeoglu M, Sager O, Dincoglan F, Demiral S (2019) Evaluation of Target Definition for Stereotactic Reirradiation of Recurrent Glioblastoma. Arch Can Res 7(13): 3.
52. Sager O, Dincoglan F, Demiral S, Gamsiz H, Uysal B, et al. (2019) Evaluation of the Impact of Magnetic Resonance Imaging (MRI) on Gross Tumor Volume (GTV) Definition for Radiation Treatment Planning (RTP) of Inoperable High Grade Gliomas (HGGs). Concepts in Magnetic Resonance Part A 2019, Article ID 4282754.
53. Sager O, Dincoglan F, Demiral S, Gamsiz H, Uysal B, et al. (2019) Utility of Magnetic Resonance Imaging (Imaging) in Target Volume Definition for Radiosurgery of Acoustic Neuromas. Int J Cancer Clin Res 6(3): 119.
54. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2019) Assessment of Computed Tomography (CT) And Magnetic Resonance Imaging (MRI) Based Radiosurgery Treatment Planning for Pituitary Adenomas. Canc Therapy & Oncol Int J 13(2): 555857.
55. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2019) Multimodality Imaging for Radiosurgical Management of Arteriovenous Malformations. Asian Journal of Pharmacy, Nursing and Medical Sciences 7(1): 7-12.
56. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2019) Evaluation of Radiosurgery Target Volume Determination for Meningiomas Based on Computed Tomography (CT) And Magnetic Resonance Imaging (MRI). Cancer Sci Res Open Access 5(2): 1-4.
57. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2019) Assessment of target definition based on Multimodality imaging for radiosurgical Management of glomus jugulare tumors (GJTs). Canc Therapy & Oncol Int J 15(2): 555909.
58. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2019) Incorporation of Multimodality Imaging in Radiosurgery Planning for Craniopharyngiomas: An Original Article. SAJ Cancer Sci 6: 103.
59. Beyzadeoglu M, Dincoglan F, Demiral S, Sager O (2020) Target Volume Determination for Precise Radiation Therapy (RT) of Central Neurocytoma: An Original Article. International Journal of Research Studies in Medical and Health Sciences 5(3): 29-34.
60. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2020) Utility of Multimodality Imaging Based Target Volume Definition for Radiosurgery of Trigeminal Neuralgia: An Original Article. Biomed J Sci & Tech Res 26(2): 19728-19732.
61. Demiral S, Beyzadeoglu M, Dincoglan F, Sager O (2020) Assessment of Target Volume Definition for Radiosurgery of Atypical Meningiomas with Multimodality Imaging. Journal of Hematology and Oncology Research 3(4): 14-21.
62. Dincoglan F, Beyzadeoglu M, Demiral S, Sager O (2020) Assessment of Treatment Volume Definition for Irradiation of Spinal Ependymomas: an Original Article. ARC Journal of Cancer Science 6(1): 1-6.
63. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2020) Target Volume Definition for Stereotactic Radiosurgery (SRS) Of Cerebral Cavernous Malformations (CCMs). Canc Therapy & Oncol Int J 15(4): 555917.
64. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2020) Treatment Volume Determination for Irradiation of Recurrent Nasopharyngeal Carcinoma with Multimodality Imaging: An Original Article. ARC Journal of Cancer Science 6(2): 18-23.
65. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2020) Assessment of Target Volume Definition for Irradiation of Hemangiopericytomas: An Original Article. Canc Therapy & Oncol Int J 17(2): 555959.
66. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2020) Evaluation of Treatment Volume Determination for Irradiation of chordoma: an Original Article. International Journal of Research Studies in Medical and Health Sciences 5(10): 3-8.
67. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2020) Multimodality Imaging Based Target Definition of Cervical Lymph Nodes in Precise Limited Field Radiation Therapy (Lfrt) for Nodular Lymphocyte Predominant Hodgkin Lymphoma (Nlphl). ARC Journal of Cancer Science 6(2): 06-11.
68. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2020) Radiosurgery Treatment Volume Determination for Brain Lymphomas with and without Incorporation of Multimodality Imaging. Journal of Medical Pharmaceutical and Allied Sciences 9: 2398-2404.
69. Beyzadeoglu M, Dincoglan F, Sager O, Demiral S (2020) Determination of Radiosurgery Treatment Volume for Intracranial Germ Cell Tumors (GCTS). Asian Journal of Pharmacy, Nursing and Medical Sciences 8(3): 18-23.
70. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2020) Target Definition of orbital Embryonal Rhabdomyosarcoma (Rms) by Multimodality Imaging: An Original Article. ARC Journal of Cancer Science 6(2): 12-17.
71. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2020) Evaluation of Target Volume Determination for Irradiatıon of Pilocytic Astrocytomas: An Original Article. ARC Journal of Cancer Science 6(1): 1-5.
72. Demiral S, Beyzadeoglu M, Dincoglan F, Sager O (2020) Evaluation of Radiosurgery Target Volume Definition for Tectal Gliomas with Incorporation of Magnetic Resonance Imaging (MRI): An Original Article. Biomedical Journal of Scientific & Technical Research (BJSTR) 27(2): 20543-20547.
73. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2021) Assessment of Multimodality Imaging for Target Definition of Intracranial Chondrosarcomas. Canc Therapy Oncol Int J 18(2): 001-005.
74. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2021) Impact of Multimodality Imaging to Improve Radiation Therapy (RT) Target Volume Definition for Malignant Peripheral Nerve Sheath Tumor (MPNST). Biomed J Sci Tech Res 34(3): 26734-26738.
75. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2021) Multimodality Imaging Based Treatment Volume Definition for Reirradiation of Recurrent Small Cell Lung Cancer (SCLC). Arch Can Res 9: 1-5.
76. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2021) Radiation Therapy (RT) Target Volume Definition for Peripheral Primitive Neuroectodermal Tumor (PPNET) by Use of Multimodality Imaging: An Original Article. Biomed J Sci & Tech Res 34(4): 26970-26974.
77. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2021) Evaluation of Target Definition for Management of Myxoid Liposarcoma (MLS) with Neoadjuvant Radiation Therapy (RT). Biomed J Sci Tech Res 33(5): 26171-26174.
78. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2021) Radiation Therapy (RT) target determination for irradiation of bone metastases with soft tissue component: Impact of multimodality imaging. J Surg Surgical Res 7: 042-046.
79. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2021) Evaluation of Changes in Tumor Volume Following Upfront Chemotherapy for Locally Advanced Non Small Cell Lung Cancer (NSCLC). Glob J Cancer Ther 7: 031-034.
80. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2021) Assessment of posterior fossa target definition by multimodality imaging for patients with medulloblastoma. J Surg Surgical Res 7: 037-041.
81. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2021) Assessment of the role of multimodality imaging for treatment volume definition of intracranial ependymal tumors: An original article. Glob J Cancer Ther 7: 043-045.
82. Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2022) Assessment of Target Definition for Extramedullary Soft Tissue Plasmacytoma: Use of Multımodalıty Imaging for Improved Targetıng Accuracy. Canc Therapy & Oncol Int J 22(4): 556095.
83. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2022) Target Volume Determination for Recurrent Uterine Carcinosarcoma: An Original Research Article Revisiting the Utility of Multimodality Imaging. Canc Therapy & Oncol Int J 22(3): 556090.
84. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2022) Reappraisal of Computed Tomography (CT) And Magnetic Resonance Imaging (MRI) Based Target Definition for Radiotherapeutic Management of Recurrent Anal Squamous Cell Carcinoma (ASCC): An Original Article. Canc Therapy & Oncol Int J 22(2): 556085.
85. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2022) An Original Article for Assessment of Multimodality Imaging Based Precise Radiation Therapy (Rt) in the Management of Recurrent Pancreatic Cancers. Canc Therapy & Oncol Int J 22(1): 556078.
86. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2022) Assessment of Target Volume Definition for Precise Radiotherapeutic Management of Locally Recurrent Biliary Tract Cancers: An Original Research Article. Biomed J Sci & Tech Res 46(1): 37054-37059.
87. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2022) Radiation Therapy (RT) Target Volume Determination for Locally Advanced Pyriform Sinus Carcinoma: An Original Research Article Revisiting the Role of Multimodality Imaging. Biomed J Sci & Tech Res 45(1): 36155-36160.
88. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2022) Improved Target Volume Definition for Radiotherapeutic Management of Parotid Gland Cancers by use of Multimodality Imaging: An Original Article. Canc Therapy & Oncol Int J 21(3): 556062.
89. Beyzadeoglu M, Sager O, Demiral S, Dincoglan F (2022) Reappraisal of multimodality imaging for improved Radiation Therapy (RT) target volume determination of recurrent Oral Squamous Cell Carcinoma (OSCC): An original article. J Surg Surgical Res 8: 004-008.
90. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2022) Multimodality imaging based treatment volume definition for recurrent Rhabdomyosarcomas of the head and neck region: An original article. J Surg Surgical Res 8(2): 013-018.
91. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2022) Appraisal of Target Definition for Management of Paraspinal Ewing Tumors with Modern Radiation Therapy (RT): An Original Article. Biomed J Sci & Tech Res 44(4): 35691-35696.
92. Beyzadeoglu M, Sager O, Demiral S, Dincoglan F (2022) Assessment of Target Volume Definition for Contemporary Radiotherapeutic Management of Retroperitoneal Sarcoma: An Original Article. Biomed J Sci & Tech Res 44(5): 35883-35887.
93. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2023) Appraisal of Target Definition for Anaplastic Thyroid Carcinoma (ATC): An Original Article Addressing the Utility of Multimodality Imaging. Canc Therapy & Oncol Int J 24(4): 556143.
94. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2023) Reappraisal of Treatment Volume Determination for Parametrial Boosting in Patients with Locally Advanced Cervical Cancer. Canc Therapy & Oncol Int J 24(5): 556148.
95. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2023) Tumor Size Changes after Neoadjuvant Systemic Therapy for Advanced Oropharyngeal Squamous Cell Carcinoma. Canc Therapy & Oncol Int J 24(5): 556147.
96. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2023) Assessment of Changes in Tumor Volume Following Chemotherapy For Nodular Sclerosıng Hodgkin Lymphoma (NSHL). Canc Therapy & Oncol Int J 24(5): 556146.
97. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2023) Evaluation of Volumetric Changes in Transglottic Laryngeal Cancers After Induction Chemotherapy. Biomed J Sci & Tech Res 51(4): 43026-43031.
98. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2023) An Original Research Article for Evaluation of Changes in Tumor Size After Neoadjuvant Chemotherapy in Borderline Resectable Pancreatic Ductal Adenocarcinoma. Biomed J Sci & Tech Res 52(1): 43253-43255.
99. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2023) Assessment of Tumor Size Changes After Neoadjuvant Chemotherapy in Locally Advanced Esophageal Cancer: An Original Article. Biomed J Sci & Tech Res 52(2): 43491-43493.
100. Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2023) Evaluation of Target Definition for Radiotherapeutic Management of Recurrent Merkel Cell Carcinoma (MCC). Canc Therapy & Oncol Int J 24(2): 556133.
101. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2023) Reappraisal of Treatment Volume Determination for Recurrent Gastroesophageal Junction Carcinoma (GJC). Biomed J Sci & Tech Res 50(5): 42061-42066.
102. Beyzadeoglu M, Dincoglan F, Demiral S, Sager O (2023) An Original Article Revisiting the Utility of Multimodality Imagıng For Refıned Target Volume Determinatıon Of Recurrent Kidney Carcinoma. Canc Therapy & Oncol Int J 23(5): 556122.
103. Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2023) Appraisal of Target Definition for Recurrent Cancers of the Supralottic Larynx. Biomed J Sci & Tech Res 50(5): 42131-42136.
104. Dincoglan F, Beyzadeoglu M, Demiral S, Sager O (2024) Appraisal of Changes in Tumor Volume After Neoadjuvant Systemic Therapy for Hepatocellular Carcinoma (HCC). Cancer Ther Oncol Int J 26(2): 001-004.
105. Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2024) Reappraisal of Target Definition for Sacrococcygeal Chordoma: Comparative Assessment with Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Biomed J Sci & Tech Res 55 (1): 46686-46692.
106. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2024) Assessment of Changes in Tumor Size After Induction Systemic Therapy for Locally Advanced Cervical Squamous Cell Carcinoma Running title: Tumor size changes in cervical carcinoma. Cancer Ther Oncol Int J 26(1): 001-007.