Research Article
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Kemoradyoterapi Uygulanan Hastalarda İnflamatuvar İndeksler ile Tümör Volüm Değişiminin İlişkisi

Year 2021, Volume: 2 Issue: 1, 23 - 28, 06.03.2021
https://doi.org/10.48176/esmj.2021.11

Abstract

Giriş: Enflamatuar belirteçlerin tümörlerin kemoradyasyon yanıtı
üzerindeki etkisi, birden çok kanser üzerinde çalışılmaktadır. Çok
sayıda çalışma, tümör ilerlemesi ve prognozunun bağışıklık
durumu ve beslenme durumu ile ilişkili olduğunu göstermiştir. Bu
çalışmada farklı kanser tiplerinde, tümör hacmini değişimini
açısından, farklı kanser tiplerinde inflamatuar belirteçler ile
kemoradyasyon yanıtı arasındaki ilişkiyi araştırdık.
Yöntemler: Çalışmaya kanser tanısı yeterli olup eş zamanlı
kemoterapi ve radyoterapi ile tedavi edilen hastalar dahil edildi.
Hasta demografik özellikleri, lenfosit-nötrofil sayıları hemoglobin,
albümin, C-reaktif protein düzeyleri, tümörün patolojik alt tipi,
hastalığın evresi, tedavi modaliteleri, tümör hacimleri,
kemoterapötik ajanlar ve tedavi sonrası kemoradyoterapi
sonuçları kaydedildi.
Bulgular: Çalışmaya toplam 85 hasta dahil edildi. En sık tanılar
akciğer kanserini takiben beyin ve rektal kanserlerdi. En sık eş
zamanlı kemoterapi protokolü kapesitabin idi. Tam remisyon %
24,7 oranında saptanırken, hastaların yüzde altmış yedisinde
kemoradyoterapi sonrası kısmi remisyon görüldü. Tümör boyut
değişimi ile enflamatuar indeksler arasında hiçbir korelasyon
gözlenmedi. Ayrıca, tümör hacmindeki medyan değişiklik nötrofil
lenfosit oranı (NLO) - prognostik beslenme indeksi (PBI) yüksek
ve düşük gruplar arasında farklı değildi.
Sonuç: Bu çalışmada, tümör hacmi değişikliği ile inflamatuar
belirteçler arasında bir ilişki bulunmamıştır. Tümör hacminde
azalma ile bir ilişki olmamakla birlikte, kesin kemoradyoterapi
uygulanan hastalarda NLO prognostik bir belirteç olduğu
sonucuna varılmıştır.

References

  • 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015 Jan-Feb; 65(1): 5-29.
  • 2. Chen P, Wang C, Cheng B, et al. Plasma fibrinogen and serum albumin levels (FA score) act as a promising prognostic indicator in non-small cell lung cancer. Onco Targets Ther. 2017 Jun 21; 10: 3107-18.
  • 3. Zeng Q, Xue N, Dai D, et al. A Nomogram based on Inflammatory Factors C-Reactive Protein and Fibrinogen to Predict the Prognostic Value in Patients with Resected Non-Small Cell Lung Cancer. J Cancer. 2017 Feb 25; 8(5): 744-53.
  • 4. Yang H, Liu H, Chen Y, et al. Neoadjuvant Chemoradiotherapy Followed by Surgery Versus Surgery Alone for Locally Advanced Squamous Cell Carcinoma of the Esophagus (NEOCRTEC5010): A Phase III Multicenter, Randomized, Open-Label Clinical Trial. J Clin Oncol. 2018 Sep 20; 36(27): 2796-803.
  • 5. Stahl M, Walz MK, Stuschke M, et al. Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol. 2009 Feb 20; 27(6): 851-6.
  • 6. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov; 68(6): 394-424.
  • 7. Adelstein DJ, Li Y, Adams GL, et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003 Jan 1; 21(1): 92-8.
  • 8. Sun Y, Huang Z, Chi P. An inflammation index-based prediction of treatment response to neoadjuvant chemoradiotherapy for rectal mucinous adenocarcinoma. Int J Clin Oncol. 2020 Jul;25(7): 1299-307.
  • 9. Candido J, Hagemann T. Cancer-related inflammation. J Clin Immunol. 2013 Jan; 33 Suppl 1: S79-84.
  • 10. Sapienza C, Issa JP. Diet, Nutrition, and Cancer Epigenetics. Annu Rev Nutr. 2016 Jul 17; 36: 665-81.
  • 11. Demir H, Beypınar İ, Baykara M. The Effect of the Prognostic Nutritional Index on Chemoradiotherapy Response in Lung Cancer. J Oncol Sci. 2020; 6: 96–102.
  • 12. Onodera T, Goseki N, Kosaki G. [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984 Sep; 85(9): 1001-5.
  • 13. Hirahara N, Tajima Y, Fujii Y, et al. Preoperative Prognostic Nutritional Index Predicts Long-Term Surgical Outcomes in Patients with Esophageal Squamous Cell Carcinoma. World J Surg. 2018 Jul; 42(7): 2199-208.
  • 14. Hong S, Zhou T, Fang W, et al. The prognostic nutritional index (PNI) predicts overall survival of small-cell lung cancer patients. Tumour Biol. 2015 May;36(5):3389-97.
  • 15. Nakatani M, Migita K, Matsumoto S, et al. Prognostic Significance of the Prognostic Nutritional Index in Patients with Recurrent Esophageal Squamous Cell Carcinoma. Nutr Cancer. 2018 Apr;70(3):467-473.
  • 16. Sun K, Chen S, Xu J, et al. The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol. 2014 Sep;140(9):1537-49.
  • 17. Yang Y, Gao P, Song Y, et al. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: A meta-analysis. Eur J Surg Oncol. 2016; 42: 1176–82.
  • 18. Proctor MJ, Morrison DS, Talwar D, et al. An inflammationbased prognostic score (mGPS) predicts cancer survival independent of tumour site: A Glasgow Inflammation Outcome Study. Br J Cancer. 2011; 104: 726–34.
  • 19. Proctor MJ, Morrison DS, Talwar D, et al . A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer. 2011; 47: 2633–41.
  • 20. Cannon NA, Meyer J, Iyengar P, et al. Neutrophil-lymphocyte and platelet-lymphocyte ratios as prognostic factors after stereotactic radiation therapy for early-stage non-small-cell lung cancer. J Thorac Oncol. 2015; 10: 280–5.
  • 21. Shimizu K, Okita R, Saisho S, et al. Prognostic nutritional index before adjuvant chemotherapy predicts chemotherapy compliance and survival among patients with non-small-cell lung cancer. Ther Clin Risk Manag. 2015; 11: 1555–61.
  • 22. Kinoshita A, Onoda H, Imai N, et al. Comparison of the prognostic value of inflammation-based prognostic scores in patients with hepatocellular carcinoma. Br J Cancer. 2012; 107: 988–93.
  • 23. Sheng J, Yang YP, Ma YX, Qin T, Hu ZH, Hong SD, Zhou T, Huang Y, Zhao HY, et al. Low Prognostic Nutritional Index Correlates with Worse Survival in Patients with Advanced NSCLC following EGFR-TKIs. PLoS One. 2016 Jan 19; 11(1): e0147226.
  • 24. Rosenberg SA. Progress in human tumour immunology and immunotherapy. Nature. 2001; 411: 380–4.
  • 25. d'Engremont C, Vernerey D, Pointet AL, et al. Additive value of pre-operative and one-month post-operative lymphocyte count for death-risk stratification in patients with resectable pancreatic cancer: a multicentric study. BMC Cancer. 2016 Oct 26; 16(1): 823.
  • 26. Kobayashi N, Usui S, Kikuchi S, et al. Preoperative lymphocyte count is an independent prognostic factor in nodenegative non-small cell lung cancer. Lung Cancer. 2012; 75: 223-7.
  • 27. Saito H, Kono Y, Murakami Y, et al. Prognostic Significance of Pre- and Postoperative Lymphocyte Counts in Patients with Gastric Cancer. Dig Surg. 2019; 36: 137–43.
  • 28. Chen XL, Xue L, Wang W, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: A retrospective cohort study. Oncotarget. 2015; 6: 41370–82.
  • 29. Schwegler I, Von Holzen A, Gutzwiller JP, et al. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010; 97: 92–7.
  • 30. Watanabe M, Kinoshita T, Tokunaga M, et al. Complications and their correlation with prognosis in patients undergoing total gastrectomy with splenectomy for treatment of proximal advanced gastric cancer. Eur J Surg Oncol. 2018; 44: 1181–5.
  • 31. Peng Y, Li Z, Zhang S, et al. Association of DNA base excision repair genes (OGG1, APE1 and XRCC1) polymorphisms with outcome to platinum-based chemotherapy in advanced nonsmall-cell lung cancer patients. Int J Cancer. 2014; 135: 2687– 96.
  • 32. Sherry AD, Newman NB, Anderson JL, et al. Systemic inflammatory dynamics during chemoradiotherapy predict response, relapse, metastasis, and survival in esophageal carcinoma. J Surg Oncol. 2020; 121: 303–12.
  • 33. Guthrie GJK, Charles KA, Roxburgh CSD, et al. The systemic inflammation-based neutrophil-lymphocyte ratio: Experience in patients with cancer. Crit. Rev. Oncol. Hematol. 2013; 88: 218–30.
  • 34. Gorphe P, Chekkoury Idrissi Y, Tao Y, et al. Anemia and neutrophil-to-lymphocyte ratio are prognostic in p16-positive oropharyngeal carcinoma treated with concurrent chemoradiation. Papillomavirus Res. 2018; 5: 32–7.
  • 35. Hodek M, Sirák I, Ferko A, et al. Neoadjuvant chemoradiotherapy of rectal carcinoma. Strahlentherapie und Onkol. 2016; 192: 632–40.
  • 36. Ou D, Wang X, Wu M, et al. Prognostic value of postradiotherapy neutrophil-to-lymphocyte ratio in locally advanced nasopharyngeal carcinoma. Strahlentherapie und Onkol. 2020; 196:252–61.
  • 37. Cox S, Hurt C, Grenader T, et al. The prognostic value of derived neutrophil to lymphocyte ratio in oesophageal cancer treated with definitive chemoradiotherapy. Radiother Oncol. 2017; 125: 154–9.
  • 38. Tong YS, Tan J, Zhou XL, et al. Systemic immuneinflammation index predicting chemoradiation resistance and poor outcome in patients with stage III non-small cell lung cancer. J Transl Med. 2017 Oct 31; 15(1): 221.

Evaluation of the Correlation Between Inflammatory Indices and Tumor Volume in Patients Received Chemoradiation

Year 2021, Volume: 2 Issue: 1, 23 - 28, 06.03.2021
https://doi.org/10.48176/esmj.2021.11

Abstract

Introduction: The utility of the inflammatory markers on definitive
chemoradiation is worked on multiple cancers. Several studies
had shown that tumor progression and prognosis were associated
with immune status and nutritional condition. In this study, we
aimed to elucidate the relationship between inflammatory markers
and chemoradiation response in multiple cancer types in terms of
tumor volume.
Methods: The patients who had been diagnosed with cancer and
treated with concurrent chemotherapy and radiotherapy were
included in the study. The patient characteristics, lymphocyteneutrophil counts, hemoglobin, albumin and C-reactive protein
levels, pathologic tumor subtype, stage of the disease, treatment
modalities, tumor volumes, chemotherapeutic agents, and
chemoradiotherapy outcome after the treatment were recorded.
Results: A total of 85 patients were enrolled in the study. The
most frequent diagnoses were brain and rectal cancers following
lung carcinomas. The most commonly used concurrent
chemotherapy protocol was capecitabine. Sixty-seven percent of
the patients have partial remission after chemoradiation, and
24.7% had complete remission. No correlations were observed
between the volume reduction and inflammatory indexes. Also,
the median alteration in tumor volume was not different between
neutrophil to lymphocyte ratio (NLR) - prognostic nutritional index
(PNI) high and low groups.
Conclusion: In this study, we found no relationship between
tumor volume alteration and inflammatory markers. Although there
was no association with the tumor volume change, NLR was a
prognostic marker in patients who underwent definitive
chemoradiation.

References

  • 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015 Jan-Feb; 65(1): 5-29.
  • 2. Chen P, Wang C, Cheng B, et al. Plasma fibrinogen and serum albumin levels (FA score) act as a promising prognostic indicator in non-small cell lung cancer. Onco Targets Ther. 2017 Jun 21; 10: 3107-18.
  • 3. Zeng Q, Xue N, Dai D, et al. A Nomogram based on Inflammatory Factors C-Reactive Protein and Fibrinogen to Predict the Prognostic Value in Patients with Resected Non-Small Cell Lung Cancer. J Cancer. 2017 Feb 25; 8(5): 744-53.
  • 4. Yang H, Liu H, Chen Y, et al. Neoadjuvant Chemoradiotherapy Followed by Surgery Versus Surgery Alone for Locally Advanced Squamous Cell Carcinoma of the Esophagus (NEOCRTEC5010): A Phase III Multicenter, Randomized, Open-Label Clinical Trial. J Clin Oncol. 2018 Sep 20; 36(27): 2796-803.
  • 5. Stahl M, Walz MK, Stuschke M, et al. Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol. 2009 Feb 20; 27(6): 851-6.
  • 6. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov; 68(6): 394-424.
  • 7. Adelstein DJ, Li Y, Adams GL, et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003 Jan 1; 21(1): 92-8.
  • 8. Sun Y, Huang Z, Chi P. An inflammation index-based prediction of treatment response to neoadjuvant chemoradiotherapy for rectal mucinous adenocarcinoma. Int J Clin Oncol. 2020 Jul;25(7): 1299-307.
  • 9. Candido J, Hagemann T. Cancer-related inflammation. J Clin Immunol. 2013 Jan; 33 Suppl 1: S79-84.
  • 10. Sapienza C, Issa JP. Diet, Nutrition, and Cancer Epigenetics. Annu Rev Nutr. 2016 Jul 17; 36: 665-81.
  • 11. Demir H, Beypınar İ, Baykara M. The Effect of the Prognostic Nutritional Index on Chemoradiotherapy Response in Lung Cancer. J Oncol Sci. 2020; 6: 96–102.
  • 12. Onodera T, Goseki N, Kosaki G. [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984 Sep; 85(9): 1001-5.
  • 13. Hirahara N, Tajima Y, Fujii Y, et al. Preoperative Prognostic Nutritional Index Predicts Long-Term Surgical Outcomes in Patients with Esophageal Squamous Cell Carcinoma. World J Surg. 2018 Jul; 42(7): 2199-208.
  • 14. Hong S, Zhou T, Fang W, et al. The prognostic nutritional index (PNI) predicts overall survival of small-cell lung cancer patients. Tumour Biol. 2015 May;36(5):3389-97.
  • 15. Nakatani M, Migita K, Matsumoto S, et al. Prognostic Significance of the Prognostic Nutritional Index in Patients with Recurrent Esophageal Squamous Cell Carcinoma. Nutr Cancer. 2018 Apr;70(3):467-473.
  • 16. Sun K, Chen S, Xu J, et al. The prognostic significance of the prognostic nutritional index in cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol. 2014 Sep;140(9):1537-49.
  • 17. Yang Y, Gao P, Song Y, et al. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: A meta-analysis. Eur J Surg Oncol. 2016; 42: 1176–82.
  • 18. Proctor MJ, Morrison DS, Talwar D, et al. An inflammationbased prognostic score (mGPS) predicts cancer survival independent of tumour site: A Glasgow Inflammation Outcome Study. Br J Cancer. 2011; 104: 726–34.
  • 19. Proctor MJ, Morrison DS, Talwar D, et al . A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer. 2011; 47: 2633–41.
  • 20. Cannon NA, Meyer J, Iyengar P, et al. Neutrophil-lymphocyte and platelet-lymphocyte ratios as prognostic factors after stereotactic radiation therapy for early-stage non-small-cell lung cancer. J Thorac Oncol. 2015; 10: 280–5.
  • 21. Shimizu K, Okita R, Saisho S, et al. Prognostic nutritional index before adjuvant chemotherapy predicts chemotherapy compliance and survival among patients with non-small-cell lung cancer. Ther Clin Risk Manag. 2015; 11: 1555–61.
  • 22. Kinoshita A, Onoda H, Imai N, et al. Comparison of the prognostic value of inflammation-based prognostic scores in patients with hepatocellular carcinoma. Br J Cancer. 2012; 107: 988–93.
  • 23. Sheng J, Yang YP, Ma YX, Qin T, Hu ZH, Hong SD, Zhou T, Huang Y, Zhao HY, et al. Low Prognostic Nutritional Index Correlates with Worse Survival in Patients with Advanced NSCLC following EGFR-TKIs. PLoS One. 2016 Jan 19; 11(1): e0147226.
  • 24. Rosenberg SA. Progress in human tumour immunology and immunotherapy. Nature. 2001; 411: 380–4.
  • 25. d'Engremont C, Vernerey D, Pointet AL, et al. Additive value of pre-operative and one-month post-operative lymphocyte count for death-risk stratification in patients with resectable pancreatic cancer: a multicentric study. BMC Cancer. 2016 Oct 26; 16(1): 823.
  • 26. Kobayashi N, Usui S, Kikuchi S, et al. Preoperative lymphocyte count is an independent prognostic factor in nodenegative non-small cell lung cancer. Lung Cancer. 2012; 75: 223-7.
  • 27. Saito H, Kono Y, Murakami Y, et al. Prognostic Significance of Pre- and Postoperative Lymphocyte Counts in Patients with Gastric Cancer. Dig Surg. 2019; 36: 137–43.
  • 28. Chen XL, Xue L, Wang W, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: A retrospective cohort study. Oncotarget. 2015; 6: 41370–82.
  • 29. Schwegler I, Von Holzen A, Gutzwiller JP, et al. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010; 97: 92–7.
  • 30. Watanabe M, Kinoshita T, Tokunaga M, et al. Complications and their correlation with prognosis in patients undergoing total gastrectomy with splenectomy for treatment of proximal advanced gastric cancer. Eur J Surg Oncol. 2018; 44: 1181–5.
  • 31. Peng Y, Li Z, Zhang S, et al. Association of DNA base excision repair genes (OGG1, APE1 and XRCC1) polymorphisms with outcome to platinum-based chemotherapy in advanced nonsmall-cell lung cancer patients. Int J Cancer. 2014; 135: 2687– 96.
  • 32. Sherry AD, Newman NB, Anderson JL, et al. Systemic inflammatory dynamics during chemoradiotherapy predict response, relapse, metastasis, and survival in esophageal carcinoma. J Surg Oncol. 2020; 121: 303–12.
  • 33. Guthrie GJK, Charles KA, Roxburgh CSD, et al. The systemic inflammation-based neutrophil-lymphocyte ratio: Experience in patients with cancer. Crit. Rev. Oncol. Hematol. 2013; 88: 218–30.
  • 34. Gorphe P, Chekkoury Idrissi Y, Tao Y, et al. Anemia and neutrophil-to-lymphocyte ratio are prognostic in p16-positive oropharyngeal carcinoma treated with concurrent chemoradiation. Papillomavirus Res. 2018; 5: 32–7.
  • 35. Hodek M, Sirák I, Ferko A, et al. Neoadjuvant chemoradiotherapy of rectal carcinoma. Strahlentherapie und Onkol. 2016; 192: 632–40.
  • 36. Ou D, Wang X, Wu M, et al. Prognostic value of postradiotherapy neutrophil-to-lymphocyte ratio in locally advanced nasopharyngeal carcinoma. Strahlentherapie und Onkol. 2020; 196:252–61.
  • 37. Cox S, Hurt C, Grenader T, et al. The prognostic value of derived neutrophil to lymphocyte ratio in oesophageal cancer treated with definitive chemoradiotherapy. Radiother Oncol. 2017; 125: 154–9.
  • 38. Tong YS, Tan J, Zhou XL, et al. Systemic immuneinflammation index predicting chemoradiation resistance and poor outcome in patients with stage III non-small cell lung cancer. J Transl Med. 2017 Oct 31; 15(1): 221.
There are 38 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Articles
Authors

İsmail Beypınar 0000-0002-0853-4096

Fuzuli Tuğrul 0000-0001-9724-253X

Publication Date March 6, 2021
Published in Issue Year 2021 Volume: 2 Issue: 1

Cite

APA Beypınar, İ., & Tuğrul, F. (2021). Evaluation of the Correlation Between Inflammatory Indices and Tumor Volume in Patients Received Chemoradiation. Eskisehir Medical Journal, 2(1), 23-28. https://doi.org/10.48176/esmj.2021.11
AMA Beypınar İ, Tuğrul F. Evaluation of the Correlation Between Inflammatory Indices and Tumor Volume in Patients Received Chemoradiation. Eskisehir Med J. March 2021;2(1):23-28. doi:10.48176/esmj.2021.11
Chicago Beypınar, İsmail, and Fuzuli Tuğrul. “Evaluation of the Correlation Between Inflammatory Indices and Tumor Volume in Patients Received Chemoradiation”. Eskisehir Medical Journal 2, no. 1 (March 2021): 23-28. https://doi.org/10.48176/esmj.2021.11.
EndNote Beypınar İ, Tuğrul F (March 1, 2021) Evaluation of the Correlation Between Inflammatory Indices and Tumor Volume in Patients Received Chemoradiation. Eskisehir Medical Journal 2 1 23–28.
IEEE İ. Beypınar and F. Tuğrul, “Evaluation of the Correlation Between Inflammatory Indices and Tumor Volume in Patients Received Chemoradiation”, Eskisehir Med J, vol. 2, no. 1, pp. 23–28, 2021, doi: 10.48176/esmj.2021.11.
ISNAD Beypınar, İsmail - Tuğrul, Fuzuli. “Evaluation of the Correlation Between Inflammatory Indices and Tumor Volume in Patients Received Chemoradiation”. Eskisehir Medical Journal 2/1 (March 2021), 23-28. https://doi.org/10.48176/esmj.2021.11.
JAMA Beypınar İ, Tuğrul F. Evaluation of the Correlation Between Inflammatory Indices and Tumor Volume in Patients Received Chemoradiation. Eskisehir Med J. 2021;2:23–28.
MLA Beypınar, İsmail and Fuzuli Tuğrul. “Evaluation of the Correlation Between Inflammatory Indices and Tumor Volume in Patients Received Chemoradiation”. Eskisehir Medical Journal, vol. 2, no. 1, 2021, pp. 23-28, doi:10.48176/esmj.2021.11.
Vancouver Beypınar İ, Tuğrul F. Evaluation of the Correlation Between Inflammatory Indices and Tumor Volume in Patients Received Chemoradiation. Eskisehir Med J. 2021;2(1):23-8.