Lokal ileri evre mesane kanserli olgularda radyoterapi ile eş zamanlı Gemsitabin tedavisinin etkinlik ve toksisitesinin değerlendirilmesi
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Date
2009
Authors
Öztürk, Huriye
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmada lokal ileri evre mesane kanserli olgularda radyoterapi (RT) ile eş zamanlı gemsitabin uygulanmasının etkinlik ve tolerabilitesinin değerlendirilmesi amaçlanmıştır. Ocak 2005–Ocak 2009 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Muammer Ağım Radyoterapi Merkezi’ne başvuran, evre II–IV mesane kanseri tanısıyla eş zamanlı gemsitabin kemoradyoterapisi (KRT) uygulanan 20 olgu retrospektif olarak değerlendirildi. Olguların ikisi (%10) kadın, 18’i (%90) erkek olup, ortanca yaş 72 (sınırlar: 40–78) idi. RT dozu olarak primer tümör ve bölgesel lenfatiklere yönelik 45 Gray (Gy) uygulandıktan sonra, primer tümöre yönelik 21,6 Gy’lik boost dozu verilerek toplam 66,6 Gy’ye ulaşıldı. RT haftada beş gün 1,8 Gy/fraksiyonluk konvansiyonel şema ile uygulandı. Tüm olgulara RT süresince 350 mg/m²/gün intravenöz gemsitabin (haftada bir gün) verildi. Ortanca izlem süresi 27 ay (sınırlar: 3–49) olup, bu süre içinde üç olguda (%15) lokorejyonel yineleme, iki olguda (%10) uzak metastaz geliştiği saptandı. Đzlem süresi içinde 10 olgu kansere bağlı metabolik yetmezlik, bir olgu intrakranial kanama (tedaviye bağlı kanama diatezi bulgusu olmaksızın), bir olgu ikinci primer pankreas kanseri nedeniyle tetkik edilirken, bir olgu renal yetmezlik nedeniyle kaybedildi. Yaşam Süresi Tabloları kullanılarak yapılan istatistiksel analizde 2 yıllık genel sağkalım ve hastalıksız sağkalım oranları %71 olarak bulundu. Tedavi sürecinde görülen akut yüksek gradlı (G3–4) hematolojik toksisite 10 (%50) ve non–hematolojik toksisite üç (%15) olguda kaydedildi. Sonuçta, gelişen yüksek gradlı toksisitenin kabul edilebilir düzeyde, lokorejyonel ve uzak yineleme oranlarının az, sağkalım oranlarının da yüksek olması nedeniyle, izlem süresi ve olgu sayısı sınırlı olmasına karşın, RT ile eş zamanlı uygulanan gemsitabin, etkin ve tolere edilebilir bir tedavi olarak değerlendirildi.
The aim of the study was to investigate the efficacy and tolerability of concomitant chemoradiotherapy (CRT) with gemcitabine in patients with locally advanced bladder cancer. Twenty patients with stage II–IV bladder urothelial carcinoma who were treated with CRT consisting of gemcitabine at Uludag University Faculty of Medicine Muammer Agim Radiotherapy Center, between January 2005 and January 2009, were evaluated retrospectively. The median age of the patients was 72 years (range: 40–78). Two (10%) and 18 (90%) of the cases were female and male, respectively. Radiotherapy was delivered with 1,8 Gy daily fractions 5 days per week. The median irradiation dose given to the primary tumor and regional lymph nodes was 45 Gy, followed by a boost dose of 21,6 Gy to the primary tumor, bringing to a total dose of 66,6 Gy. All patients received intravenous gemcitabine 350mg/m²/week (the first day of every week) during radiotherapy. During the median follow–up time of 27 months (range: 3–49), three of the patients (15%) showed locoregional failure. Distant metastases occured in two cases (10%). Ten cases (50%) died due to cancer–related metabolic failure, one patient died because of intracranial heamorrheage, one patient died because of second primary pancreatic carcinoma and one because of renal failure. In statistical analyses by Life Tables method the 2–year overall survival (OS), and disease–free survival (DFS) rates were both 71%, respectively. High grade (grade 3–4) haemathological toxicities were detected in 10 (50%), and non–haemathological toxicities were detected in three cases (15%), respectively. Although the follow–up time and the number of cases were not sufficient, given the acceptable rates of high grade toxicity, the low rates of locoregional and distant failure, and the high survival rates the concomitant CRT with gemcitabine is considered as an effective and tolerable treatment modality in locally advanced bladder cancer.
The aim of the study was to investigate the efficacy and tolerability of concomitant chemoradiotherapy (CRT) with gemcitabine in patients with locally advanced bladder cancer. Twenty patients with stage II–IV bladder urothelial carcinoma who were treated with CRT consisting of gemcitabine at Uludag University Faculty of Medicine Muammer Agim Radiotherapy Center, between January 2005 and January 2009, were evaluated retrospectively. The median age of the patients was 72 years (range: 40–78). Two (10%) and 18 (90%) of the cases were female and male, respectively. Radiotherapy was delivered with 1,8 Gy daily fractions 5 days per week. The median irradiation dose given to the primary tumor and regional lymph nodes was 45 Gy, followed by a boost dose of 21,6 Gy to the primary tumor, bringing to a total dose of 66,6 Gy. All patients received intravenous gemcitabine 350mg/m²/week (the first day of every week) during radiotherapy. During the median follow–up time of 27 months (range: 3–49), three of the patients (15%) showed locoregional failure. Distant metastases occured in two cases (10%). Ten cases (50%) died due to cancer–related metabolic failure, one patient died because of intracranial heamorrheage, one patient died because of second primary pancreatic carcinoma and one because of renal failure. In statistical analyses by Life Tables method the 2–year overall survival (OS), and disease–free survival (DFS) rates were both 71%, respectively. High grade (grade 3–4) haemathological toxicities were detected in 10 (50%), and non–haemathological toxicities were detected in three cases (15%), respectively. Although the follow–up time and the number of cases were not sufficient, given the acceptable rates of high grade toxicity, the low rates of locoregional and distant failure, and the high survival rates the concomitant CRT with gemcitabine is considered as an effective and tolerable treatment modality in locally advanced bladder cancer.
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Keywords
Mesane kanseri, Gemsitabin, Kemoradyoterapi, Bladder cancer, Gemcitabine, Chemoradiotherapy
Citation
Öztürk, H. (2009). Lokal ileri evre mesane kanserli olgularda radyoterapi ile eş zamanlı Gemsitabin tedavisinin etkinlik ve toksisitesinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.