Küçük hücreli dışı akciğer kanserli kranial metastaz gelişen olgularda metastazektomi yapılan ve sistemik tedavi alan hastaların retrospektif değerlendirilmesi
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Date
2020-03-20
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Bursa Uludağ Üniversitesi
Abstract
Küçük hücreli dışı akciğer kanseri (KHDAK)’nin en sık metastaz yaptığı organlardan biri beyindir. Beyin metastazı olan hastalar tedavi edilmediğinde ortalama yaşam süresi aylarla sınırlıdır. Bu çalışmanın amacı beyin metastazı yapmış evre 4 KHDAK hastalarda beyin metastazı için cerrahi tedavi uygulamasının onkolojik sonuçlarını göstermektir. Kliniğimizde 2004-2012 yılları arasında KHDAK tanısı konan ve BM nedeniyle cerrahi tedavi uygulanan 59 hastanın verileri prospektif olarak kaydedildi ve retrospektif olarak incelendi. Hastaların cerrahi ve onkolojik sonuçları irdelendi. Sağ kalım süresi beyin metastazı tanısı konulduğu tarih ile ölüm tarihi veya mevcut en son takip arasındaki zaman olarak hesaplandı. Hastaların 51’i erkek, 8’i kadın, ortalama yaş 56.92 (37-81) yıl idi. Cerrahi olarak 55 hastaya total eksizyon, 4 hastaya subtotal eksizyon yapıldı. Ameliyat sonrası mortalite saptanmadı. Patolojik inceleme sonucunda 55 hastada cerrahi sınırlar tümörsüz, 4 hastada ise cerrahi sınır mikroskobik pozitif olarak bildirildi. Ameliyat sonrasında tüm hastalara palyatif kranial radyoterapi ve sistemik kemoterapi verildi. 11 hastaya(%18,6) akciğerdeki primer kitleye kemoradyoterapi verildi. 8 hastaya akciğere yönelik cerrahi lobektomi, 7 hastaya pnömonektomi uygulandı. Medyan genel sağkalım süresi 12,00 (1,0-159,0) aydı. Hastaların 12, 24 ve 60 aylık sağkalım oranları sırasıyla %47.5, %28.8 ve %13.5 olarak bulundu. Üç olguda ise 10 yılın üzerinde genel sağ kalım elde edildi. Beyin metastazı yapmış KHDAK’lu hastalarda kranial metastazektomi hastaların sağkalımına olumlu katkı sağlayabilir.
The brain is one of the organs that non-small cell lung cancer (NSCLC) metastasizes most frequently. The life expectancy is limited to months in patients with brain metastasis (BM), which is not treated. This study aims to show the oncological outcomes of surgical treatment of cranial lesion in patients with stage 4 NSCLC. The data of 59 patients who were diagnosed with NSCLC and underwent surgical treatment of BM between 2004 and 2012 in our clinic were prospectively recorded and analyzed retrospectively. The surgical and oncological outcomes of the patients were studied. Survival was calculated as the time between the diagnosis of BM and the date of death or the last followup. Fifty-one of the patients were male, and eight were female, and the median age was 56.9 (37-81) years. Fifty-five patients underwent total excision, and four patients underwent subtotal excision. No postoperative mortality was detected. As a result of the pathological examination, the surgical margins were reported as tumor-free in 55 patients, and microscopically positive in 4 patients. Palliative cranial radiotherapy and systemic chemotherapy were given to all patients after surgery. Eleven patients (18.6%) underwent chemoradiotherapy to the primary mass in the lung. Lobectomy and pneumonectomy were performed in 8 and 7 patients. The median overall survival was 12.00 (1.0159.0) months. The 12, 24, and 60-month survival rates of the patients were 47.5%, 28.8%, and 13.5%, respectively. In three cases, overall survival over ten years was obtained. Cranial metastasectomy may contribute positively to the survival of patients with NSCLC.
The brain is one of the organs that non-small cell lung cancer (NSCLC) metastasizes most frequently. The life expectancy is limited to months in patients with brain metastasis (BM), which is not treated. This study aims to show the oncological outcomes of surgical treatment of cranial lesion in patients with stage 4 NSCLC. The data of 59 patients who were diagnosed with NSCLC and underwent surgical treatment of BM between 2004 and 2012 in our clinic were prospectively recorded and analyzed retrospectively. The surgical and oncological outcomes of the patients were studied. Survival was calculated as the time between the diagnosis of BM and the date of death or the last followup. Fifty-one of the patients were male, and eight were female, and the median age was 56.9 (37-81) years. Fifty-five patients underwent total excision, and four patients underwent subtotal excision. No postoperative mortality was detected. As a result of the pathological examination, the surgical margins were reported as tumor-free in 55 patients, and microscopically positive in 4 patients. Palliative cranial radiotherapy and systemic chemotherapy were given to all patients after surgery. Eleven patients (18.6%) underwent chemoradiotherapy to the primary mass in the lung. Lobectomy and pneumonectomy were performed in 8 and 7 patients. The median overall survival was 12.00 (1.0159.0) months. The 12, 24, and 60-month survival rates of the patients were 47.5%, 28.8%, and 13.5%, respectively. In three cases, overall survival over ten years was obtained. Cranial metastasectomy may contribute positively to the survival of patients with NSCLC.
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Keywords
Akciğer kanseri, Beyin metastazı, Brain metastasis, Lung cancer
Citation
Deligönül, A. vd. (2020). ''Küçük hücreli dışı akciğer kanserli kranial metastaz gelişen olgularda metastazektomi yapılan ve sistemik tedavi alan hastaların retrospektif değerlendirilmesi''. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 46(1), 21-24.