Postoperatif radyoterapi uygulanan medulloblastoma tanılı çocuklarda uygulanan tedavinin, hastalıksız sağkalıma, genel sağkalıma etkisi ve radyoterapiye bağlı gelişen komplikasyonların araştırılması
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Date
2010
Authors
Karadağ, Oya
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Medulloblastoma serebellumdan gelişen bir primitif nöroektedermal tümör olup multidisipliner tedavi yaklaşımlarıyla %60'lara varan 5 yıllık sağkalım oranları elde edilebilmektedir. Radyoterapi (RT) multidisipliner tedavi yaklaşımının en önemli öğelerinden birisidir. Ancak çocukluk çağında uygulanan RT'nin; hastalığın lokal kontrolüne katkısının yanısıra, uzun dönem yan etkileri göz önünde bulundurulması gereken bir etmendir. Bu çalışmada medulloblastoma tanısıyla postoperatif RT uygulanan çocuklarda tedavinin hastalıksız ve genel sağkalıma etkisiyle RT'ye bağlı gelişen komplikasyonlar irdelenecektir.Ekim 1995-Aralık 2008 tarihleri arasında, Uludağ Üniversitesi Tıp Fakültesi Radysyon Onkolojisi Anabilim Dalı, Radyoterapi Merkezinde postoperatif RT uygulanan 21 medulloblastomalı olgu çalışmaya dahil edildi. Hastalara postoperatif kranial ortanca 4500 cGy (3690-5400 cGy), 5 fx/hafta, 1 fx da 150-180 cGy, spinal ortanca 3600 cGy (2850-3740 cGy), 5 fx/hafta, 1 fx da 150-180 cGy, posterior fossaya ortanca 5400 cGy (4500-6300 cGy), 5 fx/hafta, 1 fx da 150-180 cGy external RT uygulandı. Hastalardan birine (%4.7)`sine preoperatif kemoterapi (KT), 13'üne (%61.9) eş zamanlı KT, 16'sına (%76.1) postoperatif RT sonrası KT uygulanmıştır. Olgular uygulanan tedavinin genel ve hastalıksız sağkalıma etkisi ile geç dönem komplikasyonları açısından değerlendirildi. İstatiksel analiz için Ki-kare, Mann Whitney-u, Kaplan Meier Testleri kullanıldı.Hastalıksız sağkalım süresi, ortanca 39 ay (1-169 ay) ve genel sağkalım süresi, ortanca 50 ay (4-171 ay) olarak hesaplandı. Radyoterapi sonrası kemoterapi alan hasta grubuyla hastalıksız sağkalım ve genel sağkalım arasında istatistiksel olarak anlamlı ilişki gösterildi (sırasıyla p= 0.001, p= 0.012). Benzer şekilde RT sonrası regresyon görülen grup ile hastalıksız sağkalım ve genel sağkalım arasında istatistiksel anlamlı ilişki görülmüştür (sırasıyla p= 0.000, p= 0.000). Hastaların 8 (%66.6)`sının ders başarısı iyi, 3 (%25)`inin orta ve sadece 1 (%8.3) hastanın kötü seviyede olduğu görüldü. 12 çocuk boy persentil eğrilerine göre değerlendirildiğinde 11 çocuğun (%91.6) 50 persentil altında kaldığı, sadece 1 (%8.4) çocuğun 50 persentil üzerinde boya sahip olduğu tespit edildi .Radyoterapinin tedavi edici etkisi yanı sıra, sağlıklı vücut dokularının da radyasyonun zararlı etkilerine maruz kalabilmesi, medulloblastoma gibi intrakranyal tümörlerin tedavisinde, hastalıksız sağkalım ve genel sağkalımı etkilemeyecek şekilde, daha düşük doz seçeneklerine yönelmek gerekmektedir.
Medullablastoma is a primitive neuroectodermal tumour developing from cerebellum that has 5-years survival rates of 60% with multidisiplinary approach. Radiotherapy is one of the most significant component of this multidisiplinary treatment. However, long term adverse effects of radiotherapy in childhood should be considered besides its effect on local control of the disease. In this study, the effect of radiotherapy on disease free and overall survival and the complications due to administered radiotherapy post-operatively in children with medullablastoma will be discussed. Between October 1995-December 2008, 21 medullablastoma patients who received radiotherapy post-operatively in Uludağ University Faculty of Medicine, Department of Radiation Oncology were included in the study. Post-operatively, the externally radiotherapy doses administered were all 150-180 per fx and 5 fx weekly with cranial median of 4500 cGy (3690-5400 cGy); spinal median of 3600 cGy (2850-3740 cGy and posterior fossa median of 5400 cGy (4500-6300 cGy). One patient (4.7%) pre-operatively, 13 patients (61.9%) concomitant and 16 patients (76.1%) post-operatively received chemotherapy after RT. Subjects are evaluated for the effect on disease free and overall survival and long term complications of the administered therapy. Χ2 , Mann Whitney-U and Kaplan Meier tests are used for the statistical analyses. Disease free survival was 39 months (range; 1-169 months) and overall survival was 50 months (range; 4-171 months). In post-radiotherapy chemotherapy receiving patient group there was statistically significance in disease free and overall survival rates, with p=0.001 and p=0.012, respectively. Similarly in the post-radiotherapy group where regression was observed, disease free and overall survival rates were also statistically significant, both with p<0.0001. Eight patient’s (66.6 %) school performance was good, three patient’s (25%) was moderate and one patient’s (8.3%) was poor. Compared with height percentiles, 11 out of 12 children (91.6%) were under 50 percentile whereas one patient (8.4%) was above 50 percentile. In the treatment of intracranial tumours such as medullablastoma because of its harmful effects and radiation exposure to the healthy tissue besides the curative impact of radiotherapy, it is necessary to find lower dose alternatives which will not affect on disease free and overall survival.
Medullablastoma is a primitive neuroectodermal tumour developing from cerebellum that has 5-years survival rates of 60% with multidisiplinary approach. Radiotherapy is one of the most significant component of this multidisiplinary treatment. However, long term adverse effects of radiotherapy in childhood should be considered besides its effect on local control of the disease. In this study, the effect of radiotherapy on disease free and overall survival and the complications due to administered radiotherapy post-operatively in children with medullablastoma will be discussed. Between October 1995-December 2008, 21 medullablastoma patients who received radiotherapy post-operatively in Uludağ University Faculty of Medicine, Department of Radiation Oncology were included in the study. Post-operatively, the externally radiotherapy doses administered were all 150-180 per fx and 5 fx weekly with cranial median of 4500 cGy (3690-5400 cGy); spinal median of 3600 cGy (2850-3740 cGy and posterior fossa median of 5400 cGy (4500-6300 cGy). One patient (4.7%) pre-operatively, 13 patients (61.9%) concomitant and 16 patients (76.1%) post-operatively received chemotherapy after RT. Subjects are evaluated for the effect on disease free and overall survival and long term complications of the administered therapy. Χ2 , Mann Whitney-U and Kaplan Meier tests are used for the statistical analyses. Disease free survival was 39 months (range; 1-169 months) and overall survival was 50 months (range; 4-171 months). In post-radiotherapy chemotherapy receiving patient group there was statistically significance in disease free and overall survival rates, with p=0.001 and p=0.012, respectively. Similarly in the post-radiotherapy group where regression was observed, disease free and overall survival rates were also statistically significant, both with p<0.0001. Eight patient’s (66.6 %) school performance was good, three patient’s (25%) was moderate and one patient’s (8.3%) was poor. Compared with height percentiles, 11 out of 12 children (91.6%) were under 50 percentile whereas one patient (8.4%) was above 50 percentile. In the treatment of intracranial tumours such as medullablastoma because of its harmful effects and radiation exposure to the healthy tissue besides the curative impact of radiotherapy, it is necessary to find lower dose alternatives which will not affect on disease free and overall survival.
Description
Keywords
Medulloblastoma, Radyoterapi, Sağkalım, Komplikasyon, Radiotherapy, Survival, Complication
Citation
Karadağ, O. (2010). Postoperatif radyoterapi uygulanan medulloblastoma tanılı çocuklarda uygulanan tedavinin, hastalıksız sağkalıma, genel sağkalıma etkisi ve radyoterapiye bağlı gelişen komplikasyonların araştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.