Lokal ileri rezeke edilemeyen pankreas kanserinde kemoterapi ve kemoradyoterapi tedavilerinin etkinliklerinin karşılaştırılması
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Date
2012
Authors
Tandoğan, Gülen
Journal Title
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Publisher
Uludağ Üniversitesi
Abstract
Pankreas kanseri, Amerika Birleşik Devletleri'nde dördüncü sırada kanserden ölüm nedenidir. Pankreas tümörlerin büyük çoğunluğu (%85), duktal epitelden kaynaklanan adenokarsinomlardır. Medyan sağkalım lokal ileri hastalığı olanlar için 8 -12 ay iken, metastatik hastalığı olanlar için daha azdır. Lokal ileri rezeke edilemeyen pankreas kanserinde radyoterapi ve kemoterapi uygulanması ile sağkalım artar. Lokal ileri rezeke edilemeyen pankreas kanseri için optimal tedavi tartışmalıdır.Bu çalışmada lokal ileri rezeke edilemeyen pankreas kanseri olan 59hasta retrospektif olarak incelenmiştir. Hastaların genel (OS) ve progresyonsuz sağkalımları (PFS) ve toksisiteleri değerlendirilmiştir. Hastaların 25'i kemoterapi (19'u 5FU ile gemsitabin, 6'sı tekli gemsitabin) alıp, daha sonra eş zamanlı gemsitabin ile beraber radyoterapi almış olup, 34'ü ise sadece kemoterapi almıştır (15'i tekli gemsitabin, 19'u ise 5FU ile gemsitabin). Kemoradyoterapi ve kemoterapi grubu OS ve PFS açısından karşılaştırıldığında iki grup arasında genel sağkalım süreleri açısından anlamlı fark saptanmıştır. Kemoradyoterapi grubunda OS 19.27±4.14 ay bulunurken, PFS 17.094±4.065 ay bulunmuştur. Kemoterapi grubunda ise OS 12.394±2.43 ay, PFS 7.602±0.93 ay bulunmuştur (sırasıyla p=0.040 ve p=0,006). Toksisite açısından bakıldığında kemoradyoterapi kolunda grade 3-4 gastrointestinal mukozit %20,8 görülmüş olup grade 3-4 hematolojik toksisite %4-12.5 bulunmuştur. Kemoterapi kolunda ise grade 3-4 hematolojik toksisite %11-14, gastrointestinal toksisite ise %17,6 bulunmuştur. Her iki grup arasında toksisite açısından anlamlı fark görülmemiştir.Sonuç olarak; bizim çalışmamızda kemoradyoterapi alan ve kemoterapi alan hastalar karşılaştırıldığında, OS ve PFS kemoradyoterapi alan grupta anlamlı olarak daha uzun bulunmuş, her iki grup arasında toksisite açısından anlamlı fark görülmemiştir.
Pancreatic cancer is the fourth cause of deaths cancer-related in the United States. The majority of these tumors (85%), are adenocarcinomas arising from the ductal epithelium. Approximately 40 percent of the patients have metastatic disease and 30 to 40 percent have locally advanced unresectable tumors. Median survival is 8 to 12 months for patients with locally advanced disease, and quite short those with metastatic disease. Radiotherapy and chemotherapy increases survival of unresectable locally advanced pancreatic cancer. However, the optimal treatment for locally advanced unresectable pancreatic cancer is controversial.In this study, 59 patients with locally advanced unresectable pancreatic cancer were analyzed retrospectively and chemoradiotherapy and chemotherapy arms evaluated for overall and progression-free survival and toxicity. Tweenty-five of the patients received chemotherapy (19 patients received gemcitabine and 5FU and 6 patients gemcitabine alone) then received radiotherapy with concurrent gemcitabine and 34 of the patients received only chemotherapy. Overall survival and progression-free survival were significantly longer in the chemoradiotherapy group compared to the chemotherapy only group. In Chemoradiotherapy arm, overall survival (OS), was 19.7±4.4 months, and progression-free survival (PFS) was 17.094±4.065 months, ın chemotherapy group OS was 12.394±2.43 months, and PFS was 7.602±0.93 months (p=0.040 and p=0.006, respectively). In chemoradiothreapy arm grade 3-4 gastrointestinal toxicity rate %20.8, and grade 3-4 hematologic toxicity was %4-12.5, ın chemothreapy arm grade 3-4 hematologic toxicity %11-14 while gastrointestinal toxicity was %17.6. No significant difference was found interm of toxicity between the groups.As a result, our findings suggest that chemoradiotherapy confers significant survival benefit with comperabl toxicity profile compared to the chemotherapy only.
Pancreatic cancer is the fourth cause of deaths cancer-related in the United States. The majority of these tumors (85%), are adenocarcinomas arising from the ductal epithelium. Approximately 40 percent of the patients have metastatic disease and 30 to 40 percent have locally advanced unresectable tumors. Median survival is 8 to 12 months for patients with locally advanced disease, and quite short those with metastatic disease. Radiotherapy and chemotherapy increases survival of unresectable locally advanced pancreatic cancer. However, the optimal treatment for locally advanced unresectable pancreatic cancer is controversial.In this study, 59 patients with locally advanced unresectable pancreatic cancer were analyzed retrospectively and chemoradiotherapy and chemotherapy arms evaluated for overall and progression-free survival and toxicity. Tweenty-five of the patients received chemotherapy (19 patients received gemcitabine and 5FU and 6 patients gemcitabine alone) then received radiotherapy with concurrent gemcitabine and 34 of the patients received only chemotherapy. Overall survival and progression-free survival were significantly longer in the chemoradiotherapy group compared to the chemotherapy only group. In Chemoradiotherapy arm, overall survival (OS), was 19.7±4.4 months, and progression-free survival (PFS) was 17.094±4.065 months, ın chemotherapy group OS was 12.394±2.43 months, and PFS was 7.602±0.93 months (p=0.040 and p=0.006, respectively). In chemoradiothreapy arm grade 3-4 gastrointestinal toxicity rate %20.8, and grade 3-4 hematologic toxicity was %4-12.5, ın chemothreapy arm grade 3-4 hematologic toxicity %11-14 while gastrointestinal toxicity was %17.6. No significant difference was found interm of toxicity between the groups.As a result, our findings suggest that chemoradiotherapy confers significant survival benefit with comperabl toxicity profile compared to the chemotherapy only.
Description
Keywords
Lokal ileri pankreas kanseri, Kemoterapi, Kemoradyoterapi, Locally advanced pancreatic cancer, Chemoradiotherapy, Chemotherapy
Citation
Tandoğan, G. (2012). Lokal ileri rezeke edilemeyen pankreas kanserinde kemoterapi ve kemoradyoterapi tedavilerinin etkinliklerinin karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.