Nazofarenks kanserinde prognostik faktörler
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Date
2004
Authors
Kartal, Candan
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
AMAÇ: Lokal ileri evre nazofarenks kanserinde standart tedavi yöntemi olan radyoterapi ile beraber kemoterapi ve brakiterapi kullanımının tedavi sonuçları üzerindeki etkisini incelemek ve prognostik faktörleri belirlemektir. GEREÇ VE YÖNTEM: Birimimizde 1996-2003 yılları arasında radyoterapi ve kemoterapi ile tedavi edilen lokal ileri nazofarenks karsinomlu 39 hasta değerlendirildi. Yirmidokuz erkek ve 10 kadın hasta çalışmaya alındı. Hastaların ortanca yaşı 50 idi. Onbir hasta (%28,2) yassı epitel hücreli karsinom, 25 hasta andiferansiye karsinom (64,1), 3 hasta sınıflandırılmayan karsinoma sahipti. Yirmi iki hastaya eksternal radyoterapi (%56.4), 13 hastaya radyoterapi ve brakiterapi (%33,3), 4 hastaya (%10.3) hiperfraksiyone radyoterapi uygulandı. Toplam radyoterapi dozu 1.8-2 Gy/fx'dan 60-70 Gy olarak verildi. Brakiterapi radyoterapi bitiminden 2-3 hafta sonra 7Gy/fx'dan 1 kez uygulandı. Yirmi beş hasta eş zamanlı kemoterapi (%64), 13 hasta neoadjuvan (%33.3) ve 31 hasta adjuvan (%79.5) kemoterapi aldı. Neoadjuvan ve adjuvan olarak en sık kullanılan kemoterapi protokolü sisplatin ve 5-flurourasil idi. Radyoterapi ile eş zamanlı olarak sisplatin (20-40 mg/m2) uygulandı. Hastalar tedavi sonrasında ilk yıl için ayda bir, ikinci yıl için iki ayda bir, üçüncü yılda üç ayda bir fizik muayene, endoskopik muayene ve/veya biyopsi, hemogram ve biokimya değerleriyle kontrol edildi. Radyolojik yanıt değerlendirmesi RT bitiminden sonraki 1. ayda yapıldı. Hastalar yaş, cinsiyet, histopatoloji, evre, tümör ve nodal evre, toplam radyoterapi dozu, radyoterapi seması, eş zamanlı-neoadjuvan-adjuvan kemoterapi alımı, radyoterapiye ara verilmesinin patolojik yanıt, radyolojik tam/belirgin yanıt ve metastaz gelişimi üzerine etkileri ve bu değişkenlerin toplam ve metastazsız sağkalım ile ilişkileri incelendi. İstatistiksel değerlendirmede Kolmogorow Smirnov, Fisher kesin ki-kare testi, Mann-vVhitney testi, Kaplan Meier, tek değişkenli ve çok değişkenli Cox Regresyon analiz testleri kullanıldı. BULGULAR: Nazofarenks karsinomlu hastalar üzerinde yaptığımız çalışmada hastaların hiçbirinde progresyon ve nüks görülmedi. Radyoterapi ile eş zamanlı kemoterapi uygulamasının patolojik yanıtı artırdığı tesbit edildi (p=0,03). Pre Hb değeri ≥12 olan hastalarda lokal kontrol (p=0,053), mid ve post Hb değerleri ≥12 olan hastalarda radyolojik tam/belirgin yanıtın arttığı belirlendi (sırasıyla p=0,029, p=0,011). Adjuvan kemoterapi kullanımının uzak metastazsız sağkalımı (p=0,01) ve toplam sağkalımı (p=0,0006) uzattığı görüldü. Radyolojik olarak tam/belirgin yanıt alınan hastalarda metastazsız sağkalım ve toplam sağkalım anlamlı derecede uzun bulundu (p=0,0004, 0,0001 ). Benzer şekilde patolojik yanıt alınan hastalarda metastazsız ve toplam sağkalımın uzadığı belirlendi (p=0,0025, p=0,0001). SONUÇ: Nazofarenks karsinomunun küratif tedavisinde modern radyoterapi yöntemleri ve optimum tümör dozu uygulaması ile daha iyi lokal ve bölgesel kontrol sağlanabilir. Radyoterapiye kemoterapi eklenmesi ile lokal ve bölgesel kontrol oranları artarken, hastalıksız ve toplam sağkalım süreleri de belirgin şekilde uzamaktadır. Daha iyi sonuçlar için homojen hasta gruplarının olduğu, daha etkili kemoterapi ilaçlarının ve radyoterapi şemalarının kullanıldığı geniş hasta serili çalışmalara ihtiyaç duyulmaktadır.
PURPOSE: The aim of this study is to investigate the effectiveness of radiotherapy usage, the main treatment method in local advanced nasopharyngeal carcinoma, with chemotherapy and adjuvant brachytherapy applications on treatment results and to determine their prognostic factors. MATERIALS AND METHODS: Thirty-nine locally advanced nasopharyngeal carcinoma patients, who received radiotherapy and chemotherapy between 1996-2003, were evaluated. Twenty-nine males, 10 females patients were enrolled in our study. The median age was 50. Tumors were classified as squamous cell carcinoma in 11 (%28.2), undifferantiated carcinomas in 25 (%64.1) and as unclassified carcinomas in 3 (% 7. 7) patients. Conventional radiotherapy was given to 22 patients (%56.4), radiotherapy and brachytherapy to 13 (%33.3) patients and hyperfractionated radiotherapy'to 4 (%10.3) patients. The total radiotherapy dose was 60-70 Gy fractions was with 1.8-2 Gy per day. Brachytherapy was delivered 2 or 3 weeks after the completion of radiotherapy with 7 Gy single fraction. While 25 patients received concurrent chemotherapy (%64), 13 of them (%33.3) received neoadjuvant chemotherapy and 31 of them (%79.5) received adjuvant chemotherapy. The commonly used neoadjuvant and adjuvant chemotherapy protocol was 5- fluouracil and cisplatin. Cisplatin (20-40 mg/2) was also given as a concurrent chemotherapy agent during radiotherapy. Following the treatment, the patients were followed-up monthly for 1 the year, every second month for the second year and every third month for the third year including physical examination, endoscopic examination and/or biopsy, complete blood count and biochemical values. Radiological response to treatment was evaluated in the first month after the completion of radiotherapy. Parameters such as age, gender, histopathology, stage, tumor stage, nodal stage, radiation dose, radiotherapy course, the application of concurrent, neoadjuvant and adjuvant chemotherapy, interruption period during radiotherapy were evaluated for the pathological response, radiological complete/evident response and the development of metastasis and the relations between the sum of these variables on overall and distant metastasis free survival were also investigated. The statistical evaluation is generated by using Kolmogorow Smirnov test, x2 and Ficher's exact test, Kaplan Meier test and univariate - multivariate Cox Regression analyse tests. OUTCOMES: In our study, no disease, progression or recurrence was seen any of the patients. It revealed that the usage of concurrent chemoradiotherapy improved the pathological response (p=0,03). While the value of preHb ≥12 was important on the local control (p=0,053), the values of mid and postHb ≥12 were found statistically significant on the radiological complete/evident response (p=0,029, p=0,011, respectively). The usage of adjuvant chemotherapy was also effective on distant metastasis free survival (p=0,01) and overall survival (p=0,0006). Distant metastasis free survival and overall surv!val were found statistically significant in the patients who presented radiological complete/evident response (p=0,0004, p=0,0001, respectively). Similarly, distant metastasis free survival and overall survival were longer in the patients whom had pathological response (p=0,0025, p=0,0001, respectively). CONCLUSION: The definitive treatment of nasopharyngeal carcinoma with using modern radiotherapy techniques and delivering optimum tumor dose can provide an advanced locoregional control. With the chemotherapy added to radiotherapy, locoregional control rates increase while disease-free survival and overall survival periods clearly get longer. As a conclusion, there is a certain need to have homogeneous patients groups, more effective chemotherapy agents and radiotherapy courses to get more improved treatment results.
PURPOSE: The aim of this study is to investigate the effectiveness of radiotherapy usage, the main treatment method in local advanced nasopharyngeal carcinoma, with chemotherapy and adjuvant brachytherapy applications on treatment results and to determine their prognostic factors. MATERIALS AND METHODS: Thirty-nine locally advanced nasopharyngeal carcinoma patients, who received radiotherapy and chemotherapy between 1996-2003, were evaluated. Twenty-nine males, 10 females patients were enrolled in our study. The median age was 50. Tumors were classified as squamous cell carcinoma in 11 (%28.2), undifferantiated carcinomas in 25 (%64.1) and as unclassified carcinomas in 3 (% 7. 7) patients. Conventional radiotherapy was given to 22 patients (%56.4), radiotherapy and brachytherapy to 13 (%33.3) patients and hyperfractionated radiotherapy'to 4 (%10.3) patients. The total radiotherapy dose was 60-70 Gy fractions was with 1.8-2 Gy per day. Brachytherapy was delivered 2 or 3 weeks after the completion of radiotherapy with 7 Gy single fraction. While 25 patients received concurrent chemotherapy (%64), 13 of them (%33.3) received neoadjuvant chemotherapy and 31 of them (%79.5) received adjuvant chemotherapy. The commonly used neoadjuvant and adjuvant chemotherapy protocol was 5- fluouracil and cisplatin. Cisplatin (20-40 mg/2) was also given as a concurrent chemotherapy agent during radiotherapy. Following the treatment, the patients were followed-up monthly for 1 the year, every second month for the second year and every third month for the third year including physical examination, endoscopic examination and/or biopsy, complete blood count and biochemical values. Radiological response to treatment was evaluated in the first month after the completion of radiotherapy. Parameters such as age, gender, histopathology, stage, tumor stage, nodal stage, radiation dose, radiotherapy course, the application of concurrent, neoadjuvant and adjuvant chemotherapy, interruption period during radiotherapy were evaluated for the pathological response, radiological complete/evident response and the development of metastasis and the relations between the sum of these variables on overall and distant metastasis free survival were also investigated. The statistical evaluation is generated by using Kolmogorow Smirnov test, x2 and Ficher's exact test, Kaplan Meier test and univariate - multivariate Cox Regression analyse tests. OUTCOMES: In our study, no disease, progression or recurrence was seen any of the patients. It revealed that the usage of concurrent chemoradiotherapy improved the pathological response (p=0,03). While the value of preHb ≥12 was important on the local control (p=0,053), the values of mid and postHb ≥12 were found statistically significant on the radiological complete/evident response (p=0,029, p=0,011, respectively). The usage of adjuvant chemotherapy was also effective on distant metastasis free survival (p=0,01) and overall survival (p=0,0006). Distant metastasis free survival and overall surv!val were found statistically significant in the patients who presented radiological complete/evident response (p=0,0004, p=0,0001, respectively). Similarly, distant metastasis free survival and overall survival were longer in the patients whom had pathological response (p=0,0025, p=0,0001, respectively). CONCLUSION: The definitive treatment of nasopharyngeal carcinoma with using modern radiotherapy techniques and delivering optimum tumor dose can provide an advanced locoregional control. With the chemotherapy added to radiotherapy, locoregional control rates increase while disease-free survival and overall survival periods clearly get longer. As a conclusion, there is a certain need to have homogeneous patients groups, more effective chemotherapy agents and radiotherapy courses to get more improved treatment results.
Description
Keywords
Nazofarenks, Kanser, Prognostik faktorler, Nasopharynx, Cancer, Prognostic factors
Citation
Kartal, C. (2004). Nazofarenks kanserinde prognostik faktörler. Yayınlanmamış tıpta uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.