Güler YAVAŞ, Nasuh Utku DOĞAN, Çağdaş YAVAŞ, Çetin ÇELİK

Radyoterapi Uygulanan Jinekolojik Tümör Tanılı Olgularda Tedavi Sonuçları ve Prognostik Faktörler

Amaç: Radyoterapi tedavisi alan jinekolojik tümörlü hastaların değerlendirilmesi. Gereç ve Yöntemler: Haziran 2010-Ocak 2013 tarihleri arasında küratif radyoterapi RT uygulanan 78 jinekolojik tümörlü hasta retrospektif olarak değerlendirildi. Bulgular: Olguların 33’ü serviks kanseri, 44’ü endometriyum kanseri ve 1’i endoservikal kanal tümörü nedeni ile tedavi edildi. Medyan yaşı 56 idi aralık: 34–83 . Ortalama izlem süresi 23,9±1,4 ay idi. Tanı anında 18 hasta %23,1 premenopozal, 60 hasta %74,9 postmenopozaldi. Endometriyum kanseri nedeni ile opere edilen olguların 31’i adjuvan RT alırken; 9 olgu postoperatif KT ve RT aldı. Endometriyum kanseri tanısı olan 5 hasta nüks nedeni ile kurtarma cerrahisi ardından RT aldı. Serviks kanseri nedeni ile RT uygulanan hastaların 16’sına lokal ileri evre serviks kanseri nedeni ile defi nitif kemoradyoterapi uygulandı. On %30,3 serviks kanseri tanılı olgu ise adjuvan RT; 6 hasta %18,2 adjuvan kemoradyoterapi KRT , 1 olgu ise %3 kurtarma amaçlı RT aldı. Endoservikal kanal tümörü tanısı olan hastaya adjuvan KRT uygulandı. Endometriyum kanseri nedeni ile RT uygulanan hastalarda medyan sağkalım 26,3 ay, serviks kanseri nedeni ile RT uygulanan hastalarda ise 21,1 ay olarak bulundu. Endometriyum kanseri tanısı ile tedavi edilen hastalarda cox-regresyon analizinde lokal nüks p=0,046 , tümör çapı p= 0,030 ve evrenin p= 0,036 sağkalım ile ilişkisi gösterilirken; lenfovasküler alan invazyonu p=0,711 , myometriyal invazyonun p=0,684 sağkalım ile ilişkisi gösterilememiştir. Serviks kanseri nedeni ile tedavi edilen hastalarda ise lenf nodu pozitifl iği ile progresyonsuz hastalık arasında ilişki gösterilmiştir p=0,043 . Sonuç: Endometriyum kanserinde lokal nüks , tümör çapı ve evre sağkalım ile ilişkilidir. Serviks kanserinde ise lenf nodu pozitifl iği ile progresyonsuz hastalık arasında ilişki mevcuttur

Anahtar Kelimeler:

Endometriyum kanseri, Jinekolojik tümörler, Prognostik faktörler, Radyoterapi, Serviks kanseri

Radiotherapy in Gynecological Cancers: Analysis of Treatment Results and Prognostic Factors

Objective: To evaluate the patients with gynecologic tumors undergoing radiotherapy. Material and Methods: Seventy-eight patients with a diagnosis of gynecological malignancy who received curative radiotherapy RT between June 2010-January 2013 were retrospectively evaluated. Results: We treated 33, 44 and 1 patient for cervical cancer, endometrial cancer and endocervical canal tumor respectively. The median age was 56 years 34–83 . The mean follow-up period was 23.9±1.4 months. At the time of diagnosis, 18 23.1% patients were premenopausal whereas 60 74.9% patients were postmenopausal. Thirty-one endometrial cancer patients received adjuvant RT while 9 received adjuvant chemotherapy and RT. Five of the patients with a diagnosis of recurrent endometrial cancer received RT after salvage surgery. Sixteen patients with locally advanced cervical cancer were treated with defi nitive chemoradiotherapy. Ten patients 30.3% who were operated on for cervical cancer were administered adjuvant RT whereas 6 patients 18.2% received adjuvant chemoradiotherapy. The patient with endocervical canal tumor received adjuvant chemoradiotherapy. The median overall survivals were 26.3 and 21.1 months for patients with endometrial and cervical cancer respectively. Cox-regression analyses revealed that there was a relationship between the overall survival and local recurrence p=0.046 , tumor diameter p= 0.030 and stage p= 0.036 ; on the other hand there was no relationship between the overall survival and lymphovascular invasion p=0.711 and myometrial invasion p=0.684 . Conclusion: Survival in endometrial cancer is associated with local recurrence, maximal tumor diameter and stage. For cervical cancer, there is a close association with lymph node involvement and disease-free survival

Keywords:

Endometrial cancer, Gynecologic tumors, Prognostic factors, Radiotherapy, Cervical cancer,

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