Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi

Giriş ve Amaç: Evre IB-IIA Serviks kanseri tanılı hastaların yarıdan fazlası primer cerrahi sonrası adjuvan radyoterapiye ihtiyaç duymaktadır. Özellikle büyük tümör boyutu varlığında tedavide definitif radyoterapi önerilir. Evre III hastalarda ise definitif kemoradyoterapi standart yaklaşım olarak önerilmekte iken klinik uygulamada primer modalite olarak cerrahi halen kullanılmaktadır. Bu çalışmada kliniğimizde FIGO 2018’e göre Evre IB-III serviks kanseri tanısı ile definitif veya adjuvan radyoterapi uygulanmış hastaların tedavi sonuçlarının karşılaştırmalı değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: 2011-2019 yıllarında kliniğimizde serviks kanseri tanısı ile definitif radyoterapi (DRT) uygulanan 28 hasta ve adjuvan radyoterapi (ART) uygulanan 20 hasta çalışmaya dahil edildi. DRT ve ART hasta gruplarının özellikleri Ki-Kare testi ile, genel sağkalım (GS) ve progresyonsuz sağkalım (PSK) değerlendirmeleri Kaplan-Meier analizi ve log-rank testi ile, çok değişkenli analizler ise Cox regresyon analizi ile yapıldı. Bulgular: Medyan 39,6 ay (0,5-90,5) takip süresi sonunda 33 hasta hayattaydı. DRT ve ART gruplarında GS sırasıyla 39,65 ay ve 42,46 ay; PSK sırasıyla 26,10 ay ve 22,93 ay ve 3 yıllık sağkalım oranları sırasıyla %79,6 ve %72,2 idi. İki grup arasında GS ve PSK açısından istatistiksel olarak anlamlı fark tespit edilmedi (p=0.936, p=0,756). Çok değişkenli analiz sonuçlarında ECOG durumunun GS üzerinde, tümör boyutunun ise PSK üzerinde istatistiksel anlamlı etkisi bulundu (sırasıyla p=0,009, p=0,044). Tedavi modalitesinin ise PSK (p=0,724) veya GS (p=0,908) üzerinde istatistiksel olarak anlamlı bir etkisi gösterilmedi. Sonuç: Hastaların GS, PSK ve 3 yıllık sağkalım sonuçları literatür ile uyumludur. Evre IB-III serviks kanserinde definitif radyoterapi ve postoperatif adjuvan radyoterapi benzer sağkalım sonuçlarına sahiptir. Adjuvan radyoterapiye ihtiyaç duyacak hastalarda definitif radyoterapi tercih edilmesi düşünülmelidir.

Comparative Evaluation of Definitive and Adjuvant Radiotherapy Results in Stage IB-III Cervical Cancer

Objective: More than half of stage IB-IIA cervical carcinoma patients need adjuvant radiotherapy. Especially in cases with large tumors definitive radiotherapy is preferred. In stage III although definitive chemoradiotherapy is accepted as standard of care, surgery has still a non–negligible utilization in clinical practice. In this study we aimed to evaluate and compare the survival outcome of stage IB-III by FIGO 2018 cervical carcinoma patients after definitive or adjuvant radiotherapy. Materials and Methods: 28 patients who underwent definitive radiotherapy (DRT) and 20 patients who underwent adjuvant radiotherapy (ART) in our clinic between 2011-2019 were enrolled in the study. DRT and ART groups were compared with Chi-square test in terms of clinicopathological features. Overall (OS) and progression free survival (PFS) were evaluated via Kaplan-Meier analysis and log-rank test. Multivariate analysis was performed by Cox regression. Results: After a follow up period of median 39,6 (0,5-90,5) months, 33 patients were alive. In the DRT group OS, PFS and 3 years OS were 39,65 months, 26,10 months and 79,6% respectively where in the ART group they were calculated as 42,46 months, 22,93 months and 72,2% respectively. The difference between 2 groups in terms of OS and PFS was not statistically significant (p=0,936 and p=0,756). Multivariate analysis revealed a statistical significance for ECOG on OS and tumor size on PFS (p=0,009, p=0,044). However, the influence of treatment modality was not statistically significant on PFS (p=0,724) or OS (p=0,908). Conclusion: OS, PFS and 3 years OS results of our sample were compatible with previous literature. For stage IB-III cervical cancer, definitive radiotherapy and postoperative adjuvant radiotherapy have similar survival results. Definitive radiotherapy should be considered in patients who would need adjuvant radiotherapy.

Kaynakça

1.World Health Organization, Globocan 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012, http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed July 8 2017.

2.Bhatla, N, Aoki, D, Sharma, DN, Sankaranarayanan, R, FIGO Cancer Report 2018, Cancer of the cervix uteri, International Journal of Gynecology & Obstetrics, 2018,143 Suppl 2, 22-36.

3.Landoni, F, Maneo, A, Colombo, A, Placa, F, Milani, R, Perego P ve ark., Randomised study of radical surgery versus radiotherapy for stage Ib–IIa cervical cancer, Lancet, 1997, 350, 535-40.

4.Green, JA, Kirwan, JM, Tierney, JF, ve ark., Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis, Lancet, 2001, 358, 781–6.

5.Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials, Journal of Clinical Oncology, 2008, 26, 5802–12.

6.Ferrandina, G, Ercoli, A, Fagotti, A, ve ark., Completion surgery after concomitant chemoradiation in locally advanced cervical cancer: a comprehensive analysis of pattern of postoperative complications, Annals of Surgical Oncology, 2014,21,1692–9.

7.Hansen EK, Roach M. Hand-Book of Evidence based Radiation Oncology 3rd Edition, Springer, USA, 2018, s: 625-645, https://doi.org/10.1007/978-3-319-62642-0.

8.Horiot JC, Pigneux J, Pourquier H: Radiotherapy alone in carcinoma of the intact uterine cervix according to GH Fletcher guidelines: a French Cooperative study of 1383 cases, International Journal of Radiation Oncology, Biology, Physics, 1988, 14,605.

9.Perez, C, Camel HM, Walz, BJ, Radiation therapy alone in the treatment of carcinoma of the cervix: a 20 year experience, Gynecologic Oncology, 1986, 23,127.

10. Kim, RY, Trotti, A, Wu, CJ, Radiation alone in the treatment of cancer of the uterine cervix: analysis of pelvic failure and dose response relationship, International Journal of Radiation Oncology, Biology, Physics, 1989, 17,973.

11. Eifel, P, Morris, M, Wharton, JT, The influence of tumor size and morphology on the outcome of patients with FIGO stage IB squamous cell carcinoma of the uterine cervix, International Journal of Radiation Oncology, Biology, Physics, 1994,29,9.

12. Fuller, AFJ, Elliott, N, Kosloff, C, Determinants of increased risk for recurrence in patients undergoing radical hysterectomy for stage IB and IIA carcinoma of the cervix, Gynecologic Oncology, 1989, 33,34.

13. Artman, LE, Hoskins, WJ, Bibro, MC, Radical hysterectomy and pelvic lymphadenectomy for stage IB carcinoma of the cervix: 21 years experience, Gynecologic Oncology, 1987, 28,8.

14. Smiley, LM, Burk, TW, Silva, EG, Prognostic factors in stage IB squamous cervical cancer patients with low risk for recurrence, Obstetrics & Gynecology,1991, 77, 271.

15. Lee, YN, Wang, KL, Lin, MH, Radical hysterectomy with lymph node dissection for treatment of cervical carcinoma: a clinical review of 954 cases, Gynecologic Oncology, 1989, 32,135.

16. Peters WA ve ark., Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix, Journal of Clinical Oncology, 2000, 18(8),1606–1613.

17. Sedlis, A ve ark, A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a Gynecologic Oncology Group Study, Gynecologic Oncology, 1999, 73(2),177–183.

18. Berman, ML, Keys, H, Creasman, W, Survival and patterns of recurrence in cervical cancer metastatic to periaortic lymph nodes (a Gynecologic Oncology Group study), Gynecologic Oncology, 1984, 19,8.

19. Yeo, RM, Chia, YN, Namuduri, RP ve ark., Tailoring adjuvant radiotherapy for stage IB IIA node negative cervical carcinoma after radical hysterectomy and pelvic lymph node dissection using the GOG score, Gynecologic Oncology, 2011,123,225–229.

20. Minig, L, Patrono, MG, Romero, N ve ark., Different strategies of treatment for uterine cervical carcinoma stage IB2-IIB, World Journal of Clinical Oncology, 2014, 5, 86–92. 21. Sedlis, A, Bundy, BN, Rotman, MZ, Lentz, SS, Muder spach, LI, Zaino, RJ, A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study, Gynecologic Oncology, 1999,73,177–183.

22. Rose, PG, Ali, S, Watkins, E ve ark., Gynecologic Oncology Group. Long-term follow-up of a randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: A Gynecologic Oncology Group Study, Journal of Clinical Oncology, 2007, 25, 2804–2810.

23. Small, W Jr, Beriwal, S, Demanes, DJ ve ark., American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy, Brachytherapy, 2012, 11, 8–67.

24. Peters, WA, Liu, PY, Barrett, RJ ve ark, Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix, Journal of Clinical Oncology, 2000, 18, 1606–1613.

25. Whitney, CW, Sause, W, Bundy, BN ve ark., Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage llB-IVA carcinoma of the cervix with negative para-aortic lymph nodes: A Gynecologic Oncology Group and Southwest Oncology Group study, Journal of Clinical Oncology, 1999, 17, 1339–1348.

26. Morris, M, Eifel, PJ, Lu, J ve ark., Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. The New England Journal of Medicine, 1999, 340, 1137–1143.

27. Rose, PG, Bundy, BN, Watkins, EB ve ark., Concurrent cisplatinbased radiotherapy and chemotherapy for locally advanced cervical cancer, The New England Journal of Medicine, 1999, 340,1144–1153.

28. Keys, HM, Bundy, BN, Stehman, FB ve ark., Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma, The New England Journal of Medicine, 1999,340,1154–1161.

29. Keys, HM ve ark, Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the Gynecologic Oncology Group, Gynecologic Oncology, 2003, 89(3), 343–353

30. Mazeron, R, Gouy, S, Chargari C, Rivin Del Campo, E, Dumas, I, Mervoyer, A ve ark., Post radiation hysterectomy in locally advanced cervical cancer: outcomes and dosimetric impact, Radiotherapy & Oncology, 2016, 120, 460-6.

31. Albert, A, Allbright, R, Lee, A, Vijayakumar, S. Preoperative chemoradiation followed by hysterectomy for cervical cancer: patterns of care and survival in a large, hospital database, Journal of Gynecologic Oncology, 2019, 30(3), e41.

32. Fanfani, F, Vizza, E, Landoni, F ve ark., Radical hysterectomy after chemoradiation in FIGO stage III cervical cancer patients versus chemoradiation and brachytherapy: Complications and 3-years survival, European Journal of Surgical Oncology, 2016, 42(10),1519-25.

Kaynak Göster

Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi
  • ISSN: 2147-9607
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2014

4.4b2.3b

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