Vildan ATICI, Vahap GENÇ, Fazilet KAYASELÇUK, İlhan TUNCER, Melek ERKİŞİ, Refik BURGUT, Candaş TUNALI

Meme kanserinde prognostik faktörler

1990-94 yılları arasında Çukurova Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalında 185 meme kanserli olguya mastektomi sonrası adjuvan radyoterapi (RT) verildi. Olgular yaş, menstruel durum, histopatoloji, grade, östrojen reseptörü, tümör büyüklüğü, aksiller lenf nodu durumu ve tedavi şeklinin prognoza etkisi açısından retrospektif olarak değerlendirildi. 49 olgu sitotoksik tedavi görmedi. 136 olguya en az 6 kür kemoterapi (KT) uygulandı. 118 olguya tamoksifen verildi. 67 olgu hormonal tedavi görmedi. Median 27 ay takip sonunda 185 olgunun 5'inde lokal nüks, 13'ünde kemik metastazı, 8'inde organ metastazı, 12'sinde kemik ve organ metastazı tespit edildi. 21 olgu kanser nedeniyle (8 olgu organ metastazı, 12 olgu kemik ve organ metastazı, 1 olgu lokal nüks, kemik ve organ metastazı), 9 olgu kanser dışı nedenle eks. oldu. 138 olgu tümörsüz takiptedir. Lokal rekürrens oranı %2.7, uzak metastaz oranı %18.9, hastalıksız sağkalım oranı %74.5, sağkalım oranı %88.7'dir. İstatistiksel analizlerde tümör büyüklüğü, aksiller lenf nodu sayısı, grade, operasyon tipi, aksillaya verilen RT dozu ile hastalıksız sağkalım ve sağkalım arasında anlamlı bir ilişki tespit edildi. T3-4 tümörler, grade II, 4 ve daha fazla sayıda aksiller lenf nodu metastazlı (aksiller bölgeye uygulanan ilave RT prognozu olumlu yönde etkilemedi.) ve simple mastektomi yapılan olguların prognozu daha kötü bulundu.

Prognostic factors in breast cancer

Adjuvant irradiation (RT) was given to 185 numbers of breast carcinoma case after mastectomy in Çukorova University Medical Faculty Main Science Branch of Radiation Oncology between 1990-94 years. The cases have been evaluated retrospectively according to age, menopausal status, histopatology, grade,estrogen receptors, tumor size, axillary nodal status and the impact of treatment on prognosis. 49 cases haven't got adjuvant chemotherapy. Six cycles chemotherapy have been applied to 136 cases. 118 cases have been given tamoxifen. 67 cases haven't got hormonotherapy. After a median follow-up of 27 months, local recurrence in 5 of 185 cases, bone métastase in 13 of them, organ métastase in 12 of them have been found. 21 cases have been exitus because of cancer (8 cases organ métastase, 12 cases organ and bone métastase, 1 case local recurrence, organ and bone métastase). 9 cases have been exitus because of the reason out of cancer. 138 cases have being followed without tumor. The incidence of local recurrence, distant métastase, disease free survival, overall survival is %2.7, %18.8, %74.5, %88.7 retrospectively. A significant relation has been found between tumor size, axillary nodal status, grade, type of operation, the dose of RT given to axilla and disease free survival and overall survival in statistical analysis. The prognos of T3-4 tumor, grade II, the cases with four or more positive nodes (boost irradiation to axillar area hasn't effected prognosis positively) and the cases treated with simple mastectomy has been found worse.

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1. Bianco A, de Placido S, Gallo C et al. Adjuvant therapy with tamoxifen in operable breast cancer. Lancet 1988; 2:1095-1099.
2. Bonadonna G, Valagussa P, Rossi A, et al. Ten-year experience with CMF- based adjuvant chemothreapy in resectable breast cancer. Breast cancer Res Treat 1985; 5:95-115.
3. Caldarola L, Volterrani P, Caldarola B, Lai M, Jayme A, Gaglia P. The influence of hormone receptors and hormonal adjuvant therapy on disease-free survival in breast cancer: A multifactorial analysis. Eur J Cancer Clin Oncol 1986; 22:151-155.
4. Chevallier B, Heintzman F, Mosseri V, et al. Prognostic value of estrogen and progesterone receptors in operable breast cancer. Cancer 1988; 15: 2517-2524.
5. Danoff B, Gray R, Gilchrist K, et al. Identification of a subgroup of patients with breast cancer and histologically positive axillary nodes receiving adjuvat chemothreapy who may benefit from post-op radiotherapy. Proc ASTRO 1985; 11 (suppl 1):151.
6. Davidson EN... Moleculer approaches and cell kinetics in assesing breast cancer risk. Ýn: Niederhuber John EN, ed. Current therapy in Oncology. USA: 1 st ed, Mosby Year book, 1993: 304-308.
7. Early Breast Cancer Trialists’ Collaborative Group: Effects of adjuvant tamoxifen and of cytotoxic on mortality in early breast cancer. N Engl J Med 1988; 319(26):1681-1692.
8. Fisher B, Redmond C, Fiþher ER,et al. The contribution of recent NSABP clinical trials of primary breast cancer therapy to an understanding of tumör biology. Cancer 1980; 46:1009-1025.
9. Fisher B, Slack NH, Bross ID et al. Cancer of the breast: Size of neoplazm and prognosis. Cancer 1969; 24:1071-1080.
10. Goldie JH, Coldman AJ. A matematical model for relating the drug sensitivity of tumors to their spontaneous mutation rate. Cancer Treat Rep 1979; 63:1727-1731.
11. Griem KL, Henderson IC, Gelman R, et al. The 5- year results of a randomized trial of adjuvant radiation therapy after chemotherapy in breast cancer patients treated with mastectomy. J Clin Oncol 1987; 5:1546-1555.
12. Haagensen CD. Diseases of the Breast. 3rd ed. Philadelphia: WB Saunders, 1986.
13. Henderson IC, Harris JR, Kinne DW, Helman S et al. Cancer of the breast. Ýn: Devita VT, Helman JR, Rosenberg SA, ed. Cancer Principles and practice of oncology. Philadelphia: 3rd edition: JB Lippincott Company, 1989:1197-1268.
14. Host H, Brennhovd IO, Loeb M. Postoperative radiotherapy in breast cancer-long term results from the oslo study. Int J Radiat Oncol Biol Phys 1986; 12:727-732.
15. Levitt SH, Potish RA, Boen JR, et al. The effect of definitive irradiation on local control and disease free survival in breast cancer. Int J Radiat Oncol Biol Phys 1986; 12:673-679.
16. Müller AGS, Van Zyl JA, Joubert G. Analysis of prognostic Factors in 568 Patients treated for breast cancer by surgery. J Surgy Oncol 1989, 42:126-131.
17. Perez CA, Garcia DM, Kuske RR et al. Breast: Stage T1 and T2 tumors in Perez CA, Brady LW, ed. Principles and practise of Radiation Oncology.. Philadelphia: 2nd ed: JB Lippincott CO, 1992: 877- 947.
18. Robins SL. The breast. Ýn: Robbins SL ed.. Pathologic basis of disease. Philadelphia: 1st edition, WB Sounders Company, 1265-1296.
19. Rutquist LE, Cedermark B, Glas U, et al: Randomized trial of adjuvant tamoxifen combined with postoperative radiation therapy or adjuvant chemotherapy in post menopausal breast cancer. Cancer 1990; 66:89-96.
20. Saver R, Schauer A, Rauschecker HF, et al. Therapy of small breast cancer: A prospective study on 1036 patients with special emphasis on prognostic factors. Int J Radiat Oncol Biol Phys 1992; 23:907-914.
21. Tapley NO, Spanos WJ, Fletcher GH, et al. Results in patients with breast cancer treated by radical mastectomy and postoperative irradiation with no adjuvant chemotherapy. Cancer 1982; 49:1316- 1319,.
22. Thorpe SM, Rose C, Rasmussen BB, Mouridsen HT, Bayer T, Keiding N. Prognostic value of steroid hormone receptors: Multivariate analysis of systemically untreated patients with node negative primary breast cancer. Cancer Res 1987; 47:6126- 6133.
23. Uematsu M, Born Stein BA, Recht A, et al. Longterm results of postoperative radiation therapy following mastectomy with or without chemotherapy in stage I-III breast cancer. Int J Radiat Oncol Biol Phys 1993; 25:765-770.
24. Winchester DP, Bernstein JR, Paige ML, et al. The Early Detection and Diagnosis of Breast Cancer. Atlanta: American cancer Society, 1988: 1-20.