Kamal Sabir AKBAROV, Niyazi Mustafa ASGAROV, Elchin Huseyn GULİYEV, Kamal İdrak KAZİMOV, Orkhan Galib DUNYAMALİYEV, Kamal S AKBAROV

Yalnız Radyoterapi ile Eşzamanlı Kemo-Radyoterapi Alan Servikal Kanserli Hastalarda Tümör Regresyon Oranlarının Karşılaştırılması

Amaç: Bu araştırmanın amacı, yalnız radyoterapi alan hastalar ile eşzamanlı kemo-radyoterapi alan Servikal kanserli hastalarda tümör regresyon oranlarını karşılaştırmaktır. Hastalar ve yöntem: Evre IIA-IIIB Servikal kanserli 72 hasta çalışmaya alındı. Hastalar iki gruba ayrıldı. Grup I’de, haftalık iki doza bölünmüş olarak 9,0 Gy HDR ICBT ve 46-50 Gy toplam doz EBRT kullandık. Grup II’de, aynı radyoterapi rejimine ilaveten sisplatin (40 mg/m2, haftada, 5 hafta) eklendi. Tümörün tedavi öncesi en uzun çapı EBRT tedavisinden sonraki ölçümlerle karşılaştırıldı, ancak ICBT tedavisi öncesi ile karşılaştırılmadı. Tedaviye yanıt oranı, tedavinin sona ermesinden 1 ay sonra değerlendirildi. Bulgular: Tümör regresyonu, ICBT öncesi %12’ den %61’e değin geniş ölçüde değişmekteydi. Ancak, tümör regresyon oranı, kemo-radyoterapi alan hastalarda, (%39’dan %61’e kadar değişmekte olup, ortalaması %53), yalnız radyoterapi alan hastalara (%12’den %49’a kadar değişmekte olup, ortalaması %35), göre daha yüksekti. ≥5 cm’den daha uzun çaplı tümörlerde, tümör regresyon oranı, yalnız radyoterapi alan hastalarda %12’den %42’ye kadar değişmekte olup, medyan %26,2’dir, kemo-radyoterapi alan hastalarda ise %39’dan %48’e kadar değişmekte olup, medyan %44,8’dir. Sonuç: EBRT, brakiterapi ve eşzamanlı kemoterapi yoluyla ileri evre servikal kanserin tedavi edilmesine dair çalışmamızdaki sonuçlar, bütün hastalarda tümör küçülme oranının tatmin edici oranlarda olduğunu göstermiştir. Sonuçlarımız, tümör regresyon oranının eşzamanlı kemoradyoterapi alan hastalarda, yalnız radyoterapi alan hastalardan belirgin olarak yüksek olduğunu göstermektedir.

Anahtar Kelimeler:

Servikal kanser, brakiterapi, kemo-radyoterapi, tümör küçülme oranı, sisplatin

Comparison of Tumor Regression Rate in Cervical Cancer Patients Treated with Radiotherapy Alone versus Chemoradiotherapy

Aim: The aim of the research was to compare the tumor regression rate between Cervical Cancer patients treated with radiation therapy alone or concurrent chemo-radiotherapy. Patients and methods: Seventy-two patients with IIA-IIIB stage cervical cancer were included. Patients were divided to 2 groups. In group I, we used EBRT in total dose of 46-50 Gy and HDR ICBT – two divided doses of 9,0 Gy weekly. In group II, we carried out the same radiotherapy regimen with additionally cisplatin (40 mg/m2, weekly, 5 weeks). The longest diameter of the tumor before treatment was compared to measurement after EBRT but prior to ICBT. Treatment response rate was evaluated 1 month after end of the treatment. Results: Tumor regression prior to ICBT varied widely, ranging from 12% to 61%. However, the tumor regression rate was higher in patients treated with chemo-radiotherapy, ranging from 39% to 61% (Mean 53%) compared to radiotherapy alone ranging from 12% to 49% (Mean 35%). In tumors with longest diameter ≥5 cm, tumor regression rate was ranged between 12% to 42% (median 26,2%) in patients treated with radiotherapy alone, and between 39% to 48% (median 44,8%) in patients treated with chemoradiotherapy. Conclusions: Outcome of this study for advanced cervical cancer treated by EBRT, brachytherapy and simultaneous chemotherapy shows satisfactory tumor shrinkage rate among all patients. Our results show that tumor regression rate is significantly higher in patients treated with concurrent chemoradiotherapy compared to radiotherapy alone.

Keywords:

cervical cancer, brachytherapy, chemoradiotherapy, tumor shrinkage, cisplatin,

PDF

___

Choi CH, Lee JW, Kim TJ, Kim WY, Nam HR, Kim BG, Huh SJ, Lee JH, Bae DS: Phase II Study of Consolidation Chemotherapy after Concurrent Chemoradiation in Cervical Cancer: Preliminary Results. Int J Radiation Oncology Biol Phys. 68(3): 817–822, 2007.

Ohno T, Nakano T, Kato S, Koo CC, Chansilpa Y, Pattaranutaporn P, Calaguas MJ, de Los Reyes RH, Zhou B, Zhou J, Susworo R, Supriana N, Dung TA, Ismail F, Sato S, Suto H, Kutsutani-Nakamura Y, Tsujii H: Accelerated Hyperfractionated Radiotherapy for Cervical Cancer: Multi-Institutional Prospective Study of Forum for Nuclear Cooperation in Asia among Eight Asian Countries. Int. J. Radiation Oncology Biol. Phys. 70(5): 1522–1529, 2008.

Asgarov NM, Guliyev EG, Huseynov RR: Radiotherapy of Cervical Cancer. Azerbaijan Oncology and Hematology Journal 2: 72-75, 2007.

Cetina L, Rivera L, Hinojosa J, Poitevin A, Uribe J, López-Graniel C, Cantş D, Candelaria M, de la Garza J, Dueñas-González A: Routine Management of Locally Advanced Cervical Cancer with Concurrent Radiation and Cisplatin. Five-Year Results. BMC Women's Health. 6:3, 2006.

Gaffney DK, Winter K, Dicker AP, Miller B, Eifel PJ, Ryu J, Avizonis V, Fromm M, Small W, Greven K: Efficacy and Patterns of Failure for Locally Advanced Cancer of the Cervix Treated with Celebrex (Celecoxib) and Chemoradiotherapy in Rtog 0128. J. Radiation Oncology Biol. Phys. 69(1):111-7, 2007.

Kasibhatla M, Clough RW, Montana GS, Oleson JR, Light K, Steffey BA, Jones EL: Predictors of Severe Gastrointestinal Toxicity After External Beam Radiotherapy and Interstitial Brachytherapy for Advanced or Recurrent Gynecologic Malignancies. Int. J. Radiation Oncology Biol. Phys. 65(2):398-403, 2006.

Saibishkumar EP, Patel FD, Sharma SC, Karunanidhi G, Ghoshal S, Kumar V, Kapoor R: Prognostic Value of Response to External Radiation in Stage IIIB Cancer Cervix in Predicting Clinical Outcomes: a Retrospective Analysis of 556 Patients From India. Radiotherapy and Oncology 79:142–146, 2006.

Lin LL, Yang Z, Mutic S, Miller TR, Grigsby PW: FDG- PET Imaging for the Assessment of Physiologic Volume Response During Radiotherapy in Cervix Cancer. Int. J. Radiation Oncology Biol. Phys. 1;65(1):177-81, 2006.

Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG: New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 92:205-16, 2000.