Zeynep ÖZSARAN, Deniz YALMAN, Vuslat YÜRÜT, Arif ARAS, Aydın ÖZSARAN, Merih HANHAN, Ayfer HAYDAROĞLU

Lokal ileri evre serviks kanseri tanısı ile radyokemoterapi uygulanan olgularda erken sonuçlar

Radyoterapi, lokal ileri evre serviks kanserlerinde standart tedavi yöntemidir. Ancak son yıllarda yapılan prospektif randomize çalışmaların sonuçları radyoterapi ile eşzamanlı kemoterapi uygulamasının yalnız radyoterapiye oranla lokal kontrol ve sağkalım avantajı sağladığını göstermiştir. Bu amaçla Ekim 1999-Aralık 2000 tarihleri arasında serviks kanseri tanısıyla kliniğimizde radyokemoterapi uygulanan 39 olgu erken dönem tedavi yanıtı, lokal kontrol ve yan etkiler açısından değerlendirilmiştir. Evre IB-IVA serviks kanseri tanılı 39 olguya pelvik radyoterapiyle eş zamanlı, haftalık 40 mg/m2 cisplatin uygulanmıştır. Cisplatin uygulaması medyan 5 hafta yapılmış, 32 olguya eksternal ve intrakaviter radyoterapi uygulanırken 7 olguda tümör yanıtının intrakaviter tedavi için uygun olmaması nedeniyle yalnız eksternal radyoterapi uygulanmıştır. Eksternal radyoterapi günlük 1.8 Gy'lik fraksiyonlarla yalnız eksternal radyoterapi uygulanan olgularda toplam 64.8 Gy, eksternal radyoterapi ve brakiterapi uygulanan olgularda ise 50.4 Gy'de orta hat koruması yapılarak toplam 54-59.4 Gy dozlarda uygulanmıştır. Brakiterapi uygulamaları Rotterdam aplikatör seti ile A noktasına toplam 8.5-18 Gy olacak şekilde mikroSelectron-HDR IR-192 cihazı ile gerçekleştirilmiştir. Medyan yaşı 55 olan olguların evrelere göre dağılımı FIGO evreleme sistemine göre %5.1 evre IB, %28.2 evre IIA, %43.6 evre IIB, %7.7 evre IIIA, %12.8 evre IIIB ve %2.6 evre IVA oranında şeklindedir. Histopatolojik değerlendirmede 33 olguda (%84.6) epidermoid karsinom, 1 olguda (%2.6) adenokarsinom, 2 olguda (%5.1) indiferan tümör, 1 olguda (%2.6) malign epitelial tümör saptanmış, 2 olguda (%5.1) ise biopsi sonucu yalnız malign tanısı konulabilmiş, histopatolojik tip belirlenememiştir. Medyan 20 ay takip edilen olguların 4'ünde (%10.3) lokal yineleme, 3 olguda (%7.7) biri kemik, ikisi akciğere olmak üzere uzak metastaz gelişmiştir. Klinik yanıt değeriendirmesinde 30 olguda (%76.9) tam, 8 olguda (%20.5) kısmi yanıt, 1 olguda (%2.6) stabil yanıt saptanmıştır. Radyokemoterapi sırası ve sonrasında kemoterapiye bağlı toksisite oranı %46.2, radyoterapiye bağlı erken toksisite oranı %66.7, geç toksisite oranı %71.8 olup olguların ileri evre serviks kanserlerinde eşzamanlı radyokemoterapi uygulamaları yüksek yanıt oranları ve kabul edilebilir toksisitesi nedeniyle uygun olgularda tercih edilen tedavi yöntemidir.

Anahtar Kelimeler:

Serviks neoplazmları, Sisplatin, İlaç tedavisi, İlaç toksisitesi, Radyoterapi

Radiochemotherapy for patients with locally advanced cervical cancer: Early results

Radiotherapy is the standart treatment of locally advanced cervical cancer. Recent results of the prospective randomized trials showed an overall survival and local control advantage for cisplatin based therapy given concurrently with radiation therapy. Thirty-nine patients who received concurrent chemoradiation between October 1999 and December 2000 were evaluated for treatment response, local control and toxicity. Thirty-nine patients with stage IB-IVA cervical carcinoma received weekly cisplatin 40 mg/m2 concurrent with radiotherapy. Median cisplatin administration was 5 weeks. Thirty-two patients received both external and intracavitary radiotherapy and seven patients received only external radiotherapy because of insufficient tumor response for intracavitary apllication. Total external radiotherapy dose was 64.8 Gy with 1.8 Gy daily fractions in patients who received only external radiotherapy. Midline shielding was performed at 50.4 Gy in patients who were going to receive brachytherapy and the total external radiotherapy dose was 54-59.4 Gy. Brachytherapy was performed with Rotterdam applicator via microSelectron HDR machine. A total dose of 8.5-18 Gy was applied to point A. Median age was 55. Distribution by stages according to FIGO staging system were as follows: stage IB 5.1 %, IIA 28.2%, IIB 43.6%, IIIA 7.7%, IIIB 12.8% and IVA 2.6%. Histologically 33 (84.6%) were epidermoid carcinoma, 1 was adenocarcinoma, 2 were indiffrentiated carcinoma, 1 was malignant epithelial tumor. In two patients histological subtype could not be specified. The median duration of follow-up was 20 months. Four patients (10.3%) had local recurrence and three developed distant metastases being two lung and one bone metastases. Thirty patients (76.9%) had complete response, 8 had (20.5%) partial response and one had (2.6%) stable disease. During or after radiochemotherapy 46.2% of the patients developed toxicity due to chemotherapy. Early and late radiation morbidity rates were 66.7% and 71.8% respectively. No grade III-IV toxicity was observed. Concurrent chemoradiation for locally advanced cervical cancer is the treatment of choice in suitable patients providing high response rates with acceptable toxicity.

Keywords:

Cervix Neoplasms, Cisplatin, Drug Therapy, Drug Toxicity, Radiotherapy,

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