Atınç AKSU, Yücel PAK, Müge AKMANSU, Diclehan ÜNSAL

Ekstranodal baş-boyun lenfomalarında sağkalımı etkileyen faktörler: Tek merkez sonuçları

Baş-boyun bölgesi yerleşimli, yüksek gradlı, ekstranodal, Hodgkindışı lenfoma (NHL) tanılı olgularımızın özellikleri ve sağkalım üzerinde etkili prognostik faktörlerin retrospektif olarak incelenmesi amaçlanmıştır. Hasta ve Yöntemler: Yüksek gradlı, ekstranodal, baş-boyun yerleşimli 33 NHL olgusu 1997-2004 yılları arasında tedavi edilmiştir. Kadın/erkek oranı 13/20 ve medyan yaş 48’dir. Tümör yerleşimi 19 olguda tonsil olmak üzere 29’unda Waldeyer halkasındadır. B semptom(ları) 14 olguda ve serum LDH yüksekliği 12 olguda mevcuttu. 30 olgu diffüz büyük hücreli fenotipindeydi. Tüm hastalara medyan 6 kür kemoterapi (30 olguda CHOP, 3 olguda CEOP rejimi) sonrasında medyan 40 Gy tutulmuş alan radyoterapisi uygulandı. “Bulky” tümör (6 cm üzerine tümör çapı), yaş, LDH düzeyi, performans durumu ve evre parametrelerini içeren düşük, orta ve yüksek olmak üzere 3 ayrı risk grubu oluşturularak sağkalım analizleri yapılmıştır. Bulgular: Ortalama takip süresi 32.64 aydır. Genel ve hastalıksız sağkalım süreleri sırasıyla 75.73 ve 74.89 ay, 2 yıllık sağkalım oranları sırasıyla %78 ve %67 olarak bulundu. Genel ve hastalıksız sağkalım açısından düşük-orta riskli gruplar lehine istatiksel anlamlı fark tespit edildi. Kötü performans durumu, yüksek serum LDH düzeyi veya “bulky” hastalık varlığının hem tek başına hem de bir arada sağkalımı olumsuz etkilediği tespit edildi. Sonuç: “Bulky” tümör, yüksek gradlı, ekstranodal baş-boyun yerleşimli NHL olgularında performans durumu ve serum LDH seviyesi yanında önemli bir diğer prognostik faktördür. Tedavi planlaması yapılırken değerlendirilmesi gereken bir parametredir.

Factors affecting survival in extranodal head neck lymphomas: Results form a single centre

Torotroapeatlely analyze the prognastik factors on survival in high grate head and neck non hodgkin lymphomas. Materials and Methods: Between 1997 and 2004, 33 patients with highgrade extranodal head-neck NHL were treated. The female to male ratio was 13:20 and median age was 48 years. The tumor was located in the Waldeyer ring in 29 patients; in 19 of these, it was in the tonsillar region. B symptom(s) and elevated serum LDH levels were present in 14 and 12 patients, respectively. The phenotype was diffuse large cell in 30 patients. A median of 6 cycles of chemotherapy (CHOP for 30 patients and CEOP for 3 patients) was administered to all patients followed by a median 40 Gy involved- field radiotherapy. Survival was analyzed by creating three different risk groups (low, moderate or high risk) including the parameters of bulky tumor (tumor diameter more than 6 cm), age, LDH level, performance status and stage. Results: The mean follow-up was 32.64 months. Overall and disease-free survival, and 2-year survival rates were 75.73 and 74.89 months, and 78% and 67%, respectively. Poor performance status, elevated serum LDH levels or the presence of bulky disease were found to have a negative impact on both overall and disease-free survival. Statistically significant differences were determined according to overall and disease-free survival in favor of the low-moderate risk groups. Poor performance status, elevated serum LDH level and bulky disease were determined to affect survival both alone and together. Conclusion: Bulky tumor is another important prognostic factor with performance status and serum LDH levels in patients with high grade, extranodal head-neck NHL. It is a parameter that should be evaluated during the treatment plan.

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