Öznur AKSAKAL, Orhan KIZILKAYA, Oktay İNCEKARA, Doğan Özcan, At All.

NAZOFARENGEAL KARSİNOMLU 100 HASTANIN RETROSPEKTİF ANALİZİ

Amaç: Bu retrospektiv çalışmanın amacı, nonmetastatik nazofarengeal karsinomlu 100 hastanın survi ve rekürrens paternini analiz etmekti. Gereç ve yöntem: 1991-2003 yılları arasında tedavi edilen 100 nazofarengeal karsinomlu hasta retrospektif olarak incelendi. 24’ü yalnız radyoterapi ile tedavi edilirken, 76’sına kombine model tedavi (cisplatin bazlı 2-4 kür neoadjuvant kemoterapi ve radyoterapi) uygulanmıştı. Nazofarengeal bölgeye 66-70 Gy, lenf nodlarına 50 Gy, servikal hastalık mevcut ise tutulan alana 15-20 Gy boost dozu verilmişti. Bulgular: AJCC 1997 evreleme sistemine göre, hastaların 20’si evre II, 47’si evre III, 33’ü evre IV’tü. Tüm hastalar skuamoz hücreli nazofarengial karsinom tanısı almıştı (18 WHO I-II, 82 WHO III). Minimum takip süresi 2 yıldı. İndüksiyon kemoterapisine yanıt oranı %75 (%13,2 tam ve %61,8 kısmi), yanıtsız olanların oranı (progresif hastalık) %7,9 ve stabil hastalık oranı %17,1’di. Radyoterapi sonrası başarısızlık oranı %53’tü. Bunların %56,6’sı lokoregional nüks, %28,3’ü lokoregional nüks ve uzak metastaz ve %15,1’i izole metastazdı. 5 yıllık genel sağ kalım yalnız radyoterapi verilenlerde %57,1, kombine tedavi verilenlerde %57,7 idi. Sonuç: İndüksiyon kemoterapisi nazofarengeal karsinomlu hastalarda tedavi sonuçlarını ve başarısızlık paternini değiştirmemiştir.

Anahtar Kelimeler:

Nazofarengeal karsinoma, radyoterapi, kemoterapi, sürvi

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Al-Sarraf M, Reddy MS. Nasopharyngeal carcinoma. Curr Tre- at Options Oncol 2002; 3:21-32.
Chan AT, Teo PM, Leung TW, Leung SF, Lee WY, Yeo W, Choi PH, Johnson PJ. A prospective randomized study of chemothe- rapy adjunctive to definitive radiotherapy in advanced nasop- haryngeal carcinoma. Int J Radiat Oncol Biol Phys 1995; 33:569-577.
Cheng SH, Yen KL, Jian JJ, Tsai SY, Chu NM, Leu SY, Chan KY, Tan TD, Cheng JC, Hsieh CY, Huang AT. Examining prog- nostic factors and patterns of failure in nasopharyngeal carcino- ma following concomitant radiotherapy and chemotherapy: im- pact on future clinical trials. Int J Radiat Oncol Biol Phys 2001; 50:717-726.
Cheng SH, Jian JJ, Tsai SY, Yen KL, Chu NM, Chan KY, Tan TD, Cheng JC, Leu SY, Hsieh CY, Huang AT. Long-term sur- vival of nasopharyngeal carcinoma following concomitant radi- otherapy and chemotherapy. Int J Radiat Oncol Biol Phys 2000; 48:1323-1330.
Chua DT, Ma J, Sham JS, Mai HQ, Choy DT, Hong MH, Lu TX, Min HQ. Long-term survival after cisplatin-based induction chemotherapy and radiotherapy for nasopharyngeal carcinoma: a pooled data analysis of two phase III trials. J Clin Oncol 2005; 23:1118-1124.
Chua DT, Sham JS, Wei WI, Ho WK, Au G, Choy D. Control of regional metastasis after induction chemotherapy and radiothe- rapy for nasopharyngeal carcinoma. Head Neck 2002; 24:350- 360.
Chua DT, Sham JS, Choy D, Lorvidhaya V, Sumitsawan Y, Thongprasert S, Wootiprux V, Cheirsilpa A, Azhar T, Reksodi- putro AH. Preliminary report of the Asian-Oceanian Clinical On- cology Association randomized trial comparing cisplatin and epirubicin followed by radiotherapy versus radiotherapy alone in the treatment of patients with locoregionally advanced nasop- haryngeal carcinoma. Asian-Oceanian Clinical Oncology Asso- ciation Nasopharynx Cancer Study Group. Cancer 1998; 83:2270-2283.
Chua DT, Sham JS, Choy D, Kwong DL, Au GK, Kwong PW, Yau CC, Cheng AC, Wan KY. Patterns of failure after induction chemotherapy and radiotherapy for locoregionally advanced na- sopharyngeal carcinoma: the Queen Mary Hospital experience. Int J Radiat Oncol Biol Phys 2001; 49:1219-1228.
Daniilidis J, Constantinidis J, Fountzilas G. Combined radioche- motherapy in locally advanced nasopharyngeal carcinoma HNO 2001; 49:732-738.
Farias TP, Dias FL, Lima RA, Kligerman J, de Sa GM, Barbosa MM, Goncalves FB Jr. Prognostic factors and outcome for na- sopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 2003; 129:794-799.
Fonseca E, Cruz JJ, Rodriguez CA, Gomez-Bernal A, Martin A, Sanchez P, Nieto A, Soria P, Vega MJ, Munoz A, Pardal JL. Ne- oadjuvant chemotherapy with continuous infusion of cisplatin and 5-fluorouracil, with or without leucovorin, for locally advan- ced nasopharyngeal carcinoma. J Infus Chemother 1996; 6:217- 220
Geara FB, Glisson BS, Sanguineti G, Tucker SL, Garden AS, Ang KK, Lippman SM, Clayman GL, Goepfert H, Peters LJ. In- duction chemotherapy followed by radiotherapy versus radiot- herapy alone in patients with advanced nasopharyngeal carcino- ma: results of a matched cohort study. Cancer 1997; 79:1279- 1286.
Gruner A, Grabenbauer GG, Rodel C, Weidenbecher M, Martus P, Iro H, Sauer R. Nasopharyngeal carcinoma: only irradiation or simultaneous radiochemotherapy? Strahlenther Onkol 1999; 175:591-596.
Hareyama M, Sakata K, Shirato H, Nishioka T, Nishio M, Su- zuki K, Saitoh A, Oouchi A, Fukuda S, Himi T. A prospective, randomized trial comparing neoadjuvant chemotherapy with ra- diotherapy alone in patients with advanced nasopharyngeal car- cinoma.Cancer 2002; 94:2217-2223.
Hong S, Wu HG, Chie EK, Bang YJ, Heo DS, Kim KH, Sung MW, Park CI. Neoadjuvant chemotherapy and radiation therapy compared with radiation therapy alone in advanced nasopharyn- geal carcinoma. Int J Radiat Oncol Biol Phys 1999; 45:901-905.
Huncharek M, Kupelnick B. Combined chemoradiation versus radiation therapy alone in locally advanced nasopharyngeal car- cinoma: results of a meta-analysis of 1,528 patients from six ran- domized trials. Am J Clin Oncol 2002; 25:219-223.
Langendijk JA, Leemans CR, Buter J, Berkhof J, Slotman BJ. The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Oncol 2004; 22:4604-4612.
Ma BB, Chan AT. Recent perspectives in the role of chemothe- rapy in the management of advanced nasopharyngeal carcino- ma. Cancer 2005; 103:22-31.
Ma J, Mai HQ, Hong MH, Min HQ Mao ZD, Cui NJ, Lu TX, Mo HY. Results of a prospective randomized trial comparing ne- oadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol 2001; 19:1350-1357
Ozyar E, Gurkaynak M, Yildiz F, Atahan IL. Non-metastatic sta- ge IV nasopharyngeal carcinoma patients: analysis of the pattern of relapse and survival. Radiother Oncol 2004; 72:71-77.
Rischin D, Corry J, Smith J, Stewart J, Hughes P, Peters L. Ex- cellent disease control and survival in patients with advanced na- sopharyngeal cancer treated with chemoradiation. J Clin Oncol 2002; 20:1845-1852.
Teo PM, Chan AT, Lee WY, Leung TW, Johnson PJ. Enhance- ment of local control in locally advanced node-positive nasop- haryngeal carcinoma by adjunctive chemotherapy. Int J Radiat Oncol Biol Phys 1999; 43:261-271.