Zeynep Zeren UÇAR, Nimet AKSEL, Aydan ÇAKAN, Ayşe ÖZSÖZ

İLERİ EVRE KÜÇÜK HÜCRELİ DIŞI AKCİĞER KANSERİNDE SİSPLATİNETOPOSİD TEDAVİSİNİN ETKİNLİĞİ

İleri evre küçük hücreli dışı akciğer kanserinde kemoterapinin yeri uzun yıllardır tartışma konusudur. Bu çalışmada sisplatin-etoposid tedavi rejiminin etkinliğinin semptomatik tedavi ile sağkalıma etkisi açısından karşılaştırılması amaçlanmıştır. Ocak 1997-Mart 2001 arasında kliniğimizde evre IIIB ve IV küçük hücreli dışı akciğer kanseri tanısı almış 60 olgu çalışmaya alındı. Otuz olguya kemoterapi, 30 olguya semptomatik tedavi uygulandı. Kemoterapi alan olgulara üç hafta aralarla maksimum altı siklus olacak şekilde ilk gün 80 mg/m2 sisplatin ve ilk başlanacak üç gün sürecek şekilde günde 100 mg/m2 etoposide IV uygulandı. Sağkalım analizleri ‘Kaplan-Meier Product-Limit' yöntemiyle hesaplandı. Evre IIIB'de kemoterapi alan 20 olguda medyan sağkalım süresi 13.9 ay, bir yıllık sağkalım oranı % 60, semptomatik tedavi alan 22 olguda ise 6.3 ay ve % 18 bulundu. Evre IV'te ise, kemoterapi alan 10 olguda medyan sağkalım süresi 9.4 ay ve bir yıllık sağkalım oranı % 40, semptomatik tedavi alan 8 olguda ise 3.7 ay ve %25 bulundu. Semptomatik tedavi ve kemoterapi gruplarının medyan sağkalım süreleri ve bir yıllık sağkalım oranları arasındaki fark evre IIIB olgularında kemoterapi lehine istatistiksel olarak anlamlı bulundu (p<0.0003, p<0.005). Evre IV’te ise fark anlamlı değildi. Kemoterapiye yanıt %26 kısmi, %3.3 tam yanıt şeklindeydi. Toplam yanıt oranı %29.3 idi. Toplam yan etki görülme oranı % 63.3 idi (5 olguda grade 3, 1 olguda grade 4). Sonuç olarak; ileri evre küçük hücreli dışı akciğer kanserinde sisplatinetoposid kemoterapisinin etkin bir tedavi yöntemi olduğu ve hala tercih edilebileceği, bu etkinliğin evre IV’ ten çok evre IIIB’ de daha belirgin olduğu sonucuna vardık.

Anahtar Kelimeler:

Küçük hücreli dışı akciğer kanseri, kemoterapi, sisplatin, etoposid

EFFICACY OF CISPLATIN-ETOPOSIDE CHEMOTHERAPY IN ADVANCED NON-SMALL CELL LUNG CANCER

The role of chemotherapy in the treatment of non-small cell lung cancer has been a matter of concern for many years. This study aims to compare cisplatinetoposide combined treatment modality with supportive treatment according to their effects on survival. Between 1997-2001, 60 patients, who were diagnosed as having stage IIIB and IV non-small cell lung cancer in our clinic, were included in the study. Following all necessary clinical staging procedures, 30 cases received chemotherapy, while remaining 30 cases were treated symptomatically. Chemotherapy protochol included cisplatin with a dose of 80 mg/m2/day intravenously administered on the first day and etoposide with a dose of 100 mg/m2/day starting the first day, continuing for three days in three weeks intervals for a maximum of six cycles. “Kaplan-Meier Product- Limit” method was utilized for survival analysis. In stage IIIB; 20 cases, who received chemotherapy, had a median survival as 13.9 months and one year survival rate as 60 %. 22 cases, who were treated symptomatically, had a median survival as 6.3 months and one year survival rate as 18 %. In stage IV; 10 cases, who received chemotherapy, had a median survival, as 9.4 months and one year survival rate as 40 %. 8 cases, who were treated symptomatically, had a median survival as 3.7 months and one year survival rate as 25 %. The difference of median survivals and one year survival rates between chemotherapy group and symptomatic group were istatistically significant for chemotherapy group in stage IIIB ( p<0.0003, p<0.005) while the difference wasn’t significant in stage IV. Partial and complete response rates were 26 % and 3.3 % respectively, with a total response rate of 29.3 %. Chemotherapy related side effects were encountered in 63.3 % of the cases (grade 3 side effect in 5 cases, grade 4 side effect in one case). In conclusion; we have suggested that chemotherapy with cisplatin-etoposide is an effective treatment method in management of advanced stage non-small cell lung cancer and can still be preferred, and this effect is more appaerent in stage IIIB disease than stage IV disease

Keywords:

Non-small cell lung cancer, chemotherapy, cisplatin, etoposide,

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