Cerrahi ve radyoterapi ile tedavi edilen erken evre jinekolojik kanserli geriatrik hastalarda onkolojik sonuçlar

ÖZ Amaç: Erken evre jinekolojik kanserli geriatrik hasta grubunda cerrahi ve adjuvan radyoterapi ile elde edilen onkolojik sonuçların değerlendirilmesidir. Metod: 65 yaş ve üzeri, erken evre jinekolojik kanser nedeni ile opere edilmiş ve adjuvan radyoterapi uygulanmış 31 hasta çalışmaya dahil edilmiştir. Tüm hastalar genel özellikler, uygulanan local ve sistemik tedaviler, ve onkolojik sonuçlar açısından değerlendirimiştir. Bulgular: Hastaların tanısına bakıldığında 80,6% sının endometrıum ca,19,4%ünün serviks ca olduğu gözlenmiştir. The median age of the patients was 69 (range, 65-86). All patients underwent TAH+BSO. Hastaların tamamına eksternal pelvik RT ygulanmıştı. Intrakaviter vaginal braki terapi hastaların 90,3 %’sine uygulanmıştı. Hastaların 3,2% sinde lokal rekürrens ve yine 3,2% sinde uzak metastaz gözlenmişti. The five-year DFS and OS rates were 93% and 80%, respectively Sonuç: Geriatrik hasta grubunda tedavi planlaması prognostik faktörler, yaş grubu ve komorbidite ye göre uygun olarak şekillendirilmelidir. Seçili hasta grubunda multimodalite tedaviler ile gayet iyi onkolojik sonuçlar elde edilebilmektedir.

Anahtar Kelimeler:

Jinekolojik kanser, Radyoterapi, Geriatri

Oncological outcomes in geriatric patients with early stage gynecological cancer who underwent surgery and radiotherapy

ABSTRACT Background: Evaluation of oncological results obtained with surgery and adjuvant radiotherapy in geriatric patient group with early stage gynecological cancer. Methods: 31 patients aged 65 years and older who were operated for early stage gynecological cancer and had adjuvant radiotherapy were included in the study. All patients were evaluated in terms of general characteristics, local and systemic treatments, and oncological outcomes. Results: Percentages of patients diagnosed with endometrium ca and cervix ca are 80.6% and 19.4%, respectively. The median age of the patients was 69 (range, 65-86). All patients underwent total abdominal hysterectomy and bilateral salpingo oophorectomy, followed by adjuvant pelvic radiotherapy. Intracavitary vaginal brachytherapy was applied to 90.3% of the patients. At a median follow-up of 69 months, 3.2% of patients had local recurrence and 3.2% had distant metastases. The five-year DFS and OS rates were 93% and 80%, respectively Conclusions: Treatment planning in geriatric patient group should be shaped according to prognostic factors, age group and comorbidity. Remarkable oncological results can be obtained with multimodality treatments in the selected patient group.

Keywords:

Gynecologic cancer, Radiotherapy, Geriatric patients,

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1. Bourgin C, Saidani M, Poupon C, et al. Endometrial cancer in elderly women: Which disease, which surgical management? A systematic review of the literature. Eur J Surg Oncol. 2016 Feb;42(2):166-75. doi: 10.1016/j.ejso.2015.11.001. Epub 2015 Nov 11. PMID: 26647302.
2. Swaminathan D, Swaminathan V. Geriatric oncology: problems with under-treatment within this population. Cancer Biol Med. 2015 Dec;12(4):275-83. doi: 10.7497/j.issn.2095-3941.2015.0081. PMID: 26779364; PMCID: PMC4706517.
3. Barton MB, Jacob S, Shafiq J, et al. Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012. Radiother Oncol. 2014;112(1):140–4.
4. Asli LM, Kvaløy SO, Jetne V, et al. Utilization of radiation therapy in Norway after the implementation of the national cancer plan—a national, population-based study. Int J Radiat Oncol Biol Phys. 2014;90(3):707–14.
5. Diver EJ, Hinchcliff EM, Gockley AA, et al. Assessment of treatment factors and clinical outcomes in cervical cancer in older women compared to women under 65 years old. J Geriatr Oncol. 2018 Sep;9(5):516-519. doi: 10.1016/j.jgo.2018.02.004. Epub 2018 Mar 2. PMID: 29503115.
6. Wright JD, Lewin SN, Barrena Medel NI, et al. Endometrial cancer in the oldest old: Tumor characteristics, patterns of care, and outcome. Gynecol Oncol. 2011;122:69-74.
7. Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011 Sep 1;29(25):3457-65. doi: 10.1200/JCO.2011.34.7625. Epub 2011 Aug 1. PMID: 21810685; PMCID: PMC3624700.
8. Wildiers H, Heeren P, Puts M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol. 2014 Aug 20;32(24):2595-603. doi: 10.1200/JCO.2013.54.8347. PMID: 25071125; PMCID: PMC4876338.
9. Røyset I, Saltvedt I, Rostoft S, et al. Geriatric assessment with management for older patients with cancer receiving radiotherapy. Protocol of a Norwegian cluster-randomised controlled pilot study. J Geriatr Oncol. 2022 Apr;13(3):363-373. doi: 10.1016/j.jgo.2021.11.001. Epub 2021 Nov 12. PMID: 34776384.
10. Huisingh-Scheetz M, Walston J. How should older adults with cancer be evaluated for frailty? J Geriatr Oncol. 2017;8(1):8–15.
11. Handforth C, Clegg A, Young C, et al. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol Off J Eur Soc Med Oncol. 2015;26(6):1091– 101.
12. Dumas L, Ring A, Butler J, Kalsi T, Harari D, Banerjee S. Improving outcomes for older women with gynaecological malignancies. Cancer Treat Rev. 2016 Nov;50:99-108. doi: 10.1016/j.ctrv.2016.08.007. Epub 2016 Aug 29. PMID: 27664393; PMCID: PMC5821169.
13. Sourdet S, Brechemier D, Steinmeyer Z, Gerard S, Balardy L. Impact of the comprehensive geriatric assessment on treatment decision in geriatric oncology. BMC Cancer. 2020 May 6;20(1):384. doi: 10.1186/s12885-020-06878-2. PMID: 32375695; PMCID: PMC7201727.
14. Racin A, Raimond E, Bendifallah S, et al. Lymphadenectomy in elderly patients with high-intermediate-risk, high-risk or advanced endometrial cancer: Time to move from personalized cancer medicine to personalized patient medicine! Eur J Surg Oncol. 2019 Aug;45(8):1388-1395. doi: 10.1016/j.ejso.2019.02.015. Epub 2019 Feb 18. PMID: 30846299.
15. Xie S, Pan S, Zou S, Zhu H, Zhu X. Characteristics and Treatments of Patients Aged 65 Years or Over with Cervical Cancer. Clin Interv Aging. 2020 Jun 3;15:841-851. doi: 10.2147/CIA.S255305. PMID: 32606624; PMCID: PMC7293398.
16. Cushman TR, Haque W, Menon H, et al. Postoperative chemoradiotherapy versus radiotherapy alone for elderly cervical cancer patients with positive margins, lymph nodes, or parametrial invasion. J Gynecol Oncol. 2018 Nov;29(6):e97. doi: 10.3802/jgo.2018.29.e97. PMID: 30207105; PMCID: PMC6189436.