Ayşe DEMİRCİ, Ceyhun VARIM, Vedat BAYOĞLU, Cemil BİLİR, İlhan HACIBEKİROĞLU

Baş Boyun Kanseri Hastalarının Klinik Özellikleri ve Tedavi Sonuçlarının Değerlendirilmesi: Tek Merkez Deneyimi

Amaç: Bu çalışmanın amacı baş boyun kanserli (BBK) hastalarımızın genel özelliklerini, risk faktörlerini, tedavi modalitelerini gözden geçirmek ve sağkalımlarını hesaplayıp sağkalımı ve tedavi sonuçlarını etkileyen faktörleri değerlendirmekti. Gereç ve Yöntemler: Altmış yedi BBK tanılı hasta değerlendirildi. Çalışmanın verileri Sakarya Üniversitesi Eğitim ve Araştırma Hastanesinde 2011-2020 yılları arasında takipli hastaların dosyalarından elde edildi. Bulgular: Tanı anındaki medyan yaş erkekler 62, kadınlar 50 olmak üzere tüm hastalarda 62 ± 11,42 (aralık: 19-82) idi. En sık yerleşim yeri %55 oranla larinks idi. Sigara ve alkol kullanım oranları sırasıyla %69 ve %18 idi. Sekonder malignite oranı %18 olup en sık görüleni akciğer kanseriydi (%9, n = 6). Hastaların tanı anındaki evreleri 1,2,3 ve 4 sırasıyla %13,45 (n = 9), %22,47 (n = 15), %50,77(n = 34) ve %11,93 (n = 8) idi. Hastaların tanı anında ya da takibi sırasında olmak üzere toplam %42’si metastatikti. Metastaz bölgeleri 13 hastada (%19,45) akciğer, 10 hastada (%15) lenf nodu, 7 hastada (%10,56) kemik, ve 1 hastada (%1,50) karaciğerdi. Lokal rekürrens %27 (n = 18) oranındaydı. Evre 1,2 ve 3 58 hastanın %50’sinde lokal rekürrens ve/veya metastaz gelişmişti. Bu hastaların çoğunluğu evre 3 hastalardı (n = 17 (%59)). Evre 1-2 hastalarda medyan hastalıksız sağkalım 49 ± 29,65 ay (aralık: 0-107 ay) iken evre 3 hastalarda medyan hastalıksız sağkalım 19 ± 10,95 ay (aralık: 0-40 ay) idi. Metastatik birinci seri kemoterapi sonrası medyan progresyonsuz sağkalım 8±3 ay (aralık: 2-14 ay) ve tüm hastalarda medyan genel sağkalım 192±83 ay idi. Sonuç: Çalışmamızda sekonder malignite gelişme oranı hafif yüksekti. Radyoterapi eş zamanlı sisplatin total dozları literatürdeki benzer diğer çalışmalara göre hafifçe düşüktü. En çok tercih edilen metastatik birinci seri kemoterapi kombinasyonu sisplatin/5Fluorourasil/setuximab’tı. Progresyonsuz sağkalım sonuçları literatüre göre hafif yüksekti.

Anahtar Kelimeler:

Baş ve Boyun Kanseri, Kemoterapi, Tedavi

PDF

___

1. Emadzadeh M., Shahidsales S., Bajgiran AM., Salehi M., Massoudi T., Nikfarjam Z., & Salehi M. Head and neck cancers in North-east Iran: A 25 year survey. Iranian journal of otorhinolaryngology 2017; 29,92:137-145.
2. Ferlay J., Shin HR., Bray F., Forman D., Mathers C., Parkin DM. (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008 International journal of cancer 2008;127,12:2893-2917.
3. Pezzuto F., Buonaguro L., Caponigro F., Ionna F., Starita N., Annunziata C., Tornesello ML. (2015). Update on head and neck cancer: current knowledge on epidemiology, risk factors, molecular features and novel therapies Oncology 2015;89,3:125-136.
4. Marur S., Forastiere AA. Head and neck squamous cell carcinoma: update on epidemiology, diagnosis, and treatment. In Mayo Clinic Proceedings 2016;91,3:386-396
5. Wheless SA., McKinney KA., Zanation AM. (2010). A prospective study of the clinical impact of a multidisciplinary head and neck tumor board. Otolaryngology—Head and Neck Surgery 2010;143,5:650-654. 6. Shah JP. Staging for Head and Neck Cancer: Purpose, Process and Progress. Indian journal of surgical oncology 2018;9,1:116-120.
7. Adeyemi BF., Adekunle LV., Kolude BM., Akang EE., Lawoyin JO. Head and neck cancer—a clinicopathological study in a tertiary care center. Journal of the National Medical Association 2008;100,6:690-697.
8. Priante AVM., Castilho EC., Kowalski LP. Second primary tumors in patients with head and neck cancer. Current oncology reports 2011;13,2:132-137.
9. Adoga AA., Kokong DD., Ma’an ND., Silas O A., Dauda AM., Yaro JP., Yabak CJ. The epidemiology, treatment, and determinants of outcome of primary head and neck cancers at the Jos University Teaching Hospital. South Asian journal of cancer 2018;7,3;183.
10. León X., del Prado Venegas M., Orús C., López M., García J.,Quer M. Influence of the persistence of tobacco and alcohol use in the appearance of second neoplasm in patients with a head and neck cancer. A case–control study. Cancer Causes & Control 2009;20,5:645-652.
11. Chuang SC., Scelo G., Tonita JM., Tamaro S., Jonasson JG., Kliewer EV., Friis S. (2008). Risk of second primary cancer among patients with head and neck cancers: a pooled analysis of 13 cancer registries. International journal of cancer 2008;123,10:2390-2396.
12. Di Martino E., Sellhaus B., Hausmann R., Minkenberg R. Survival in second primary malignancies of patient with head and neck cancer. The Journal of laryngology and otology 2002;116,10:831.
13. Lin K., Patel SG., Chu PY., Matsuo JM., Singh B., Wong RJ.,Boyle JO. Second primary malignancy of the aerodigestive tract in patients treated for cancer of the oral cavity and larynx. Head & Neck: Journal for the Sciences and Specialties of the Head and Neck 2005;27,12: 1042-1048.
14. Haughey BH., Arfken CL., Gates GA., Harvey J. Meta-analysis of second malignant tumors in head and neck cancer: the case for an endoscopic screening protocol. Annals of Otology, Rhinology & Laryngology1992;101,2:105-112.
15. Cooper JS., Zhang Q., Pajak TF., Forastiere AA., Jacobs J., Saxman SB., Lustig R. (2012). Long-term follow-up of the RTOG 9501/intergroup phase III trial: postoperative concurrent radiation therapy and chemotherapy in high-risk squamous cell carcinoma of the head and neck. International Journal of Radiation Oncology* Biology* Physics 2012;84,5:1198-1205.
16. Mendenhall WM., Hinerman RW., Amdur RJ., Malyapa RS., Lansford CD., Werning JW., Villaret DB. (2006). Postoperative radiotherapy for squamous cell carcinoma of the head and neck. Clinical medicine & research 2006;4,3:200-208.
17. Cooper JS., Pajak TF., Forastiere AA., Jacobs J., Campbell BH., Saxman SB., Machtay M. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. New England Journal of Medicine 2004;350,19:1937-1944.
18. Aydil U. Recent Landmark Studies on Head and Neck Cancers: Evidence-Based Fundamentals of Modern Therapeutic Approaches. Turkish archives of otorhinolaryngology 2015;53,1:26.
19. Wang JQ., Han R., Li XP., Zhao YT., Yu XX., Wang XW., Li G. The efficacy and safety of salvage surgery for local recurrent nasopharyngeal carcinoma: a systematic review and Meta-analysis. Zhonghua er bi yan hou tou jing wai ke za zhi= Chinese journal of otorhinolaryngology head and neck surgery 2019;54,9:676-684.
20. Salom MC., López F., Pacheco E., Muñoz G., García-Cabo P., Fernández L., Llorente JL. Salvage surgery in the treatment of local recurrences of nasopharyngeal carcinomas. Acta Otorrinolaringologica (English Edition) 2018;69,6:339-344.
21. P. Szturz et al., “Weekly Low-Dose Versus Three-Weekly High-Dose Cisplatin for Concurrent Chemoradiation in Locoregionally Advanced Non-Nasopharyngeal Head and Neck Cancer: A Systematic Review and Meta-Analysis of Aggregate Data.Oncologist, vol. 22, no. 9, pp. 1056–1066, 2017.
22. Kose F., Besen A., Sumbul T., Sezer A., Karadeniz C., Disel U., Ozyilkan O. Weekly cisplatin versus standard three-weekly cisplatin in concurrent chemoradiotherapy of head and neck cancer: the Baskent University experience. Asian Pac J Cancer Prev 2011;12,12:1185-1188.
23. Espeli V., Zucca E., Ghielmini M., Giannini O., Salatino A., Martucci F., Richetti, A. Weekly and 3-weekly cisplatin concurrent with intensity-modulated radiotherapy in locally advanced head and neck squamous cell cancer. Oral oncology 2012;48,3;266-271.
24. Tsan DL., Lin CY., Kang CJ., Huang SF., Fan KH., Liao CT., Chang JTC. The comparison between weekly and three-weekly cisplatin delivered concurrently with radiotherapy for patients with postoperative high-risk squamous cell carcinoma of the oral cavity. Radiation Oncology 2012;7,1:215.
25. Marur S., Forastiere AA. Head and neck squamous cell carcinoma: update on epidemiology, diagnosis, and treatment. In Mayo Clinic Proceedings, 2016;91,3:386-396.
26. Clavel M., Vermorken JB., Cognetti F., Cappelaere P., De Mulder PHM., Schornagel JH., Dalesio O. (1994). Randomized comparison of cisplatin, methotrexate, bleomycin and vincristine (CABO) versus cisplatin and 5-fluorouracil (CF) versus cisplatin (C) in recurrent or metastatic squamous cell carcinoma of the head and neck: A phase III study of the EORTC Head and Neck Cancer Cooperative Group. Annals of oncology 1994;5,6:521-526
27. Veronesi A., Zagonel V., Tirelli U., Galligioni E., Tumolo S., Barzan L., Grigoletto E. (1985). High-dose versus low-dose cisplatin in advanced head and neck squamous carcinoma: a randomized study. Journal of Clinical Oncology 1985;3,8:1105-1108.
28. Vermorken JB., Mesia R., Rivera F., Remenar E., Kawecki A., Rottey S., Peyrade F. Platinum-based chemotherapy plus cetuximab in head and neck cancer. New England Journal of Medicine 2008;359,11:1116-1127.
29. Burtness B., Harrington KJ., Greil R., Soulières D., Tahara M., de Castro Jr G., Fuereder T. (2019). Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study. The Lancet 2019; 394,10212:1915-1928.
30. Phase III Open Label Study of MEDI 4736 With/Without Tremelimumab Versus Standard of Care (SOC) in Recurrent/Metastatic Head and Neck Cancer - Full Text View - ClinicalTrials.gov. [Online]. 2020 Available: https://www.clinicaltrials.gov/ct2/show/NCT02551159?term=NCT02551159&rank=1.