E. Elif ÖZKAN, H. Erol EROĞLU, Nermin KARAHAN, Sevim Süreyya ŞENGÜL

REKTUM KANSERİNDE NEOADJUVAN KEMORADYOTERAPİ SONRASI RADYOLOJİK VE PATOLOJİK YANIT PREDİKTÖRLERİNİN DEĞERLENDİRİLMESİ

AmaçBu çalışmada lokal ileri evre rektum tümörlü olgularda preoperatif kemo-radyoterapi (KRT) sonrası klinik, radyolojik patolojik özelliklerin radyolojik ve patolojikyanıt ile korelasyonunun araştırılması amaçlandı.Gereç ve YöntemÇalışmada Ocak 2012 ve Mayıs 2017 tarihleri arasında endoskopik biyopsi ile rektum kanseri tanısı alan ve kliniğimizde neoadjuvan kemoradyoterapi (KRT)uygulanan 26 hasta retrospektif olarak değerlendirildi. Hastaların tedavi öncesi endoskopik bulguları (dentat çizgiye uzaklık, çevresel tutulum, ülserasyon), radyolojik tümör boyutu, Pozitron Emisyon tomografi (PET) de görülen kitle boyutu, lenf nodu pozitifliği, standart uptake değeri (SUV) düzeyi ile tedavi sonrası radyolojik ve patolojik yanıt düzeylerinin ilişkisi araştırıldı. Patolojik regresyon düzeyi modifiye Ryan skorlaması ile değerlendirildi.BulgularHastaların 19’u erkek 7’si kadın olup median yaşları 61 (40 – 83) idi. Olgularımızın medyan pelvik radyoterapi dozu 4500 cGy (3600 – 5040) tümöre yönelik boost dozu ise median 900 cGy (360 – 900) idi. Biri ileri yaşta diğeri ise kardiak morbiditesi olan iki hastanın dışında tüm hastalara radyoterapi eş zamanlı kapasitabin uygulandı. Kemoterapi sonrası yanıt tüm hastalarda RECIST kriterlerine göre değerlendirildiğinde 1 hasta tam yanıtlı, 10 hasta stabil, kalan 15 hasta iseparsiyel yanıtlı olarak değerlendirildi. Tedavi sonrası opere edilen 22 hastanın 11’ine abdominoperineal rezeksiyon (APR) 11’ine ise low anterior rezeksiyon (LAR) uygulandı, 4 hasta ise opere edilmedi. Radyoterapi sonrası operasyona kadar geçen süre median 42 gün (15 – 194) olarak hesaplandı. Tedavi öncesi PET BT de lenf nodu pozitif olan hastaların 11 inde patolojik lenf nodu saptanmadı. Buna karşın başlangıçta lenf nodu görülmeyen 5 hastanın 1 inde postop lenf nodu (+) idi. Endoskopide görülen tümörün çevreselliği, lokalizasyonunun anal verge’den 5 cm ve daha fazla olması ve radyolojik yanıt varlığı sfinkter koruma açısından anlamlı bulunurken (sırasıyla p: 0,03, p:0,019 ve p:0,022), bu faktörlerin hiçbirisininradyolojik yanıt üzerinde istatistiksel anlamlı düzeyde prediktif etkisi saptanmadı. Hastalar risk gruplarına göre değerlendirildiğinde radyolojik ve patolojik yanıtüzerinde anlamlı bir etki saptanmadı. Operasyon sonrası 1 hastada patolojik tam yanıt saptandı. Regresyon skoru değerlendirilen 17 hastanın 2’sinde skor 3, 10’unda 2, 5 hastada ise 1 olarak değerlendirildi.SonuçTümörün çevresel yayılımı, lokalizasyonunun anal verge’den 5 cm ve daha yüksek olması ve radyolojik yanıt varlığı sfinkter koruma açısından anlamlı bulunurken (sırasıyla p: 0,03, p:0,019 ve p:0,022), bu faktörlerin hiçbirisinin radyolojik yanıt üzerinde istatistiksel anlamlı düzeyde prediktif etkisi saptanmadı.

EVALUATION OF NEOADJUVANT TREATMENT RESPONSE PREDICTOR FACTORS IN RECTUM CARCINOMA

Objective The aim of this study was to evaluate the clinical, radiologic and pathologic predictive factors of neoadjuvant treatment response in rectum carcinoma patients. Material and Method Twenty-six rectum carcinoma patients diagnosed with endoscopic biopsy who underwent neoadjuvant chemoradiotherapy (CRT) between January 2012 and May 2017 are enrolled in the study. Pretreatment endoscopic findings, radiologic signs, tumor volume, lymph nodes and max SUV in PET-CT are investigated in terms of correlation with radiologic and pathologic response. Pathologic regression degree is evaluated via modified Ryan scoring system. Results Median age of 19 male, 7 female patients was 61 (40 – 83). All of the cases were diagnosed as adenocarcinoma with endoscopic biopsy. Median pelvic radiotherapy dose was 4500 cGy (3600 – 5040) while median additional boost dose to tumor volume was 900 cGy (360 – 900). Concomitant capacitabin was given to all patients except two cases. Postchemoradiotherapy response investigated via RECIST criteria revealed complete response, stable disease and partial response in 1, 10 and 15 patients respectively. Due to old age, comorbidities and rejection 4 patients were not operated. In 22 patients who underwent surgery 11 had APR where LAR was performed in 15 of them. Time between chemoradiotherapy ending and surgery was median 42 days (15 – 194). No pathologic lymph nodes were observed in the surgical specimen of 11 patients who had lymph nodes in pretreatment evaluation. On the contrary 1 patient revealed postoperative pathologic lymph node although he was node negative in pretreatment staging. Only one patient had pathologic complete response. Regression score was reported in 17 patients and it was 3.2 and 1 in 2,10 and 5 patients respectively. Endoscopic tumor circumferentiality, localization higher than 5 cm from anal verge and radiologic response are found to be statistically significant in terms of sphincter preservation (p: 0,03, p: 0,019 and p: 0,022 respectively). However, none of the factors investigated were predictive on radiologic response. Conclusion Tumor circumferentiality, localization higher than 5 cm from anal verge and radiologic response are found to be statistically significant in terms of sphincter preservation (p: 0,03, p: 0,019 and p: 0,022 respectively). However, none of the factors investigated were predictive on radyolojik response.

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