Ufuk ÇAĞIRICI, Alpaslan ÇAKAN, Özgür SAMANCILAR, Mustafa ÖZHAN, Ali VERAL

Akciğerin büyük hücreli nöroendokrin karsinomunda cerrahi tedavi sonuçları

Akciğer kanserleri içinde oldukça nadir izlenen bir tip olan büyük hücreli nöroendokrin karsinomun (BHNK) tanı ve tedavi ilkeleri ile prognozu üzerindeki tartışmalar sürmektedir. Bu çalışmada, kliniğimizde primer akciğer karsinomu nedeniyle opere edilen ve BHNK tanısı alan olgular değerlendirilerek literatür eşliğinde retrospektif olarak tartışılmıştır. Şubat 1997- Mart 2005 tarihleri arasında, küçük hücreli dışı akciğer karsinomu (KHDAK) nedeniyle rezeksiyon uygulanan hastalar içinde, BHNK tanısı alan sekiz olgu tedavi yaklaşımı, hastalıksız geçen süre ve sağkalım açısından değerlendirildi. Olguların tümü erkek ve ortalama yaşları 64 ± 7.6 (50-72) yıl idi. Dört olguya lobektomi, iki olguya pnömonektomi, iki olguya da sınırlı rezeksiyon uygulandı. Bir olguya neoadjuvan kemoterapi (KT), diğer bir olgu hariç tüm olgulara ise adjuvan KT, radyoterapi (RT) ya da her ikisi birden uygulandı. Ortalama izlem süresi olan 19.7 ± 12.5 (3-39) ay boyunca hastalıksız geçen süre ortalama 19 ± 12.9 (3-39) ay olarak bulundu. Olguların ikisi postoperatif 14. ve 16. aylarda nüks nedeniyle yaşamını yitirirken, altısı hastalıksız olarak yaşamını sürdürmektedir. Agresif bir tümör olarak bildirilen BHNK’da prognoz bazı kaynaklarda oldukça kötü olarak belirtilmekle birlikte, erken evrede cerrahi tedavi sonrası prognozun iyi olabileceğini bildiren yayınlar da vardır. Serimizde olduğu gibi genellikle az sayıda olgu içeren çalışmalara dayalı veriler ışığında tedavi protokolleri oluşturulmaya çalışılmaktadır.

Surgical results of large cell neuroendocrine carcinoma of the lung

Large cell neuroendocrine carcinoma is rare in the group of primary lung cancers and its appropriate treatment and prognosis are controversial. In this report, patients diagnosed as large cell neuroendocrine carcinoma of the lung were presented and discussed in the light of pertaining literature. Between February 1997 and March 2005, eight patients, who were diagnosed as large cell neuroendocrine carcinoma postoperatively among the patients with a preoperative diagnosis of nonsmall cell lung cancer, were analyzed retrospectively, by means of treatment method, disease free survival and overall survival. All eight patients were male and their mean age and age range were 64 ± 7.6 and 50-72, respectively. Four patients had lobectomy, two had pneumonectomy and two had limited resections. One patient received neoadjuvant chemotherapy and seven patients received adjuvant chemotherapy, radiotherapy, or chemoradiotherapy. Follow-up period was 19.7 ± 12.5 (3-39) months and disease-free interval was 19 ± 12.9 (3-39) months. Two patients died of recurrence 14 and 16 months postoperatively, whereas six of the cases are alive with disease-free. Large cell neuroendocrine carcinomas are aggressive tumors with poor prognosis but better prognosis is also revealed after surgery at early stages. Most of the series in the literature are small in number of patients, as in our report, and treatment strategies are tried to be formed according to these data.

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