Müge AKMANSU, Ö. Petek ERPOLAT, Fatih GÖKSEL, Haluk AŞIKOĞLU, Hüseyin BORA, İbrahim EGEHAN, Diclehan ÜNSAL, Can ÖZTÜRK

Gazi Üniversitesi Radyasyon Onkolojisi Anabilim Dalı’nda tedavi gören küçük hücreli akciğer kanseri tanılı hastaların retrospektif analizi

Sınırlı evre küçük hücreli akciğer kanseri (KHAK)'nin temel tedavisi kemoterapi (KT) ue radyoterapi (RT) olmasına rağmen, bu kombinasyon içinde RT'nin zamanlaması, dozu, fraksiyon şeması ue profilaktik kranial ışınlamanın yapılıp yapılmaması gibi tartışmalar devam etmektedir. Retrospektif incelememizde tartışmalı konuları hastalarımız üzerinde incelemeye çalıştık. 1995-2002 yılları arasında Gazi Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı'nda tedaviye alınan sınırlı evre KHAK'lı, dosya verileri yeterli olan 70 hasta üzerinde araştırma yapıldı. KT yanıtı, toplam RT dozu ue RT'nin başlama zamanı ile ilgili verilere göre hastalar gruplandırıldı ve genel sağkalım üzerine bu değişkenlerin etkileri analiz edildi. Değerlendirilen 70 hastada kadın/erkek oranı: 5/1 ve ortalama yaş 55 (31-80) yıl idi. Ortalama izlem süresi 10 ay, ortalama sağkalım süresi 16 ay idi. RT öncesi uygulanan KT'ye 47 (%67) hastanın objektif yanıt (tam + kısmi) verdiği gözlendi. KT yanıtı olanlarda sağkalımın daha iyi olduğu bulundu (median 11 aya karşın altı ay, p= 0.002). 50 Gy'den yüksek doz uygulamanın sağkalım üzerine etkisinin olmadığı bulundu. RT'nin dördüncü kür KT'den önce başlatılmasının sağkalımı artırdığı gözlendi (median 14 aya karşın sekiz ay, p= 0.01). Profılaktik kranial ışınlamanın sağkalım üzerine etkisi sağkalım analizlerinde gözlenmemesine rağmen Cox-regresyon analizinde sağkalımı etkileyen bir parametre olduğu bulundu. RT esnasında en sık gözlenen komplikasyon özefajit olmasına rağmen, grade III özefajıt 1 (%3) hastada izlenmekteydi. KT'ye yanıt gözlenmesi sağkalım için bir gösterge olarak kabul edilebilir. RT'ye KT'nin erken döneminde başlanması, 50 Gy'den yüksek RT dozlarının kullanılmaması ve profılaktik kranial RT'nin yanıt gözlenen tüm olgulara uygulanması gerektiği retrospektif çalışmadan çıkardığımız sonuçlardır.

Retrospective analysis of patients with small cell lung cancer treated at Gazi University Department of Radiation Oncology

The combination of radiotherapy (RT) and chemotherapy (CT) is the main treatment modality of limited-stage small c lung cancer (SCLC). The application of radiation timing, doses, fraction schedules in this modality and the indication prophylactic cranial irradiation is recently controversial. In this retrospective study, these subjects were evaluated by o sidering our patients results. Seventy patients having adequate data for examination, with limited-stage SCLC were referred to our clinic in the period between December 1995 and December 2002. The patients were classified according to their response to CT, the dose and timing of RT applications. The effects of obtained variables on overall survival were analyzed, male/female ratio was 5/1; and the mean age was 55 years (range 31-80 years). The mean follow-up of all patients was months and the mean survival time was 16 months. An objective (complete and partial) response to CT administered fore RT was seen in 47 (67%) patients. The survival time was better in the CT responding patients (median 11 months versus 6 months, p= 0.002). The application of more than 50 Gy radiation dose was found to be ineffective on survival, improvement in survival was observed in RT application beginning before fourth cycle CT (median 14 months versus months p= 0.01). In despite of the ineffectiveness of prophylactic cranial irradiation on survival is observed in survival analysis, it was found to be a parameter affecting survival in Cox-regression analysis. However the most frequently compilication during RT was oesophagitis. Grade III was seen in 1 (3%) patient. The response to CT can be accepted as an indicator for survival. We concluded that the administering of RT in the beginning of CT, not administering radiation dose: more than 50 Gy and the necessity of applying prophylactic cranial irradiation to all patients showing complete response, are points to be considered according to our retrospective analysis.

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