Oğuz ÇETİNAYAK, İlhan ÖZTOP, Ayşe Nur DEMİRAL, Evrim BAYMAN, Mehmet ŞEN, Sermin ÖZKAL, Fadime AKMAN, Münir KINAY, Metin MANİSALI, Hasan HAVİTÇİOĞLU

Ameliyat sonrası radyoterapi uygulanmış yumuşak doku sarkomlarında tedavi sonuçları ve prognostik faktörler

AMAÇ Dokuz Eylül Üniversitesi Tıp Fakültesi (DEÜTF) Radyasyon Onkolojisi Kliniğinde Kasım 1991-Mart 2003 tarihleri arasında ameliyat sonrası radyoterapi (RT) verilen 53 yumuşak doku sarkomlu olguda tedavi sonuçları ve prognostik faktörlerin incelenmesi amaçlandı.GEREÇ VE YÖNTEM Ameliyat sonrası RT gören ve tanı anında uzak metastazı olmayan 53 olgunun 30'u (%57) erkekti. Medyan yaş 38 (18-80) idi. Hastaların 33'üne (%62) DEÜTF'de ilk tanısal veya cerrahi girişim uygulanmış olup 20'si (%38) ise DEÜTF dışı kurumlardan RT için gönderilmişlerdi. Yumuşak doku sarkomlu olgularda tümör yerleşimi 36 (%68) alt ekstremite, 6 (%11) üst ekstremite, 5 (%10) gövde, 6 (%11) baş-boyun şeklinde idi. Histolojik derece dağılımına göre 29 (%55) olgu derece 1, 2; 10 (%19) olgu derece 3 olup hastaların 14'ünde (%26) ise derece belirlenemedi. Cerrahi, 30 (%57) hastada geniş eksizyon, 15 (% 28) hastada marjinal veya intralezyonel eksizyon, 8 (%15) hastada ise eksizyonel biyopsi olarak uygulanmıştı. Hastaların 29'unun (%55) patoloji raporunda cerrahi sınırlar negatif idi. Makroskobik kalıntı ise olguların 15'inde (%28) vardı. Patolojik tümör boyutu medyan 80 mm (15-220) idi. Ameliyat sonrası RT karşılıklı paralel iki alan kullanılarak Co 60 veya 6 MVX foton enerjileri ile verildi. Medyan RT total dozu 6600 (4040-7500) cGy ve medyan fraksiyon dozu ise 200 (160- 250) cGy idi. Yüksek derece ve/veya tümör boyutunun büyüklüğü nedeniyle 14 olguda ameliyat sonrası RT ardından adjuvan kemoterapi eklendi. Sağkalımlar başlangıç noktası tanı zamanı alınarak Kaplan- Meier yöntemi ile hesaplandı. Prognostik faktörleri bulmak için yapılan tek değişkenli analizde log-rank testi, çok değişkenli analizde ise Cox-regresyon testi uygulandı.BULGULAR Olguların 12'sinde yerel kontrol sağlanamadı. Hastaların 15'inde sonradan uzak metastaz ortaya çıktı. Beş yıllık genel sağkalım %58 idi. Çok değişkenli analiz yapıldığında; genel sağkalım için

Prognostic factors in soft tissue sarcoma patients treated with postoperative radiotherapy

OBJECTIVES Prognostic factors were studied in 53 patients with soft tissue sarcoma treated with postoperative radiotherapy in Dokuz Eylül University Department of Radiation Oncology during the period November 1991-March 2003.METHODS Thirty of the patients (57%) were male. Median age was 38 (18-80). Thirty-three patients (62%) received their first diagnostic or surgical procedure in Dokuz Eylül University while the rest were referred from other institutions for postoperative radiotherapy. Tumor localization was as follows: 36 (68%) lower extremity, 6 (11%) upper extremity, 5 (10%) trunk, 6 (11%) head and neck. Twenty-nine patients (55%) had grade 1-2 tumors while 10 patients (19%) had grade 3 tumors. Histological grade could not be determined in 14 (26%) patients. Surgery was performed as wide excision, marginal or intralesional excision and excisional biopsy in 30 (57%), 15 (28%), and 8 (15%) patients, respectively. Surgical margins were reported as negative in 29 patients (55%). Gross residue was present in 15 patients (28%). Pathological tumor size was median 80 mm (15-220). Postoperative radiotherapy was given using two parallel opposed fields with Co 60 or 6 MVX photon energies. Median total radiotherapy dose was 6600 (4040-7500) cGy and median fraction dose was 200 (160-250) cGy. Adjuvant chemotherapy was added after postoperative radiotherapy in 14 patients who had high grade tumors and/or large tumor size. Survival times were calculated with Kaplan-Meier method considering the periods from the time of diagnosis. To find out prognostic factors, log-rank test and Cox regression test were applied in univariate and multivariate analyses, respectively.RESULTS Local control could not be achieved in 12 cases. Fifteen patients developed distant metastasis during follow-up. Five-year overall survival (OS) was 58%, respectively. In the multivariate analysis, OS was found to be independently influenced from tumor size

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