Arıcan Zümre ALICIKUŞ, Emel ADA, Mehmet ŞEN, Sülen SARIOĞLU, Fadime AKMAN, Münir KINAY, Uruk Özlem ATAMAN, Cenk ECEVİT, Ahmet Ömer İKİZ

Radyoterapi uygulanmış oral kavite ve orofarenks kanserli hastalarda tedavi sonuçlarımız

AMAÇ Ağustos 1991-Haziran 2003 tarihleri arasında Dokuz Eylül Baş-Boyun Kanserleri Grubu protokolüne uygun definitif (±kemoterapi) ve adjuvan radyoterapi uygulanan oral kavite (OK) ve orofarenks (OF) kanserli hastalarda tedavi sonuçları değerlendirildi.GEREÇ VE YÖNTEM Toplam 148 hasta (50 kadın, 98 erkek; medyan yaş 60; dağılım 24-90) (128 (%86) OK; 20 (%14) OF) değerlendirilmiştir. Evre dağılımı; evre-I: 15 (%10); evre-II: 14 (%9); evre-III: 35 (%24); evre-IV: 84 (%57) şeklindedir. Adjuvan radyoterapi 67 (%45); definitif radyoterapi 81 (%55) hastaya uygulanmıştır. Konkomitan boost tekniği 27 (%18); eş zamanlı sisplatin 23 (%16) hastaya uygulanmıştır. Definitif radyoterapide medyan doz 70 Gy (35-78), adjuvan radyoterapide 51 Gy (21- 70)'dir.BULGULAR Medyan izlem süresi 25 (3-158) aydır. Adjuvan radyoterapi uygulananlarda 2 ve 5 yıllık genel sağkalım (GSK) oranları sırasıyla %75; %61; hastalıksız aralık (HA) oranları ise %75; %64'dür. Definitif radyoterapi uygulanan OK hastalarında 2 ve 5 yıllık GSK oranları sırasıyla %48; %28; HA oranları ise %36; %24 iken OF kanserli hastalar için 2 ve 5 yıllık GSK oranları %54; %18; HA oranları ise %46; 46'dır.SONUÇ Özellikle yerel ileri evre OK ve OF tümörlerinde kombine tedavi yaklaşımları ile daha iyi sonuçlar alınmaktadır.

Radiotherapy results of patients with oral cavity and oropharynx tumours

OBJECTIVES To evaluate patients with oral cavity (OC) and oropharynx (OP) tumours treated with definitive radiotherapy (±chemotherapy) and adjuvant radiotherapy according to treatment protocol of Dokuz Eylul Head and Neck Cancer Group (DEBBKG) between August 1991 and June 2003.METHODS In total 148 patients (50 females, 98 males; median age 60; range 24 to 90 years) (128 (86%) OC; 20 (14%) OP) were evaluated. Stage distribution is as follows; stage-I: 15 (10%); stage-II: 14 (9%); stage-III: 35 (24%); stage-IV: 84 (57%). Adjuvant radiotherapy performed in 67 (45%) patients; definitive radiotherapy in 81 (55%) patients. Twenty seven (18%) patients received concomittant boost radiotherapy and 23 (16%) received concomittant cisplatin. Median total dose was 70 Gy (35-78) in the definitive setting and 51 Gy (21-70) in the adjuvant setting.RESULTS Median follow-up was 25 (3-158) months. In patients receiving adjuvant radiotherapy, 2 and 5 years overall survival (OS) and disease free interval (DFI) rates were respectively; 75%; 61% and 75%; 64%. In definitive setting 2 and 5 years OS rates were 48%; 28% and DFI rates were 36%; 24% for OC; 2 and 5 years OS rates were 54%; 18% and DFI rates were 46%; 46% for OP cancer patients.CONCLUSION It is potentially possible to achive better results with combined treatment modalities in especially locally advanced OC and OP tumours.

PDF

___

1) http://seer.cancer.gov/cgi-bin/csr/1975_2003/ search.pl#results.
2) Fein DA, Mendenhall WM, Parsons JT, McCarty PJ, Stringer SP, Million RR, et al. Carcinoma of the oral tongue: a comparison of results and complications of treatment with radiotherapy and/or surgery. Head Neck 1994;16(4):358-65.
3) Wolfensberger M, Zbaeren P, Dulguerov P, Muller W, Arnoux A, Schmid S. Surgical treatment of early oral carcinoma-results of a prospective controlled multicenter study. Head Neck 2001;23(7):525-30.
4) Pignon JP, Bourhis J, Domenge C, Designe L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three metaanalyses of updated individual data. MACH-NC Collaborative Group. Meta Analysis of Chemotherapy on Head and Neck Cancer. Lancet 2000;355(9208):949-55.
5) Horiot JC, Le Fur R, N'Guyen T, Chenal C, Schraub S, Alfonsi S, et al. Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy. Radiother Oncol 1992;25(4):231-41.
6) Horiot JC, Bontemps P, van den Bogaert W, Le Fur R, van den Weijngaert D, Bolla M, et al. Accelerated fractionation (AF) compared to conventional fractionation (CF) improves loco-regional control in the radiotherapy of advanced head and neck cancers: results of the EORTC 22851 randomized trial. Radiother Oncol 1997;44(2):111-21.
7) Fu KK, Pajak TF, Trotti A, Jones CU, Spencer SA, Phillips TL, et al. A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000;48(1):7-16.
8) American Joint Committee on Cancer (AJCC); cancer staging handbook. 5th ed. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins; 1998.
9) WHO handbook for reporting results of cancer treatment. Geneva: World Health Organization Offset Publication No: 48; 1979.
10) Layland MK, Sessions DG, Lenox J. The influence of lymph node metastasis in the treatment of squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx: N0 versus N+. Laryngoscope 2005;115(4):629-39.
11) Al-Sarraf M, Pajak TF, Byhardt RW, Beitler JJ, Salter MM, Cooper JS. Postoperative radiotherapy with concurrent cisplatin appears to improve locoregional control of advanced, resectable head and neck cancers: RTOG 88 24. Int J Radiat Oncol Biol Phys 1997;37(4):777-82.
12) Bachaud JM, Cohen-Jonathan E, Alzieu C, David JM, Serrano E, Daly Schveitzer N. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: final report of a randomized trial. Int J Radiat Oncol Biol Phys 1996;36(5):999-1004.
13) El-Sayed S, Nelson N. Adjuvant and adjunctive chemotherapy in the management of squamous cell carcinoma of the head and neck region. A meta analysis of prospective and randomized trials. J Clin Oncol 1996;14(3):838-47.
14) Al-Sarraf M, Pajak TF, Marcial VA, Mowry P, Cooper JS, Stetz J, et al. Concurrent radiotherapy and chemotherapy with cisplatin in inoperable squamous cell carcinoma of the head and neck. An RTOG Study. Cancer 1987;59(2):259-65.
15) Ang KK, Trotti A, Brown BW, Garden AS, Foote RL, Morrison WH, et al. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001;51(3):571-8.
16) Peters LJ, Goepfert H, Ang KK, Byers RM, Maor MH, Guillamondegui O, et al. Evaluation of the dose for postoperative radiation therapy of head and neck cancer: first report of a prospective randomized trial. Int J Radiat Oncol Biol Phys 1993;26(1):3-11.
17) Johnson JT, Barnes EL, Myers EN, Schramm VL Jr, Borochovitz D, Sigler BA. The extracapsular spread of tumors in cervical node metastasis. Arch Otolaryngol 1981;107(12):725-9.
18) Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004;350(19):1937 44.
19) Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefebvre JL, Greiner RH, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004;350(19):1945-52.
20) Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005;27(10):843-50.
21) Sanguineti G, Richetti A, Bignardi M, Corvo' R, Gabriele P, Sormani MP, et al. Accelerated versus conventional fractionated postoperative radiotherapy for advanced head and neck cancer: results of a multicenter Phase III study. Int J Radiat Oncol Biol Phys 2005;61(3):762-71.