Adem DELİGÖNÜL, Ahmet BEKAR, Hüseyin MELEK, Erdem ÇUBUKÇU, Süreyya SARIHAN, Ahmet Bilgehan ŞAHİN, Türkkan EVRENSEL

Küçük Hücreli Dışı Akciğer Kanserli Kranial Metastaz Gelişen Olgularda Metastazektomi Yapılan ve Sistemik Tedavi Alan Hastaların Retrospektif Değerlendirilmesi

Küçük hücreli dışı akciğer kanseri (KHDAK)’nin en sık metastaz yaptığı organlardan biri beyindir. Beyin metastazı olan hastalar tedavi edilmediğinde ortalama yaşam süresi aylarla sınırlıdır. Bu çalışmanın amacı beyin metastazı yapmış evre 4 KHDAK hastalarda beyin metastazı için cerrahi tedavi uygulamasının onkolojik sonuçlarını göstermektir. Kliniğimizde 2004-2012 yılları arasında KHDAK tanısı konan ve BM nedeniyle cerrahi tedavi uygulanan 59 hastanın verileri prospektif olarak kaydedildi ve retrospektif olarak incelendi. Hastaların cerrahi ve onkolojik sonuçları irdelendi. Sağ kalım süresi beyin metastazı tanısı konulduğu tarih ile ölüm tarihi veya mevcut en son takip arasındaki zaman olarak hesaplandı. Hastaların 51’i erkek, 8’i kadın, ortalama yaş 56.92 (37-81) yıl idi. Cerrahi olarak 55 hastaya total eksizyon, 4 hastaya subtotal eksizyon yapıldı. Ameliyat sonrası mortalite saptanmadı. Patolojik inceleme sonucunda 55 hastada cerrahi sınırlar tümörsüz, 4 hastada ise cerrahi sınır mikroskobik pozitif olarak bildirildi. Ameliyat sonrasında tüm hastalara palyatif kranial radyoterapi ve sistemik kemoterapi verildi. 11 hastaya(%18,6) akciğerdeki primer kitleye kemoradyoterapi verildi. 8 hastaya akciğere yönelik cerrahi lobektomi, 7 hastaya pnömonektomi uygulandı. Medyan genel sağkalım süresi 12,00 (1,0-159,0) aydı. Hastaların 12, 24 ve 60 aylık sağkalım oranları sırasıyla %47.5, %28.8 ve %13.5 olarak bulundu. Üç olguda ise 10 yılın üzerinde genel sağ kalım elde edildi. Beyin metastazı yapmış KHDAK’lu hastalarda kranial metastazektomi hastaların sağkalımına olumlu katkı sağlayabilir.

Anahtar Kelimeler:

akciğer kanseri, beyin metastazı

Retrospective Evaluation of Metastasectomy and Systemic Treatment in Patients with Non-Small Cell Lung Cancer and Cranial Metastasis

The brain is one of the organs that non-small cell lung cancer (NSCLC) metastasizes most frequently. The life expectancy is limited to months in patients with brain metastasis (BM), which is not treated. This study aims to show the oncological outcomes of surgical treatment of cranial lesion in patients with stage 4 NSCLC. The data of 59 patients who were diagnosed with NSCLC and underwent surgical treatment of BM between 2004 and 2012 in our clinic were prospectively recorded and analyzed retrospectively. The surgical and oncological out-comes of the patients were studied. Survival was calculated as the time between the diagnosis of BM and the date of death or the last follow-up. Fifty-one of the patients were male, and eight were female, and the median age was 56.9 (37-81) years. Fifty-five patients underwent total excision, and four patients underwent subtotal excision. No postoperative mortality was detected. As a result of the pathological exami-nation, the surgical margins were reported as tumor-free in 55 patients, and microscopically positive in 4 patients. Palliative cranial radio-therapy and systemic chemotherapy were given to all patients after surgery. Eleven patients (18.6%) underwent chemoradiotherapy to the primary mass in the lung. Lobectomy and pneumonectomy were performed in 8 and 7 patients. The median overall survival was 12.00 (1.0-159.0) months. The 12, 24, and 60-month survival rates of the patients were 47.5%, 28.8%, and 13.5%, respectively. In three cases, overall survival over ten years was obtained. Cranial metastasectomy may contribute positively to the survival of patients with NSCLC.

Keywords:

lung cancer , cranial metastasis,

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