TY  - JOUR
T1  - Comparison of oral capecitabine alone versus platinum combinations in elderly metastatic gastric cancer patients
TT  - Yaşlı metastatik mide kanserli hastalarda tek başına oral kapesitabin ile platin kombinasyonlarının karşılaştırılması
AU  - Değirmencioğlu, Serkan
AU  - Ünal, Olçun Ümit
AU  - Oktay, Esin
PY  - 2019
DA  - September
DO  - 10.5798/dicletip.550235
JF  - Dicle Medical Journal
JO  - diclemedj
PB  - Dicle University
WT  - DergiPark
SN  - 1300-2945
SP  - 567
EP  - 573
VL  - 46
IS  - 3
LA  - en
AB  - Background: Gastric cancer is responsible for a considerableproportion of all cancer-related deaths. Elderly cancer patients are oftenignored in prospective studies in which the efficacy of chemotherapy isevaluated, although more than half of all gastric cancer cases are over the ageof 70 years. The present study aims to evaluate the efficacy and feasibility ofcapecitabine-based chemotherapies in geriatric patients with gastric cancer. Methods: A total of 81 patients overthe age of 65 years who received chemotherapy for metastatic gastric cancer attwo oncology centers between 2012 and 2017 were included in the study. Themedical records of the patients were evaluated retrospectively, and thepatients and their performance status were evaluated using the American JointCommittee on Cancer staging system and the World Health Organisation scale,respectively. Results: The mean age was 74 years. Themale gender and the adenocarcinoma histological type were seen in higher rates.Most of the patients underwent capecitabine-cisplatin chemotherapy, and themean follow-up was 42 months. The median overall survival of the groups ofpatients receiving capecitabine-cisplatin, capecitabine-oxaliplatin andcapecitabine was 8 months, 10.7 months and 8.9 months, respectively, indicatingno statistically significant differences between the groups (p=0.467). Themedian overall survival of all patients was found to be 8.7. Theprogression-free survival between the different chemotherapy subgroups was notstatistically significant (p=0.59). The most common side effect was found to beanemia. Grade 3–4 adverse effects were similar between the arms of the study(p=0.725). A statistically significant increase was found in the mortality riskwith an increased number of metastatic sites in a multivariate analysis(p=0.001). No correlation was found between the chemotherapy protocols andmortality risk (p=0.472). Adverse effects such as stomatitis, nausea/vomiting,neuropathy, neutropenic fever and nephrotoxicity, independent of chemotherapy,were statistically and significantly associated with the mortality risk(p=0.045, p=0.047, p=0.036, p=0.02 and p=0.049, respectively).Conclusions: Our study resultsshow that adverse effects such as stomatitis, nausea/vomiting, neutropenicfever, nephrotoxicity and neuropathy increase the mortality risk which suggestthat particularly oral health care, the application of appropriate antiemetictreatments, the close follow-up of kidney function tests and adequatehydration, protective infection barrier measures and effective treatment ofneuropathy associated with chronic diseases are as important as chemotherapy ingeriatric cases.
KW  - Gastric cancer
KW  - capecitabine
KW  - elderly
N2  - Amaç: Mide kanseri, kanser kaynaklı ölümlerin önemlibir kısmını oluşturmaktadır. Tüm midekanseri olgularının yarısından fazlası 70 yaş üzerinde olmasına rağmen yaşlıkanser hastalar kemoterapi etkinliğinin değerlendirildiği prospektifçalışmalarda kendilerine yer bulamamaktadırlar. Bizbu çalışmada iki onkoloji merkezindeki geriyatrik gastrik kanserli hastalardakapesitabin bazlı kemoterapilerin etkinliğini ve uygulanabilirliğiniaraştırmayı amaçladık.Materyal-metod: Çalışmaya iki merkezden metastatik midekanseri tanısı ile 2012- 2017 yılları arasında kemoterapi alan 65 yaş üzerihastalar alındı. Hasta dosyaları retrospektif olarak değerlendirildi. HastalarAmerikan Kanser Komitesi evrelendirme sistemi ve performans statusu DünyaSağlık Örgütü skalasına göre değerlendirildi. Bulgular: Çalışmaya alınan 81 hastadaortalama yaş 74 idi. Erkek cinsiyet ve adenokarsinom histolojik tip daha yüksekorandaydı. Hastaların çoğunluğuna kapesitabin-sisplatin kemoterapisiverilmişti. Hastaların ortalama takip süresi 42 aydır. Kapesitabin-sisplatin,kapesitabin-okzaliplatin, kapesitabinkemoterapisi alan grupların median tüm sağ kalım sırasıyla 8 ay, 10,7 ayve 8,9 ay olarak saptandı, arada istatistiksel fark bulunmadı (p=0,467). Tümhastaların median tüm sağ kalım 8,7 bulundu.Kemoterapi alt grupları aralarındaki progresyonsuz sağ kalım farkıistatistiksel olarak anlamlı değildir (p=0,59). En sık yan etki anemi olaraksaptandı. Grad 3-4 yan etkiler kollar arası benzerdi (p=0,725). Çok değişkenlianalizde metastatik bölge sayısı ile mortalite riski istatistiksel anlamlıartış göstermiştir (p=0,001). Kemoterapi protokolleri ile mortalite riski arasıilişki yoktur (p=0,472). Kemoterapiden bağımsız olarak stomatit, bulantı-kusma,nöropati, nötropenik ateş ve nefrotoksisite yan etkileri mortalite riski ileistatistiksel anlamlı ilişki içindedir (sırasıyla p=0,045, p=0,047, p=0,036,p=0,02 ve p=0,049).Sonuç: Çalışmamızda evre IV mide kanserli olgularda 8,7 aytüm sağ kalıma ulaşılmıştır. Kemoterapi alt gruplarında ise hem yan etki hem de sağkalımlar açısından anlamlı farkyoktur. Stomatit, bulantı-kusma, nötropenik ateş, nefrotoksisiteve nöropati yan etkilerinin mortalite riskini arttırması, geriyatrik olgulardaözellikle ağız bakımı, uygun antiemetik tedavi uygulanması, böbrek fonksiyontestlerininin sıkı takibi ve yeterli hidrasyon, enfeksiyon açısından koruyucubariyer tedbirler ve nöropati ilişkili kronik hastalıkların etkin tedavisininen az kemoterapi uygulanması kadar önem taşıdığını göstermiştir.
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UR  - https://doi.org/10.5798/dicletip.550235
L1  - https://dergipark.org.tr/en/download/article-file/809602
ER  -