Abstract
Mide kanseri cerrahi sonrası kemoterapi ve radyoterapi ile kür şansı olan ve iyi sağkalım sonuçları elde edilen bir hastalıktır. Yaşlı hastalarda adjuvan tedavi ve sonuçlar ile ilgili literatürde yeterli veri yoktur. Bu sebeple 70 yaş ve üzeri mide kanserli hastalarda adjuvan tedavi sonuçlarını inceledik. Retrospektif olarak 42 hasta dosyasını inceledik. 2005 ve 2012 yılları arasında 70 yaş ve üzeri toplam 42 mide kanserli hasta adjuvan tedavi aldı. Bu hastaların 20 tanesi kadın, 22 tanesi ise erkekti. Toplam %65 hasta kemoradyoterapi, %35 hasta ise sadece kemoterapi almıştı. Çalışmadaki hastaların %48’i 6 kür kemoterapi ve radyoterapiyi tamamladı, %21 hasta ise 5 kür kemoterapi alabilmişti. Dört hasta (%15) radyoterapiyi toksisite nedeniyle tamamlayamadı. Dört hastada tedavi süresince hayatını kaybetti. Ortanca takip süresi 25 ay olup ortanca sağkalım 21 ay, progresyonsuz sağkalım 11,5 ay ve hastalıksız sağkalım ise 7 aydı. Regresyon analizinde tümör derecesi ve kemoterapi kür sayısı istatistiksel anlamlı olarak genel sağkalımla ilişkili bulunmuştur (p=0.001 ve p=0.002, sırasıyla). Sonuç olarak mide kanserli yaşlı hastaların %48’i adjuvan kemoradyoterapiden, %24’ü kemoterapiden fayda görmüşlerdir. Kemoterapi ve radyoterapiyi tamamlayabilen hastalarda bu fayda en yüksek orandadır. Kabul edilebilir bir toksisite gözlenen yaşlı hastalarda kemoterapi sonrası kolonu stimüle edici ajanlarla destekte yan etki riskini azaltmaktadır
Keywords
References
- Agboola O. 1994. Adjuvant treatment in gastric cancer. Cancer Treat Rev, 20(3):217.
- Aminia A., Sanatia H. 2011. Complete pathologic response with combination oxaliplatin and 5-fluorouracil chemotherapy in an older patient with advanced gastric cancer. Anti-Cancer Drugs, 22:1024–1026.
- Cunningham D., Allum W.H., Stenning S.H., Thompson J.N., Van De Velde C.J., Nicolson M., Scarffe J.H., Lofts F.J., Falk S.J., Iveson T.J., Smith D.B., Langley R.E., Verma M., Weeden S., Chua Y.J., Magic Trial Participants.2006. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med, 355:11.
- Earle C.C., Maroun J.A. 1999. Adjuvant chemotherapy after curative resection for gastric cancer in non-Asian patients: revisiting a meta-analysis of randomised trials. Eur J Cancer, 35(7):1059-64.
- GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group, Paoletti X., Oba K., Burzykowski T., Michiels S., Ohashi Y., Pignon J.P., Rougier P., Sakamoto J., Sargent D., Sasako M., Van Cutsem E., Buyse M. 2010. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA, 303:1729.
- Hallissey M.T., Dunn J.A., Ward L.C., Allum W.H. 1994. The second British Stomach Cancer Group trial of adjuvant radiotherapy or chemotherapy in resectable gastric cancer: five-year follow-up. Lancet, 343(8909):1309-12.
- Hermans J., Bonenkamp J.J., Boon M.C., Bunt A.M., Ohyama S., Sasako M., Van De Velde C.J. 1993. Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomized trials. J Clin Oncol, 11(8):1441-7.
- Hoffman K.E., Neville B.A., Mamon H.J., Kachnic L.A., Katz M.S., Earle C.C., Punglia R.S. 2012. Adjuvant Therapy for Elderly Patients With Resected Gastric Adenocarcinoma. Cancer, 248-57.
- Jemal A., Siegel R., XU J., Ward E. 2011. Global cancer statistics. CA Cancer J Clin, 61:69–90.
- Macdonald J.S., Smalley S.R., Benedetti J., Hundahl S.A., Estes N.C., Stemmermann G.N., Haller D.G., Ajani J.A., Gunderson L.L., Jessup J.M., Martenson J.A. 2001. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med, 345:725.
- Mari E, Floriani I., Tinazzi A., Buda A., Belfiglio M., Valentini M., Cascinu S., Barni S., Labianca R., Torri V. 2000. Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a metaanalysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell’Apparato Digerente). Ann Oncol , 11(7):837-43.
- Moertel C.G., Childs D.S., O’Fallon J.R., Holbrook M.A., Schutt A.J., Reitemeier R.J. 1984. Combined 5- fluorouracil and radiation therapy as a surgical adjuvant for poor prognosis gastric carcinoma. J Clin Oncol, 2(11):1249- 54.
- Öksüz D.Ç., Eren M.F., Beşe N.Ş., Büyükünal E., Özgüroğlu M., Mandel N.M., Turna H., Demirelli F., Erdengeçti S., Atkovar G., ÖBER A. 2010. Mide karsinomlarında postoperatif kemoradyoterapi tedavi sonuçları: Cerrahpaşa deneyimi. Türk Onkoloji Dergisi, 25(1):1-10.
- Sasako M., Sakuramoto S., Katai H., Kinoshita T., Furukawa H., Yamaguchi T., Nashimoto A., Fujii M., Nakajima T., Ohashi Y. 2011. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol, 29:4387.
Abstract
It is well known that gastric cancer (GC) has favorable outcome and survival with curative chemotherapy and radiotherapy following surgery. There is not enough literature regarding adjuvant treatment in elderly patients with GC. For this reason in this study we aimed to investigate the outcomes of adjuvant treatment of elderly (over 70 years) GC patients. We retrospectively investigated 42 elderly patients' hospital records. From 2005 to 2012, 42 gastric cancer (GC) patients older than 70 years had been treated with adjuvant therapy. The mean age of the patients were 74, 20 patients were women and 22 patients were male. Sixty five percent of patients received chemoradiation and remaining 35% received only chemotherapy as adjuvant treatment. In the study population, 48% of patients completed all 6 cycles, 21% of patients had 5 cycles of chemotherapy. Four (15%) patients have not completed radiotherapy due to toxicity. Four patients died during chemotherapy. Mean follow up period was 25 months after the adjuvant treatment. The median of overall survival was 21 months, progression-free survival was 11,5 months and disease free survival was 7 months of the study population. Multiple regression analysis revealed that, tumor grade, total dose of chemotherapy had statistically significant effecton the overall survival (P values were 0.001 and 0.002 respectively). Patients had favorable outcomes who adjuvant chemoradiotherapy or chemotherapy in elderly patients with gastric cancer. Patients who complete the all cycles of chemotherapy and radiation therapy had the most benefit from this treatment. Colony-stimulating agents following the chemotherapy reduce the risk of side effects in elderly patients and this is an acceptable toxicity profile
Keywords
References
- Agboola O. 1994. Adjuvant treatment in gastric cancer. Cancer Treat Rev, 20(3):217.
- Aminia A., Sanatia H. 2011. Complete pathologic response with combination oxaliplatin and 5-fluorouracil chemotherapy in an older patient with advanced gastric cancer. Anti-Cancer Drugs, 22:1024–1026.
- Cunningham D., Allum W.H., Stenning S.H., Thompson J.N., Van De Velde C.J., Nicolson M., Scarffe J.H., Lofts F.J., Falk S.J., Iveson T.J., Smith D.B., Langley R.E., Verma M., Weeden S., Chua Y.J., Magic Trial Participants.2006. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med, 355:11.
- Earle C.C., Maroun J.A. 1999. Adjuvant chemotherapy after curative resection for gastric cancer in non-Asian patients: revisiting a meta-analysis of randomised trials. Eur J Cancer, 35(7):1059-64.
- GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group, Paoletti X., Oba K., Burzykowski T., Michiels S., Ohashi Y., Pignon J.P., Rougier P., Sakamoto J., Sargent D., Sasako M., Van Cutsem E., Buyse M. 2010. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA, 303:1729.
- Hallissey M.T., Dunn J.A., Ward L.C., Allum W.H. 1994. The second British Stomach Cancer Group trial of adjuvant radiotherapy or chemotherapy in resectable gastric cancer: five-year follow-up. Lancet, 343(8909):1309-12.
- Hermans J., Bonenkamp J.J., Boon M.C., Bunt A.M., Ohyama S., Sasako M., Van De Velde C.J. 1993. Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomized trials. J Clin Oncol, 11(8):1441-7.
- Hoffman K.E., Neville B.A., Mamon H.J., Kachnic L.A., Katz M.S., Earle C.C., Punglia R.S. 2012. Adjuvant Therapy for Elderly Patients With Resected Gastric Adenocarcinoma. Cancer, 248-57.
- Jemal A., Siegel R., XU J., Ward E. 2011. Global cancer statistics. CA Cancer J Clin, 61:69–90.
- Macdonald J.S., Smalley S.R., Benedetti J., Hundahl S.A., Estes N.C., Stemmermann G.N., Haller D.G., Ajani J.A., Gunderson L.L., Jessup J.M., Martenson J.A. 2001. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med, 345:725.
- Mari E, Floriani I., Tinazzi A., Buda A., Belfiglio M., Valentini M., Cascinu S., Barni S., Labianca R., Torri V. 2000. Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a metaanalysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell’Apparato Digerente). Ann Oncol , 11(7):837-43.
- Moertel C.G., Childs D.S., O’Fallon J.R., Holbrook M.A., Schutt A.J., Reitemeier R.J. 1984. Combined 5- fluorouracil and radiation therapy as a surgical adjuvant for poor prognosis gastric carcinoma. J Clin Oncol, 2(11):1249- 54.
- Öksüz D.Ç., Eren M.F., Beşe N.Ş., Büyükünal E., Özgüroğlu M., Mandel N.M., Turna H., Demirelli F., Erdengeçti S., Atkovar G., ÖBER A. 2010. Mide karsinomlarında postoperatif kemoradyoterapi tedavi sonuçları: Cerrahpaşa deneyimi. Türk Onkoloji Dergisi, 25(1):1-10.
- Sasako M., Sakuramoto S., Katai H., Kinoshita T., Furukawa H., Yamaguchi T., Nashimoto A., Fujii M., Nakajima T., Ohashi Y. 2011. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol, 29:4387.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Other ID | JA29BM27FV |
| Journal Section | Research Article |
| Authors | |
| Publication Date | May 1, 2013 |
| Submission Date | May 1, 2013 |
| Published in Issue | Year 2013 Volume: 12 Issue: 1 |