Nazofarengeal Karsinom Tedavisinde Yoğunluk Ayarlı Radyoterapi ile Kombine Kemoterapinin Akut Yan Etkileri

Year 2023, , 1 - 6, 30.12.2023

Mustafa Kandaz , Atalay Balsak , Kaan Aydoğdu , Hatice Bengü Çobanoğlu

https://doi.org/10.59518/farabimedj.1323840

Abstract

Nazofarenks kanseri çok yaygın bir baş ve boyun kanseridir. Kemoradyoterapide eş zamanlı kemoterapi hastalığın kontrolünde önemli rol oynamasına rağmen tümörün anatomik yerleşimi nedeniyle akut toksisite riski yüksektir. Çalışmamızın amacı definitif kemoradyoterapi uygulanan nazofaringeal karsinom hastalarında görülen akut yan etkilerin değerlendirilmesidir. Nazofaringeal kanser tanısı alan ve tedavi gören 20-82 yaş aralığında toplam 64 (41 erkek, 23 kadın) hasta çalışmaya dahil edildi. Tüm hastalara yoğunluk ayarlı radyoterapi ile birlikte eşzamanlı kemoradyoterapi uygulandı. Tümör ve pozitif lenf nodlarına 70 Gy radyoterapi uygulanırken, tüm nazofarenks ve iki taraflı boyun lenf nodlarına 60 Gy radyoterapi uygulandı. Tedavi için üç kür sisplatin 100 mg/m2 (1., 22. ve 43. günler) veya haftalık 40 mg/m2 sisplatin kemoterapisi kullanıldı. Hastaların akut yan etkileri not edildi ve değerlendirildi. Çalışmaya dahil edilen hastaların 15'i (%23) evre II, 37'si (%58) evre III, 12'si (%19) ise evre IV hastalığa sahipti. Erkek hastalarda 2. ve 3. derece hematolojik toksisite oranları sırasıyla %47 ve %20 şeklindeydi. Kadın hastalarda 2. ve 3. derece hematolojik toksisite oranları sırasıyla %53 ve %80 tespit edildi. Her iki grup arasında hematolojik toksisite oranında anlamlı fark bulundu (p= 0.0001). 65 yaş altı hastalarda 2. ve 3. derece hematolojik toksisite oranları sırasıyla %47 ve %20 belirlendi. 65 yaş üstü hastalarda 2. derece ve 3. derece özofajit oranları sırasıyla %53 ve %80 idi. Her iki grup arasında özofajit oranında anlamlı fark görüldü (p= 0.0001). Elde ettiğimiz sonuçlar akut yan etkiler açısından literatürle uyumludur. Akut yan etkilerin sıkı takibi ve tedavisi, hastanın tedaviye uyumunu artırabilir, yaşam kalitesini iyileştirebilir ve tedavinin etkinliğini artırabilir.

Keywords

Nazofarengeal Karsinom, Kemoradyoterapi, Akut yan etki

Project Number

2017-77

Acute Side Effects of Combined Chemotherapy with Intensity-Modulated Radiotherapy in The Treatment of Nasopharyngeal Carcinoma

Abstract

Nasopharyngeal cancer is a very common head and neck cancer. Although concurrent chemotherapy plays an important role in controlling the disease, the risk of acute toxicity is high due to the anatomical location of the tumor. The aim of our study is to evaluate the acute side effects observed in nasopharyngeal carcinoma patients who underwent definitive chemoradiotherapy. A total of 64 patients (41 men, 23 women) between the ages of 20 and 82, who were diagnosed with nasopharyngeal cancer and treated, were included in the study. All patients received concurrent chemoradiotherapy along with intensity-modulated radiotherapy. While 70 Gy radiotherapy was applied to the tumor and positive lymph nodes, 60 Gy radiotherapy was applied to the entire nasopharynx and bilateral neck lymph nodes. Three cycles of cisplatin 100 mg/m2 (days 1, 22 and 43) or weekly 40 mg/m2 cisplatin chemotherapy were used for treatment. Acute side effects of the patients were noted and evaluated. Of the patients included in the study, 15 (23%) had stage II disease, 37 (58%) had stage III disease, and 12 (19%) had stage IV disease. The rates of grade 2 and 3 hematological toxicity in male patients were 47% and 20%, respectively. The rates of grade 2 and 3 hematological toxicity in male patients were 47% and 20%, respectively. A significant difference was found in the hematological toxicity rate between both groups (p= 0.0001). In patients under the age of 65, grade 2 and 3 hematological toxicity rates were determined as 47% and 20%, respectively. In patients over 65 years of age, the rates of grade 2 and 3 esophagitis were 53% and 80%, respectively. There was a significant difference in the rate of esophagitis between both groups (p= 0.0001). Our results are compatible with the literature in terms of acute side effects. Close monitoring and treatment of acute side effects can improve patient compliance with treatment, improve quality of life, and increase the effectiveness of treatment.

Keywords

Nasopharyngeal cancer, chemoradiotherapy, acute side effect

Project Number

2017-77

References

• Perez CA, Devineni VR, Marcial-Vega V, Marks JE, Simpson JR, Kucik N. Carcinoma of the nasopharynx: factors affecting prognosis. Int J Radiat Oncol Biol Phys. 1992; 23(2): 271-280. DOI: 10.1016/0360-3016(92)90741-y.
• Qin DX, Hu YH, Yan JH, et al. Analysis of 1379 patients with nasopharyngeal carcinoma treated by radiation. Cancer. 1988; 61(6): 1117-1124. DOI: 10.1002/1097-0142(19880315)61:6<1117::aid-cncr2820610611>3.0.co;2-j.
• Perez CA. Nasopharynx. In: Perez CA, Brady LW, eds. Principles and practice of radiation oncology, 4th ed. Philadelphia: Lippincot-Raven Publishers. 2004: 918-61.
• Tebra S, Kallel A, Boussen H, Bouaouina N. Traitements médicaux des carcinomes du nasopharynx [Medical treatment of nasopharyngeal cancers]. Tunis Med. 2011; 89(4): 326-331.
• Farias TP, Dias FL, Lima RA, et al. Prognostic factors and outcome for nasopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2003; 129(7): 794-799. DOI: 10.1001/archotol.129.7.794.
• Xu YC, Chen KH, Liang ZG, Zhu XD. A Systematic review and meta-analysis of studies comparing concurrent chemoradiotherapy with radiotherapy alone in the treatment of stage II nasopharyngeal carcinoma. Front Oncol. 2022; 12: 843675. DOI: 10.3389/fonc.2022.843675.
• Begg AC. Cisplatin and radiation: interaction probabilities and therapeutic possibilities. Int J Radiat Oncol Biol Phys. 1990; 19(5): 1183-1189. DOI: 10.1016/0360-3016(90)90226-a.
• Qu S, Liang ZG, Zhu XD. Advances and challenges in intensity-modulated radiotherapy for nasopharyngeal carcinoma. Asian Pac J Cancer Prev. 2015; 16(5): 1687-1692. DOI: 10.7314/apjcp.2015.16.5.1687.
• Kang M, Wang F, Liao X, Zhou P, Wang R. Intensity-modulated radiotherapy combined with endostar has similar efficacy but weaker acute adverse reactions than IMRT combined with chemotherapy in the treatment of locally advanced nasopharyngeal carcinoma. Medicine (Baltimore). 2018; 97(25): e11118. DOI: 10.1097/MD.0000000000011118.
• O'Meara WP, Lee N. Advances in nasopharyngeal carcinoma. Curr Opin Oncol. 2005; 17(3): 225-230. DOI: 10.1097/01.cco.0000156197.29872.8e.
• Akdemir EY, Cengiz M. Baş-boyun kanserlerinde organ koruyucu kemoradyoterapi. J Med Oncol-Special Topics. 2018; 11(2): 147-153.
• Huang GX, Zhao C, Han F, et al. Clinical study in prophylactic use of chinese medicine to prevent chemoradiotherapy induced mucositis in nasopharyngeal carcinoma. Ai Zheng. 2003; 22(10): 1084-1087.
• Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31(5): 1341-1346. DOI: 10.1016/0360-3016(95)00060-C.
• Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006; 354(6): 567-578. DOI: 10.1056/NEJMoa053422.
• Chan AT, Teo PM, Ngan RK, et al. Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol. 2002; 20(8): 2038-2044. DOI: 10.1200/JCO.2002.08.149.
• Daugėlaitė G, Užkuraitytė K, Jagelavičienė E, Filipauskas A. Prevention and Treatment of Chemotherapy and Radiotherapy Induced Oral Mucositis. Medicina (Kaunas). 2019; 55(2): 25. DOI: 10.3390/medicina55020025.
• Rao D, Behzadi F, Le RT, Dagan R, Fiester P. Radiation induced mucositis: What the radiologist needs to know. Curr Probl Diagn Radiol. 2021; 50(6): 899-904. DOI: 10.1067/j.cpradiol.2020.10.006.
• Liu S, Zhao Q, Zheng Z, et al. Status of treatment and prophylaxis for radiation-induced oral mucositis in patients with head and neck cancer. Front Oncol. 2021; 11: 642575. DOI: 10.3389/fonc.2021.642575.
• Minhas S, Sajjad A, Chaudhry RM, Zahid H, Shahid A, Kashif M. Assessment and prevalence of concomitant chemo-radiotherapy-induced oral mucositis in patients with oral squamous cell carcinoma. Turk J Med Sci. 2021; 51(2): 675-684. DOI: 10.3906/sag-2007-131.
• Pereira IF, Firmino RT, Meira HC, DO Egito Vasconcelos BC, DE Souza Noronha VRA, Santos VR. Radiation-induced oral mucositis in brazilian patients: prevalence and associated factors. In Vivo. 2019; 33(2): 605-609. DOI: 10.21873/invivo.11517.
• Luo Y, Cai B, Li B, et al. The Acute toxicities and efficacy of concurrent chemotherapy with docetaxel plus cisplatin, or docetaxel, or cisplatin and helical tomotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: A randomized single-center phase II trial. Technol Cancer Res Treat. 2022; 21: 15330338221109974. DOI: 10.1177/15330338221109974.
• Du L, Zhang XX, Feng LC, et al. Propensity score matching analysis of a phase II study on simultaneous modulated accelerated radiation therapy using helical tomotherapy for nasopharyngeal carcinomas. BMC Cancer. 2017; 17(1): 582. DOI: 10.1186/s12885-017-3581-1.
• Maoleekoonpairoj S, Phromratanapongse P, Puttanuparp S. Phase II study: concurrent chemo-radiotherapy in advanced nasopharyngeal carcinoma. J Med Assoc Thai. 1997; 80(12): 778-784.
• Dechaphunkul T, Pruegsanusak K, Sangthawan D, Sunpaweravong P. Concurrent chemoradiotherapy with carboplatin followed by carboplatin and 5-fluorouracil in locally advanced nasopharyngeal carcinoma. Head Neck Oncol. 2011; 3: 30. DOI: 10.1186/1758-3284-3-30.