KONVANSİYONEL EKSTERNAL RADYOTERAPİ VE KONFORMAL RADYOTERAPİ TEKNİKLERİNİN HORMONOTERAPİ DURUMUNA GÖRE AKUT YAN ETKİLER AÇISINDAN KARŞILAŞTIRILMASI

Year 2004, Volume: 17 Issue: 2, 58 - 64, 29.06.2015

İlknur Çetin Ufuk Abacıoğlu Meriç Şengöz

Abstract

Amaç : Prostat kanserinin primer tedavisinde konvansiyonel eksternal radyoterapi (EBRT) ile konformal radyoterapi teknik (CRT)uygulamaların hormonoterapi (HT) durumuna göre akut yan etkiler açısından karşılaştırılması amaçlanmıştır. Gereç ve Yöntem : Mart 1997- Temmuz 2002 tarihleri arasında lokalize prostat kanseri tanısı konmuş ve primer radyoterapi uygulanmış 75 hastanın EBRT uygulanan 47 ve CRT uygulanan 28 hasta idi. Tüm hastalar için medyan yaş 72 (55-85), medyan radyoterapi dozu 70 Gray (Gy) (63-76 Gy) olarak tespit edilmiştir. Hastaların 23’u (%31) hormonoterapi almamış , 22’si (%29) eş zamanlı hormonoterapi almış ve 30’u (%40) neoadjuvan hormonoterapi almıştı. Hastaların en az 3 aylık takibi mevcut olup, görülen akut yan etkiler EORTC/RTOG (European Organisation for Research and Treatment of Cancer / Radiation Therapy Oncology Group) skalası kullanılarak değerlendirilmiştir 1 . Bulgular: Grade I ve II akut üriner yan etkiler; konvansiyonel radyoterapi grubunda %30 ve %23 iken, konformal radyoterapi grubunda %61 ve %18 oranında gözlenmiştir (p=0.025). Grade II üriner yan etkiler; HT almayanda ve neoadjuvan hormonoterapi alanlarda %13 eş zamanlı hormonoterapi alan hastalarda %41 oranında saptanmıştır (p=0.02). Grade II rektal yan etkiler; konvansiyonel radyoterapi grubunda %30, konformal radyoterapi grubunda %7 oranında tespit edilmiştir (p=0.022). Sonuç : Konformal radyoterapi uygulaması ile grade II akut rektal ve üriner yan etkilerin azaldığı tespit edilmiştir. Eşzamanlı hormonoterapi kullanımı ile grade II akut üriner yan etki neoadjuvan kullanıma göre daha sık gözlenmiştir.

Anahtar Kelimeler: Akut yan etkiler, Konvansiyonel, Konformal radyoterapi, Prostat kanseri

Keywords

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References

• 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; 31:1341-1346.
• Zelefsky MJ, Leibel SA, Fuks Z. Conventional
• external beam radiation therapy for prostate cancer:
• Where do we go from here? Int J Radiat Oncol Biol
• Phys 1993; 26:365-367.
• Gallagher MJ, Brereton HD, Rostock RA, et al. A
• prospective study of treatment techniques to
• minimize the volume of pelvic small bowel with
• reduction of acute and late effects associated with
• pelvic irradiation. Int J Radiat Oncol Biol Phys
• ; 12:1565-1573.
• Leibel SA, Zelefsky MJ, Kutcher GJ, et al. The
• biological basis and clinical application of threedimensional
• conformal external beam radiation
• therapy in carcinoma of the prostate. Semin Oncol
• ; 21:580.
• Sandler HM, Perez-Tamayo C, Ten Haken RK, et
• al. Dose escalation for stage C (T3) prostate cancer:
• Minimal rectal toxicity observed using conformal
• therapy. Radiother Oncol 1992; 23:53.
• Sandler HM, McLaughlin PW, Ten Haken RK,
• Addision H, Forman J, Lichter A. Three
• dimensional conformal radiotherapy for the
• treatment of prostate cancer: low risk of chronic
• rectal morbidity observed in a large series of
• patients. Int J Radiat Oncol Biol Phys 1995;
• :797-801.
• Dale E, Olsen DR, Foss SD. Normal tissue
• complication probabilities correlated with late
• effects in the rectum after prostate conformal
• radiotherapy. Int J Radiat Oncol Biol Phys 1999;
• :385-391.
• Hanks GE, Schultheiss TE, Hunt MA, Epstein BE.
• Factors influencing incidence of grade 2 morbidity
• in conformal and standard radiation treatment of
• prostate cancer. Int J Radiat Oncol Biol Phys 1995;
• :25-29.
• Soffen EM, Hanks GE, Hunt MA, Epsteın BE.
• Conformal static field radiation therapy of early
• prostate cancer versus non-conformal techniques: A
• reduction in acute morbidity. Int J Radiat Oncol
• Biol Phys 1992; 24:485-488.
• Koper PC, Stroom JC, Van Putten WL, et al. Acute
• morbidity reduction using 3DCRT for prostate
• carcinoma: A randomized study. Int J Radiat Oncol
• Biol Phys 1999; 43:727-734.
• Pollack A, Zagars GK, Smith LG, et al. Preliminary
• results of a randomized radiotherapy doseescalation
• study comparing 70 Gy with 78 Gy for
• prostate cancer. J Clin Oncol 2000; 18:3904-3911.
• Storey MR, Pollack A, Zagars G, Smith L, Antolak
• J, Rosen I. Complications from radiotherapy dose
• escalation in prostate cancer: Preliminary results of
• a randomized trial. Int J Radiat Oncol Biol Phys
• ; 48:635-642.
• Zelefsky MJ, Leibel SA, Gaudin PB, et al. Dose
• escalation with three-dimensional conformal
• radiation therapy affects the outcome in prostate
• cancer. Int J Radiat Oncol Biol Phys 1998; 41:491-
• -
• Storey MR, Pollack A, Zagars G, Smith L, Antolak
• J, Rosen I. Complications from radiotherapy dose
• escalation in prostate cancer: Preliminary results of
• a randomized trial. Int J Radiat Oncol Biol Phys
• ; 48:635-642.
• Fleming I, Cooper J, Henson D, et al. Prostate .In:
• AJCC cancer staging manual. Philadelphia, New
• York: Lippincott-Raven; 1997:219-224.
• Tait DM, Nahum AE, Meyer LC, et al. Acute
• toxicity in pelvic radiotherapy; a randomised trial
• of conformal versus conventional treatment.
• Radiother Oncol 1997; 42:121-36.
• Pollack A, Zagars GK, Starkschall G, et al.
• Conventional versus conformal radiotherapy for
• prostate cancer: prelimary results of dosimetry and
• acute toxicity. Int J Radiat Oncol Biol Phys 1996;
• :555-564.
• Vijayakumar S, Awan A, Karrison T, et al. Acute
• toxicity during external beam radiotherapy for
• localized prostate cancer: comparison of different
• techniques. Int J Radiat Oncol Biol Phys 1993;
• :359-371.
• Nuyttens JJ, Milito S, Rust PF, Turrisi AT. Dosevolume
• relationship for acute side effects during
• high dose conformal radiotherapy for prostate
• cancer. Radiother Oncol 2002; 64:209-214.
• Odrazka K, Vanasek J, Vaculikova M,, et al.
• Conformal radiotherapy for prostate cancer-longer
• duration of acute genitourinary toxicity in patients
• with prior history of invasive urological procedure.
• Acta Oncol 2001; 40:7810-7815.
• Herold DM, Hanlon AL, Hanks GE. Diabetes
• Mellitus: A predictor for late radiation morbidity.
• Int J Radiat Oncol Biol Phys 1999; 43:475-479.
• Lim Joon D, Hasegawa M,Wu CS, et al. Supraadditive
• apoptotic response in predominantly
• quiescent prostate tumors when treated with
• androjen-ablation and radiotherapy. Int J Radiat
• Oncol Biol Phys 1996; 36:191.
• Forman JD, Kumar R, Haas G, Montie J, Porter
• AT, Mesina CF. Neoadjuvant hormonal downsizing
• of localized carcinoma of prostate: effect on the
• volume of normal tissue irradiation. CA Invest
• ; 13:132-133
• -
• Marmara Medical Journal 2004;17(2);58-64
• İlknur Çetin, et.al.
• A comparison of Conventıonal External Radıotherapy Technique and Conformal Radiotherapy Technique in Terms of
• Acute Toxıcity With Regard to Hormonal Treatment
• Lawton CA, Winter K, Murray K, et al. Updated
• results of the phase III radiation therapy oncology
• group (RTOG) trial 85-31 evaluating the potential
• benefit of androgen suppression following standard
• radiation therapy for unfavorable prognosis
• carcinoma of the prostate. Int J Radiat Oncol Biol
• Phys 2001; 49;937-946.
• Pilepich MV, Winter K, John MJ, et al. Phase III
• radiation therapy oncology group (RTOG) trial 86-
• of androgen deprivation adjuvant to definitive
• radiotherapy in locally advanced carcinoma of the
• prostate. Int J Radiat Oncol Biol Phys 2001;
• :1243-1252.
• Zurlo A, Collete L, van Tienhoven G, Blank L, et
• al, EORTC Radiotherapy and Genito-Urinary Tract
• Cancer Group. Acute toxicity of conventional
• radiation therapy for high-risk prostate cancer in
• EORTC trial 22863. Eur Urol 2002; 42:125-132
• Sanguineti G, Franzone P, Marcenaro M, Paoli G,
• Orsatti M, Vitale V. Androgen deprivation impacts
• late rectal toxicity after conformal radiotherapy.
• Abstr 1328, 338a. ASCO Meeting 2000; 20-23.