Eşzamanlı Radyokemoterapi Yapılan Lokal İleri Serviks Kanserli 24 Olguda Erken ve Geç Yan Etkilerin Analizi
Abstract
Amaç: İleri evre serviks kanserli hastalarda eşzamanlı radyokemoterapiye bağlı erken ve geç yan etkilerin objektif olarak analizidir. Materyal ve Metot: Mayıs 2000-Şubat 2004 tarihleri arasında ileri evre serviks kanseri tanısı alan 24 olgu değerlendirildi. Medyan yaş 57 (aralık, 35-72), biyopsi sonrası 20 (83%) olgu epidermoid karsinom idi. Olguların FİGO sistemine göre dağılımları; 18 hasta (75%) evre IIb, 4 (17%) hasta evre IIIb, ve 2 (8%) hasta evre IVa idi. Medyan tümör çapı 5 cm (aralık, 1.9-8cm) olup, hastaların yarısında pelvik lenf nodu radyolojik olarak pozitif idi. Para-aortik lenf nodu tutulumu ve performans durumu ECOG > 2 olan hastalar bu protokole dahil edilmediler. Tüm pelvise 4-alan kutu tekniği ile Kobalt 60 veya Linak şartlarında medyan 50.4Gy (aralık, 45-50.4Gy) eksternal radyoterapi (RT) ve HDR Ir-192 ile 20Gy brakiterapi uygulandı. Sisplatin 40mg/m2/haftalık toplam 6 kür olarak planlandı. Erken yan etkiler NCI - CTC Version 2.0 ile tedavi esnasında, geç yan etkiler ise LENT / SOMA skalası ile tedaviden en az 90 gün sonra değerlendirildi. Seksüel disfonksiyon sadece objektif verilere göre değerlendirildi. Bulgular: Tüm RT süresi 10 hafta olup, hastaların hepsinde eksternal RT medyan 47 günde tamamlanmıştır. Oniki hasta (%50) planlanan 6 kür kemoterapiyi tam dozunda alırken, grubun diğer yarısı grad III-IV miyelosupresyon nedeniyle sadece 4 kür kemoterapi alabilmiştir. Erken veya geç grad III-IV gastrointestinal yan etki saptanmamış, ancak medyan 19 aylık takipte hastaların %58inde hayat kalitesini etkileyen grad III-IV seksüel disfonksiyon tespit edilmiştir. Sonuç: Erken hematolojik yan etkiler nedeniyle eşzamanlı radyokemoterapi yapılan hastalarda yakın takip gerekmektedir. Uzun sağkalım gösteren hastalarda ise seksüel disfonksiyon hayat kalitesini etkileyen önemli bir problemdir.
Eşzamanlı Radyokemoterapi Yapılan Lokal İleri Serviks Kanserli 24 Olguda Erken ve Geç Yan Etkilerin Analizi
Abstract
Purpose: To assess objectively the early and late effects of concomittant radiochemotherapy on patients with locally advanced cervical carcinoma. Materials and Methods: Twenty-four patients with locally advanced cervical carcinoma diagnosis were assessed between May 2000 - February 2004. Median age was 57 years (range 35- 72), and 20 (83%) patients were epidermoid carcinoma. According to the stages, 18 patients (75%) were FIGO IIb, 4 (17%) were IIIb, and 2 (8%) were IVa. Median tumor size was 5 cm (range, 1.9 - 8 cm), and half of the patients had radiologically positive pelvic lymph nodes. Patients who had positive para-aortic lymph nodes and ECOG performance status > 2 were excluded from the protocol. External radiotherapy (RT) was delivered to whole pelvis with a median dose of 50.4Gy/28fr (range, 45- 50.4Gy) using a box technique under Cobalt-60 or Linac conditions. HDR Ir-192 brachytherapy with a median dose of 20Gy/3- 4fr was delivered after completion of external RT. Cisplatinum administration with 40mg/m2/once weekly for 6 weeks was planned. Early effects were assessed with NCI-CTC Version 2.0 during treatment, late effects were assessed with LENT/SOMA scales minimum 90 days after completion of treatment. Sexual dysfunction was assessed only according to objective data. Results: Total radiotherapy time was 10 weeks, and external RT was completed in 47 days in all patients. Twelve patients (50%) completed their 6 cycles chemotherapy, where the other half of the patients completed only 4 cycles of chemotherapy because of grade III-IV myelosupression. Early or late grade III-IV gastrointestinal effects were not detected, grade III-IV sexual dysfunction which affected quality of life and sexual life was detected in %58 of patients in a median 19 months follow-up. Conclusion: Close follow-up is necessary in patients who received concomittant radiochemotherapy due to early hematologic side effects. In the long-term surviving patients, sexual dysfunction is a major problem which affected quality of life.
Details
| Other ID | JA23TR23KR |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | July 1, 2004 |
| Submission Date | July 1, 2004 |
| Published in Issue | Year 2004 Volume: 7 Issue: 3 |