SERVİKS KANSERİNDE PRİMER KEMORADYOTERAPİ SONRASI UTERUSTA SINIRLI REZİDU TÜMÖRÜN SAĞKALIMA OLAN ETKİSİ

Year 2018, Volume: 49 Issue: 4, - , 15.12.2018

Hamdullah Sözen , Merve Baktıroglu Harika Yumru İrem Usta İbrahim Yalçın Seden Kucucuk Kamuran Ibıs Samet Topuz , Yavuz Salihoglu

https://doi.org/10.16948/zktipb.487978

Abstract

ÖZET:

Amaç: Primer kemoradyoterapi
tedavisi almış ileri evre serviks kanserli hastalarda uterusa sınırlı rezidü
tümör miktarının sağkalıma etkisini belirlemek ve bu tarz tümörlerde görüntüleme
yöntemlerinin rezidü tümör saptamadaki başarısı saptamak

Materyal Metod: İstanbul
Universitesi İstanbul Tıp Fakültesi Jinekolojik Onkoloji Kliniğinde 2009 Nisan-2017
Mayıs ayları arasında opere edilen 31 hasta çalışmaya dahil edilmiştir. Bu
hastaların klinikopatolojik özellikleri değerlendirilmiştir. Hastalar operasyon
öncesi Magnetik Rezonans inceleme (MRI) ve/veya Pozitron Emisyon Tomografi
(PET-BT) ile değerlendirilmiştir. Hastalar operasyon sonrası uterus
materyalinde tümör miktarına göre i) rezidu tümör yok ii) rezidü tümör <10
mm iii) rezidü tümör > 10 mm olarak üç gruba ayrılmış ve  hastalıksız sağkalım incelemesi yapılmıştır.

Sonuçlar: Ortanca yaş
54 olarak hesaplanmıştır. MRI rezidü tümör saptamada sensitivitesi %75
spesifitesi %50 ; PET-BT  sensitivitesi
%54.5 spesifitesi %50 olarak saptanmıştır. Bir yıllık hastalıksız sağkalım
oranları rezidü olmayan, mikroskobik rezidü olan ve makroskobik rezidü olan
hastalarda sırası ile %92.3, %80 ve %38.5 olarak tespit edildi.

Yorum: Irradiye serviks kanserinde rezidü tümör saptamada
görüntüleme yöntemlerinin başarısı kısıtlıdır. Histopatolojik olarak saptanmış
rezidü tümörün büyüklüğü arttıkça hastalıksız sağkalım rakamları azalmaktadır.

Keywords

SERVİKS KANSERİ, RADYOTERAPİ

The survival effect of residual disease on hysterectomy specimen among the patients previously treated by chemoradiotherapy

Abstract

Aim: to determine the association between the life
prospects and residual tumour size on hysterectomy specimen among the group of
patients previously treated by primary chemoradiotherapy. Secondary aim of the
study is to investigate the success of imaging methods on the same group of
patients
Materials
methods: thirty one patients operated
at istanbul university istanbul medical faculty between 2009 april and 2017
october  due to insuffient treatment after primary chemoradiotherapy are
recruited. Clinicopatholigical features of these patients were evaluated.
Patients are categorized according to residual tumour size on hysterectomy
specimen i) no residual tumour in specimen ii) residual tumour size under 10 mm
iii) residual tumour size more than 10 mm
Results: Median age is calculated as 54 . Sensitivity and
specifity of magnetic resonance investigation are found 75 percent and 50
percent whereas pozitron emission tomography sensitivity and specifity are
calculated as 54 and 50 percent respectively. One year disease free survival of
no tumour group, microscopic tumour group and macroscopic tumour group are
calculated 92 , 80, 38 percent, respectively
Conclusion: The success of imaging methods on determining
residual tumour in uterus is limited. Increasing size of residual tumour proven
by histopathological method on uterus is associated with worse prognosis

Keywords

chemoradiotherapy, cervical canser

References

• 1. Gültekin M, Küçükyıldız I, Karaca M, Trends of Gynecological Cancers in Turkey Toward Europe or Asia? Int J Gynecol Cancer 2017;27: S1YS92. Green JA, Kirwan JM, Tierney JF, et al. Survival and recurrence afterconcomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet 2001;358:781–6.3. Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol 2008;26:5802–12.4. Sturdza A, Potter R, Fokdal LU et al (2016) Image guided brachytherapy in locally advanced cervical cancer: improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study. Radiother Oncol 120:428–4335. Keys HM, Bundy BN, Stehman FB, Okagaki T, Gallup DG, Burnett AF,Rotman MZ, Fowler WC Jr, Gynecologic Oncology Group: Gynecologic Oncology Group. Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the Gynecologic Oncology Group. Gynecol Oncol 2003, 89:343-353.6. Carcopino X, Houvenaeghel G, ButtarelliMet al (2008) Equivalentsurvival in patients with advanced stage IB-II and III-IVA cervical cancer treated by adjuvant surgery following chemoradiotherapy.Eur J Surg Oncol 34:569–5757. Hass P, Eggemann H, Costa S et al. Adjuvant hysterectomy after radiochemotherapy for locally advanced cervical cancer Strahlenther Onkol (2017) 193:1048–10558. G. Ferrandina, P.A.Margariti, D. Smaniotto,M. Petrillo, M.G. Salerno, A. Fagotti, et al., Long-term analysis of clinical outcome and complications in locally advanced cervical cancer patients administered concomitant chemoradiation followed by radicalsurgery, Gynecol. Oncol. 119 (2010) 404–410.9. D. Hequet, E. Marchand, V. Place, V. Fourchotte, A. De La Rochefordiere, S. Dridi, et al., Evaluation and impact of residual disease in locally advanced cervical cancer after concurrent chemoradiation therapy: results of a multicenter study, Eur. J. Surg. Oncol. 39 (2013) 1428–1434.10. Valduvieco I, Biete A, Rios I. Et al. Correlation between clinical findings and magnetic resonance imaging fort he assesment of local response after standard treatment in cervical cancer. Rep Pract Oncol Radiother 2013;18:214-911. E. Vincens, C. Balleyguier, A. Rey, C. Uzan, E. Zareski, S. Gouy, et al., Accuracy of magnetic resonance imaging in predicting residual disease in patients treated for stage IB2/II cervical carcinoma with chemoradiation therapy: correlation of radiologicfindings with surgicopathologic results, Cancer 113 (2008) 2158–2165.12. Kim Y.J, Byun J S, Kim Y.S et al.Disease courses in patients with residual tumor following concurrent chemoradiotherapy for locally advanced cervical cancer. Gynecologic Oncology 144 (2017) 34-3913. D.M. Koh, D.J. Collins, Diffusion-weighted MRI in the body: applications and challenges in oncology, AJR Am. J. Roentgenol. 188 (2007) 1622–1635.14. T.D. Barwick , A. Taylor, A. Rockall, Functional imaging to predict tumor response inlocally advanced cervical cancer, Curr. Oncol. Rep. 15 (2013) 549–558.15. Marchand P.C, Chargari C, Bouaita R et al. What to expect from immediate salvage hysterectomy following concomitant chemoradiation and image-guided adaptive brachytherapy in locally advanced cervical cancer Cancer/Radiotherapie 19 (2015) 710-71716. Azria E, Morice P, Haie-Meder C, et al. Results of hysterectomy in patients with bulky residual disease at the end of chemoradiotherapy for stage IB2/II cervicalcarcinoma. Ann Surg Oncol 2005;12:332–7.