Radyoterapi Uygulanan Jinekolojik Tümör Tanılı Olgularda Tedavi Sonuçları ve Prognostik Faktörler

Öz

Amaç: Radyoterapi tedavisi alan jinekolojik tümörlü hastaların değerlendirilmesi. Gereç ve Yöntemler: Haziran 2010-Ocak 2013 tarihleri arasında küratif radyoterapi RT uygulanan 78 jinekolojik tümörlü hasta retrospektif olarak değerlendirildi. Bulgular: Olguların 33’ü serviks kanseri, 44’ü endometriyum kanseri ve 1’i endoservikal kanal tümörü nedeni ile tedavi edildi. Medyan yaşı 56 idi aralık: 34–83 . Ortalama izlem süresi 23,9±1,4 ay idi. Tanı anında 18 hasta %23,1 premenopozal, 60 hasta %74,9 postmenopozaldi. Endometriyum kanseri nedeni ile opere edilen olguların 31’i adjuvan RT alırken; 9 olgu postoperatif KT ve RT aldı. Endometriyum kanseri tanısı olan 5 hasta nüks nedeni ile kurtarma cerrahisi ardından RT aldı. Serviks kanseri nedeni ile RT uygulanan hastaların 16’sına lokal ileri evre serviks kanseri nedeni ile defi nitif kemoradyoterapi uygulandı. On %30,3 serviks kanseri tanılı olgu ise adjuvan RT; 6 hasta %18,2 adjuvan kemoradyoterapi KRT , 1 olgu ise %3 kurtarma amaçlı RT aldı. Endoservikal kanal tümörü tanısı olan hastaya adjuvan KRT uygulandı. Endometriyum kanseri nedeni ile RT uygulanan hastalarda medyan sağkalım 26,3 ay, serviks kanseri nedeni ile RT uygulanan hastalarda ise 21,1 ay olarak bulundu. Endometriyum kanseri tanısı ile tedavi edilen hastalarda cox-regresyon analizinde lokal nüks p=0,046 , tümör çapı p= 0,030 ve evrenin p= 0,036 sağkalım ile ilişkisi gösterilirken; lenfovasküler alan invazyonu p=0,711 , myometriyal invazyonun p=0,684 sağkalım ile ilişkisi gösterilememiştir. Serviks kanseri nedeni ile tedavi edilen hastalarda ise lenf nodu pozitifl iği ile progresyonsuz hastalık arasında ilişki gösterilmiştir p=0,043 . Sonuç: Endometriyum kanserinde lokal nüks , tümör çapı ve evre sağkalım ile ilişkilidir. Serviks kanserinde ise lenf nodu pozitifl iği ile progresyonsuz hastalık arasında ilişki mevcuttur

Anahtar Kelimeler

• Endometriyum kanseri, Jinekolojik tümörler, Prognostik faktörler, Radyoterapi, Serviks kanseri

Radiotherapy in Gynecological Cancers: Analysis of Treatment Results and Prognostic Factors

Abstract

Objective: To evaluate the patients with gynecologic tumors undergoing radiotherapy. Material and Methods: Seventy-eight patients with a diagnosis of gynecological malignancy who received curative radiotherapy RT between June 2010-January 2013 were retrospectively evaluated. Results: We treated 33, 44 and 1 patient for cervical cancer, endometrial cancer and endocervical canal tumor respectively. The median age was 56 years 34–83 . The mean follow-up period was 23.9±1.4 months. At the time of diagnosis, 18 23.1% patients were premenopausal whereas 60 74.9% patients were postmenopausal. Thirty-one endometrial cancer patients received adjuvant RT while 9 received adjuvant chemotherapy and RT. Five of the patients with a diagnosis of recurrent endometrial cancer received RT after salvage surgery. Sixteen patients with locally advanced cervical cancer were treated with defi nitive chemoradiotherapy. Ten patients 30.3% who were operated on for cervical cancer were administered adjuvant RT whereas 6 patients 18.2% received adjuvant chemoradiotherapy. The patient with endocervical canal tumor received adjuvant chemoradiotherapy. The median overall survivals were 26.3 and 21.1 months for patients with endometrial and cervical cancer respectively. Cox-regression analyses revealed that there was a relationship between the overall survival and local recurrence p=0.046 , tumor diameter p= 0.030 and stage p= 0.036 ; on the other hand there was no relationship between the overall survival and lymphovascular invasion p=0.711 and myometrial invasion p=0.684 . Conclusion: Survival in endometrial cancer is associated with local recurrence, maximal tumor diameter and stage. For cervical cancer, there is a close association with lymph node involvement and disease-free survival

Keywords

• Endometrial cancer, Gynecologic tumors, Prognostic factors, Radiotherapy, Cervical cancer

Kaynakça

1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015;65(2):87-108.
2. Anton C, Fávero GM, Köhler C, Carvalho FM, Baracat EC, Carvalho JP. Surgical treatment of endometrial cancer in developing countries: Reasons to consider systematic two-step surgical treatment. Clinics (Sao Paulo) 2015;70(7):470-4.
3. Kanserle Savaş Dairesi Başkanlığı verileri. www.kanser. gov.tr
4. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. Cancer J Clin 2007; 57:43-66.
5. Alvarez Secord A, Havrilesky LJ, Bae-Jump V. The role of multi-modality adjuvant chemotherapy and radiation in women with advanced stage endometrial cancer. Gynecol Oncol 2007;107: 285-91.
6. Dogan NU, Yavas G, Yavas C, Ata O, Yılmaz SA, Celik C. Comparison of “sandwich chemo-radiotherapy” and six cycles of chemotherapy followed by adjuvant radiotherapy in patients with stage IIIC endometrial cancer: A single center experience. Arch Gynecol Obstet 2013;288(4):845-5.
7. Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma; A gynecologic oncology group study. Gynecol Oncol 2004;92:744-51.
8. Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-I endometrial carcinoma: Multicentre randomized trial. PORTEC Study Group. Post operative radiation therapy in endometrial carcinoma. Lancet 2000;55:1404-11.

9. Morris M, Eifel PJ, Lu J, et al. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Eng J Med 1999;340:1137–43.
10. Whitney CW, Sause W, Bundy BN et al. Randomized comparison of fl hydroxyurea as an adjunct to radiation therapy in stage IIB-IVA carcinoma of the cervix with negative para- aortic lymph nodes: A Gynecologic Oncology Group and Southwest Oncology Group study. J Clin Oncol 1999;17:1339–48. Eifel PJ, Moughan J, Owen J et al. Patterns of radiotherapy practice for patients with carcinoma of the uterine cervix: Patterns of Care Study. Int J Radiat Oncol Biol Phys 1999;43:351-8.
11. Rose PG, Bundy BN, Watkins EB. Concurrent cisplatin- based chemotherapy and radiotherapy for locally advanced cervical cancer. N Engl J Med 1999; 340:1144– 53.
12. Nag S, Erickson B, Thomadsen B, Orton C, Demanes JD, Petereit D. The American Brachytherapy Society recommendations for high-dose- rate brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys 2000;48:201–11.
13. http://www.rtog.org/CoreLab/ContouringAtlases/ GYN.aspx
14. Small W Jr, Mell LK, Anderson P, Creutzberg C, De LosSantos J, Gaffney D. Consensus guide lines for delineation of clinic altar get volume for intensity- modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys 2008;71(2):428-34.
15. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31(5):1341- 46.
16. Grigsby WP, Perez CA, Kuten A. Clinical stage I endometrial cancer: Results of adjuvant irradiation and patterns of failure. Int J Radiat Oncol Biol Phys 1992;21:379-85.
17. Grigsby WP, Perez CA, Kuten A. Clinical stage I endometrial cancer: Prognostic factors for lobal control and distant metastases and implications of the new FIGO surgical staging system. Int J Radiat Oncol Biol Phys 1991;22:905-11.
18. Glassburn JR, Brady LW, Grigsby PW. Endometrium, In: Perez CA, Brady LW, eds. Principles and Practice of Radiation Oncology. 3rd ed. Philadelphia:Lippincott- Raven Publishers, 1998,1835-52.
19. Creasman WT, Morrow P, Bundy BN. Surgical pathologic spread patterns of endometrial cancer: A Gynecologic Oncology Group Study. Cancer 1987;60:2035-41.
20. Landoni F. Maneo A, Colombo A. Randomised study of radical surgery versus radiotherapy for stage Ib-lIa cervical cancer. Lancet 1997;350:535-40.
21. Moore DH, Stehman FB. What is the appropriate management of early stage cervical cancer (International Federation of Gynecology and Obstetrics stages I and IIA surgical assessment of lymph nodes, and role of therapeutic resection of lymph nodes involved with cancer? J Natl Cancer Inst Monogr 1996;(21):43-6.
22. Benedetli-Panici P, Maneschi F, D’Andrea G. Early cervical carcinoma: The natural history of lymph node involvement redefi ned on the basis of thorough parametrectomy and giant section study. Cancer 2000;88:2267-74.
23. Burghardt E, Baltzer J, Tulusan AH. Results of surgical treatment of 1028 cervical cancers studied with volumetry. Cancer 1992;70:648-55.
24. Covens A, Rosen B, Murphy J. How important is removal of the parametrium at surgery for carcinoma of the cervix? Gynecol Oncol 2002;84: 145-9.
25. Boyce J, Fichter RG, Nicastri AD. Prognostic factors in stage I carcinoma of the cervix. Gynecol Oncol 1981; 12:154-65.
26. Sedlis A. Bundy BN, Rotman MZ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A Gynecologic Oncology Group Study. Gynecol Oncol 1999:73:177-83.
27. Alvarez RD, Potter ME. Soong SJ. Rationale for using pathologic tumor dimensions and nodal status to subclassify surgically treated stage I.E cervical cancer patients. Gynecol Oncol 1991;43:108-12.
28. Okada M, Kigawa J, Minagawa Y. Indication and effi cacy of radiation therapy following radical surgery in patients with stage 1.8 to lIB cervical cancer. Gynecol Oncol 1998; 70( I):61-64.
29. Wang X, Shen Y, Zhao Y, Li Z, Gou H. Adjuvant intensity- modulated radiotherapy (IMRT) with concurrent paclitaxel and cisplatin in cervical cancer patients with high risk factors: A phase II trial. Eur J Surg Oncol 2015;41(8):1082-8.
30. Jelavić TB, Miše BP, Strikic A, Ban M, Vrdoljak E. Adjuvant chemotherapy in locally advanced cervical cancer after treatment with concomitant chemoradiotherapy - room for improvement? Anticancer Res 2015 Jul;35(7):4161-5.