Rektum Kanseri Tanısıyla Radyoterapi ile Eş Zamanlı 5-Florourasil/Kapesitabin Uygulanan Hastaların 10 Yıllık Sağkalımına Etki Eden Faktörlerin Retrospektif Değerlendirilmesi

Öz

Lokal ileri evre rektum kanseri tanısıyla, radyoterapi (RT) ile eş zamanlı 5-florourasil (5-FU) /kapesitabin uygulanan hastaların 10 yıllık sağkalım sonuçlarını ve sağkalıma etki eden faktörleri incelemeyi amaçladık. Mart 2004-Ocak 2007 arasında Radyoterapi Merkezi’nde radyoterapi ile eş zamanlı 5-florourasil/kapesitabin uygulanan lokal ileri evre rektum adenokarsinomu tanılı 81 hasta (55 5-FU, 26 kapesitabin) retrospektif değerlendirildi. Hastaların nüks ve metastaz durumu ve yaş, T evresi, N evresi, patoloji, müsin komponent varlığı, vasküler invazyon, perinöral invazyon, lenfatik invazyon, lenfositik infiltrasyon, extrakapsüler invazyon, RT tipi, RT dozunun hastalıksız sağkalım (HSK) ve genel sağkalıma (GSK) etkisi araştırıldı. Medyan 35 aylık izlem süresi sonunda, kapesitabin uygulanan 26 hastada lokal nüks gelişmezken, üç hastada (%11) metastaz, 16 hastada (%61) ölüm olmuştur. 5-FU kolunda 55 hastanın 11'inde (%20) lokal nüks saptanmış, 13 hastada (%23) metastaz gelişmiş, 42 hasta (%76) ölmüştür. Kapesitabin için genel sağkalım medyan 24 ay (1-229), hastalıksız sağkalım medyan 36 aydır (1-229). İstatistiksel analizde N evresi (p=0.034), müsin komponent varlığı (p=0.039), vasküler invazyon varlığı (p=0.02) ve radyoterapi dozu (p=0.025) GSK ile ilişkili; yaş (p=0.041), lenfositik infiltrasyon varlığı (p=0.032) ve RT dozu (p=0.04) HSK ile ilişkili saptanmıştır. Literatürle uyumlu olarak çalışmamızda olarak vasküler invazyon ve lenf nodu evresinin (N) GSK'ya istatistiksel anlamlı olarak etkili olduğunu saptadık. Lokal ileri evre rektum kanseri tedavisinde kapesitabinin iyi tolere edilmesi, tedaviye hasta uyumunun yüksek olması, 10 yıllık sağkalım sonuçlarının iyi olması; kemoradyoterapide günümüzde öncelikli olarak tercih edilmesini açıklamaktadır.

Anahtar Kelimeler

• rektum kanseri
• kemoradyoterapi
• 5-florourasil
• kapesitabin

Retrospective Evaluation of Factors Affecting 10-Year Survival in Patients with Rectal Cancer Treated with 5-Fluorouracil/Capecitabine Concomitant to Radiotherapy

Abstract

We evaluated the 10-year survival results and factors affecting the survival of patients with locally advanced rectal cancer, who received 5-fluorouracil (5-FU) / capecitabine chemoradiotherapy. Between March 2004 and January 2007, 81 patients administered 5-FU/capecitabine (55 5-FU, 26 capecitabine) concurrently with radiotherapy (RT) at Radiotherapy Center, were evaluated retrospectively. The presence of recurrence and metastasis, and the effects of age, T stage, N stage, pathology, vascular invasion, perineural invasion, lymphatic invasion, lymphocytic infiltration, extracapsular invasion, presence of mucin component, RT type, the dose of RT on disease-free survival (DFS) and overall survival (OS) were analyzed. At the end of a median follow-up period of 35 months, in the capecitabine arm none of 26 patients had a recurrence, three (%11) had metastases, 16 (%61) died. In the 5-FU arm, 11 patients (%20) had a recurrence, 13 (%23) had metastases, 42 (%76) died. For capecitabine, the median OS is 24 months (1-229), and DFS is 36 months (1-229). In statistical analysis, N stage (p=0.034), presence of vascular invasion (p=0.02), presence of mucin component (p=0.039) and radiotherapy dose (p=0.025) were associated with OS; age (p=0.041), presence of lymphocytic infiltration (p=0.032), and the dose of RT (p=0.04) were found to be associated with PFS. Consistent with the literature, we found that lymph node stage (N) and vascular invasion had a statistically significant effect on OS. Better patient compliance with capecitabine, and good 10-year survival results; explain to us why it is the first choice in rectal cancer chemoradiotherapy today.

Keywords

• rectal cancer
• chemoradiotherapy
• 5-fluorouracil
• capecitabine

Kaynakça

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