Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi

Yıl 2020, Cilt: 7 Sayı: 2, 117 - 122, 30.06.2020

Zümrüt Arda Kaymak Çerkeşli , Emine Elif Özkan

https://doi.org/10.34087/cbusbed.594329

Cited By: 1

Öz

Amaç: Evre IB-IIA Serviks kanseri tanılı hastaların yarıdan fazlası primer
cerrahi sonrası adjuvan radyoterapiye  ihtiyaç duymaktadır. Özellikle büyük tümör
boyutu varlığında tedavide definitif radyoterapi önerilir.  Evre III hastalarda ise definitif
kemoradyoterapi standart yaklaşım olarak önerilmekte iken klinik uygulamada
primer modalite olarak cerrahi halen kullanılmaktadır. Bu çalışmada
kliniğimizde FIGO 2018’e göre Evre IB-III serviks kanseri tanısı ile definitif
veya adjuvan radyoterapi uygulanmış hastaların tedavi sonuçlarının
karşılaştırmalı değerlendirilmesi amaçlanmıştır.  

Materyal ve Metod: 2011-2019 yıllarında kliniğimizde serviks kanseri tanısı ile definitif
radyoterapi (DRT) uygulanan 28 hasta ve adjuvan radyoterapi (ART)  uygulanan 20 hasta çalışmaya dahil edildi. DRT
ve ART hasta gruplarının özellikleri Ki-Kare testi ile, genel sağkalım (GS) ve
progresyonsuz sağkalım (PSK) değerlendirmeleri Kaplan-Meier analizi ve log-rank
testi ile, çok değişkenli analizler ise Cox regresyon analizi ile yapıldı.  

Bulgular: Medyan 39,6 ay(0,5-90,5) takip süresi sonunda 33 hasta hayattaydı. DRT ve
ART gruplarında GS sırasıyla 39,65 ay ve 42,46 ay; PSK sırasıyla 26,10 ay ve
22,93 ay ve 3 yıllık sağkalım oranları sırasıyla %79,6 ve %72,2 idi. İki grup
arasında GS ve PSK açısından istatistiksel olarak anlamlı fark tespit edilmedi
(p=0.936, p=0,756). Çok değişkenli analiz sonuçlarında ECOG durumunun GS
üzerinde, tümör boyutunun ise PSK üzerinde istatistiksel anlamlı etkisi bulundu
(sırasıyla p=0,009, p=0,044). Tedavi modalitesinin ise PSK (p=0,724) veya GS (p=0,908)
üzerinde istatistiksel olarak anlamlı bir etkisi gösterilmedi. 

Sonuç: Hastaların GS, PSK ve 3 yıllık sağkalım sonuçları literatür ile uyumludur.
Evre IB-III serviks kanserinde definitif radyoterapi ve postoperatif adjuvan
radyoterapi benzer sağkalım sonuçlarına sahiptir. Adjuvan radyoterapiye ihtiyaç
duyacak hastalarda definitif radyoterapi tercih edilmesi düşünülmelidir.

Anahtar Kelimeler

servik kanseri, definitif radyoterapi, adjuvan radyoterapi, sağkalım

Kaynakça

• World Health Organization. Globocan 2012: Estimated cancer incidence,mortality and prevalence worldwide in 2012. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed July 8 2017.
• Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. FIGO Cancer Report 2018. Cancer of the cervix uteri. Int J Gynaecol Obstet. 2018 Oct;143 Suppl 2:22-36
• Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, ve ark. Randomised study of radical surgery versus radiotherapy for stage Ib–IIa cervical cancer. Lancet 1997;350:535-40.
• Green JA, Kirwan JM, Tierney JF, ve ark. Survival and recurrence after concomitant chemotherapy and radiotherapy for cancer of the uterine cervix: a systematic review and meta-analysis. Lancet 2001;358:781–6.
• 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.
• Ferrandina G, Ercoli A, Fagotti A, ve ark. Completion surgery after concomitant chemoradiation in locally advanced cervical cancer: a comprehensive analysis of pattern of postoperative complications. Ann Surg Oncol 2014;21:1692–9.
• Hansen EK, Roach M. Hand-Book of Evidence based Radiation Oncology 3rd Edition, Springer , USA, 2018, s: 625-645, https://doi.org/10.1007/978-3-319-62642-0
• Horiot JC, Pigneux J, Pourquier H: Radiotherapy alone in carcinoma of the intact uterine cervix according to GH Fletcher guidelines: a French Cooperative study of 1383 cases, Int J Radiat Oncol Biol Phys 14:605, 1988.
• Perez C, Camel HM, Walz BJ: Radiation therapy alone in the treatment of carcinoma of the cervix: a 20 year experience, Gynecol Oncol 23:127, 1986.
• Kim RY, Trotti A, Wu CJ: Radiation alone in the treatment of cancer of the uterine cervix: analysis of pelvic failure and dose response relationship, Int J Radiat Oncol Biol Phys 17:973, 1989
• Eifel P, Morris M, Wharton JT: The influence of tumor size and morphology on the outcome of patients with FIGO stage IB squamous cell carcinoma of the uterine cervix, Int J Radiat Oncol Biol Phys 29:9, 1994.
• Fuller AFJ, Elliott N, Kosloff C: Determinants of increased risk for recurrence in patients undergoing radical hysterectomy for stage IB and IIA carcinoma of the cervix, Gynecol Oncol 33:34, 1989.
• Artman LE, Hoskins WJ, Bibro MC: Radical hysterectomy and pelvic lymphadenectomy for stage IB carcinoma of the cervix: 21 years experience, Gynecol Oncol 28:8, 1987.
• Smiley LM, Burk TW, Silva EG: Prognostic factors in stage IB squamous cervical cancer patients with low risk for recurrence, Obstet Gynecol 77:271, 1991.
• Lee YN, Wang KL, Lin MH: Radical hysterectomy with lymph node dissection for treatment of cervical carcinoma: a clinical review of 954 cases, Gynecol Oncol 32:135, 1989.
• Peters WA, ve ark: Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix, J Clin Oncol 18(8):1606–1613, 2000
• Sedlis A, ve ark: 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 73(2):177–183, 1999.
• Berman ML, Keys H, Creasman W: Survival and patterns of recurrence in cervical cancer metastatic to periaortic lymph nodes (a Gynecologic Oncology Group study), Gynecol Oncol 19:8, 1984.
• Yeo RM, Chia YN, Namuduri RP, ve ark. Tailoring adjuvant radiotherapy for stage IB IIA node negative cervical carcinoma after radical hysterectomy and pelvic lymph node dissection using the GOG score. Gynecol Oncol. 2011;123:225–229.
• Minig L, Patrono MG, Romero N, ve ark. Different strategies of treatment for uterine cervical carcinoma stage IB2-IIB. World J Clin Oncol. 2014;5:86–92.
• Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. 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;73:177–183.
• Rose PG, Ali S, Watkins E, ve ark. Gynecologic Oncology Group. Long-term follow-up of a randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: A Gynecologic Oncology Group Study. J Clin Oncol. 2007;25:2804–2810.
• Small W Jr, Beriwal S, Demanes DJ, ve ark. American Brachytherapy Society consensus guidelines for adjuvant vaginal cuff brachytherapy after hysterectomy. Brachytherapy. 2012;11:58–67.
• Peters WA III, Liu PY, Barrett RJ II, ve ark. Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol. 2000;18:1606–1613.
• Whitney CW, Sause W, Bundy BN, ve ark. Randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stage llB-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: 1339–1348.
• Morris M, Eifel PJ, Lu J, ve ark. Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer. N Engl J Med. 1999;340:1137–1143.
• Rose PG, Bundy BN, Watkins EB, ve ark. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999;340:1144–1153.
• Keys HM, Bundy BN, Stehman FB, ve ark. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma. N Engl J Med. 1999;340:1154–1161
• Keys HM ve ark: Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the Gynecologic Oncology Group, Gynecol Oncol 89(3):343–353, 2003.
• Mazeron R, Gouy S, Chargari C, Rivin Del Campo E, Dumas I, Mervoyer A, ve ark. Post radiation hysterectomy in locally advanced cervical cancer: outcomes and dosimetric impact. Radiother Oncol 2016;120:460-6.
• Albert A, Allbright R, Lee A, Vijayakumar S. Preoperative chemoradiation followed by hysterectomy for cervical cancer: patterns of care and survival in a large, hospital database. J Gynecol Oncol. 2019 May;30(3):e41.
• Fanfani F, Vizza E, Landoni F ve ark. Radical hysterectomy after chemoradiation in FIGO stage III cervical cancer patients versus chemoradiation and brachytherapy: Complications and 3-years survival. Eur J Surg Oncol. 2016 Oct;42(10):1519-25.