İLERİ EVRE KÜÇÜK HÜCRELİ DIŞI AKCİĞER KANSERİNDE SİSPLATİNETOPOSİD TEDAVİSİNİN ETKİNLİĞİ

Öz

İleri evre küçük hücreli dışı akciğer kanserinde kemoterapinin yeri uzun yıllardır tartışma konusudur. Bu çalışmada sisplatin-etoposid tedavi rejiminin etkinliğinin semptomatik tedavi ile sağkalıma etkisi açısından karşılaştırılması amaçlanmıştır. Ocak 1997-Mart 2001 arasında kliniğimizde evre IIIB ve IV küçük hücreli dışı akciğer kanseri tanısı almış 60 olgu çalışmaya alındı. Otuz olguya kemoterapi, 30 olguya semptomatik tedavi uygulandı. Kemoterapi alan olgulara üç hafta aralarla maksimum altı siklus olacak şekilde ilk gün 80 mg/m2 sisplatin ve ilk başlanacak üç gün sürecek şekilde günde 100 mg/m2 etoposide IV uygulandı. Sağkalım analizleri ‘Kaplan-Meier Product-Limit' yöntemiyle hesaplandı. Evre IIIB'de kemoterapi alan 20 olguda medyan sağkalım süresi 13.9 ay, bir yıllık sağkalım oranı % 60, semptomatik tedavi alan 22 olguda ise 6.3 ay ve % 18 bulundu. Evre IV'te ise, kemoterapi alan 10 olguda medyan sağkalım süresi 9.4 ay ve bir yıllık sağkalım oranı % 40, semptomatik tedavi alan 8 olguda ise 3.7 ay ve %25 bulundu. Semptomatik tedavi ve kemoterapi gruplarının medyan sağkalım süreleri ve bir yıllık sağkalım oranları arasındaki fark evre IIIB olgularında kemoterapi lehine istatistiksel olarak anlamlı bulundu (p<0.0003, p<0.005). Evre IV’te ise fark anlamlı değildi. Kemoterapiye yanıt %26 kısmi, %3.3 tam yanıt şeklindeydi. Toplam yanıt oranı %29.3 idi. Toplam yan etki görülme oranı % 63.3 idi (5 olguda grade 3, 1 olguda grade 4). Sonuç olarak; ileri evre küçük hücreli dışı akciğer kanserinde sisplatinetoposid kemoterapisinin etkin bir tedavi yöntemi olduğu ve hala tercih edilebileceği, bu etkinliğin evre IV’ ten çok evre IIIB’ de daha belirgin olduğu sonucuna vardık.

Anahtar Kelimeler

• Küçük hücreli dışı akciğer kanseri, kemoterapi, sisplatin, etoposid

EFFICACY OF CISPLATIN-ETOPOSIDE CHEMOTHERAPY IN ADVANCED NON-SMALL CELL LUNG CANCER

Abstract

The role of chemotherapy in the treatment of non-small cell lung cancer has been a matter of concern for many years. This study aims to compare cisplatinetoposide combined treatment modality with supportive treatment according to their effects on survival. Between 1997-2001, 60 patients, who were diagnosed as having stage IIIB and IV non-small cell lung cancer in our clinic, were included in the study. Following all necessary clinical staging procedures, 30 cases received chemotherapy, while remaining 30 cases were treated symptomatically. Chemotherapy protochol included cisplatin with a dose of 80 mg/m2/day intravenously administered on the first day and etoposide with a dose of 100 mg/m2/day starting the first day, continuing for three days in three weeks intervals for a maximum of six cycles. “Kaplan-Meier Product- Limit” method was utilized for survival analysis. In stage IIIB; 20 cases, who received chemotherapy, had a median survival as 13.9 months and one year survival rate as 60 %. 22 cases, who were treated symptomatically, had a median survival as 6.3 months and one year survival rate as 18 %. In stage IV; 10 cases, who received chemotherapy, had a median survival, as 9.4 months and one year survival rate as 40 %. 8 cases, who were treated symptomatically, had a median survival as 3.7 months and one year survival rate as 25 %. The difference of median survivals and one year survival rates between chemotherapy group and symptomatic group were istatistically significant for chemotherapy group in stage IIIB ( p<0.0003, p<0.005) while the difference wasn’t significant in stage IV. Partial and complete response rates were 26 % and 3.3 % respectively, with a total response rate of 29.3 %. Chemotherapy related side effects were encountered in 63.3 % of the cases (grade 3 side effect in 5 cases, grade 4 side effect in one case). In conclusion; we have suggested that chemotherapy with cisplatin-etoposide is an effective treatment method in management of advanced stage non-small cell lung cancer and can still be preferred, and this effect is more appaerent in stage IIIB disease than stage IV disease

Keywords

• Non-small cell lung cancer, chemotherapy, cisplatin, etoposide

Kaynakça

1. 1. Ardizzoni A, Antonelli G, Grossi F, et al. The combination of etoposide and cisplatin in non-small-cell lung cancer (NSCLC). Ann Oncol 1999; 10 ( suppl 5): S13-7
2. 2. Çopur SA, Fırat S, Altınbaş H ve ark. Akciğer kanserlerinde tedavi. Solunum Hastalıkları 1995; 6: 145-63.
3. 3. Stanley KE. Prognostic factors for survival in patients with inoperable lung cancer. JNCI 1980; 65: 25-32.
4. 4. Capewell S, Sudlow MF. Performance and prognosis in patients with lung cancer. Thorax 1990; 45: 951-6
5. 5. Charloux A, Hedelin G, Dietemann A. Prognostic value of histology in patients with non-small cell lung cancer. Lung Cancer 1997; 17: 123-34
6. 6. Macchiarini P, Fontanini G, Hardin MJ. Blood vessel invasion by tumor cells predicts recurrence in completely resected T1 N0 M0 Non-small cell lung cancer. J Thor Cardiovasc Surg 1993; 106: 80-9
7. 7. Halilçolar H, Aksel N, Ertuğrul G, et al. Metastatik Küçük Hücreli Dışı Akciğer Kanserinde Sisplatin-Etoposid Tedavisinin Etkinliği. Toraks Dergisi 2001; 2: 13- 16.
8. 8. Sause W, Kolesar P, Taylor S, et al. Final results of phase III trial in regionally advanced unresectabl non-small cell lung cancer. Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. Chest 2000; 117: 358-64

9. 9. Rosenthal SA, Curran CJ, Herbert SH. Clinical stage II non-small lung cancer treated with radiation therapy alone. Cancer 1992; 70: 2410-17.
10. 10.Buccheri GF. Chemotherapy and survival in non-small cell lung cancer: the old vexata questo. Chest 1991; 99: 1328-29.
11. 11.Marino P, Pampallona S, Preatoni A, et al. Chemotherapy vs supportive care in advanced non-small cell lung cancer.Results of a meta-analysis of the literature. Chest 1994; 106: 861-5.
12. 12.Ganz PA, Figlin RA, Haskell CM et al. Supportive care versus supportive care and combination chemotherapy in metastatic non-small cell lung cancer: Does chemotherapy make a difference? Cancer 1989; 63: 1271-78.
13. 13.Callerino R, Tummarello D, Porfiri E et al. Non-small cell lung cancer (NSCLC): A prospective randomized trial with alternating chemotherapy CEP/MEC versus no treatment. Eur J Cancer Clin Oncol 1988; 24: 1934-43
14. 14.Kaasa S, Lund E, Thorud E, et al. Symptomatic treatment versus combination chemotherapy for patients with extensive non-small cell lung cancer. Cancer 1991; 67: 2443-7.
15. 15.Williams CJ. Randomized trial comparing cisplatin/vindesine with no chemotherapy in unresectable non-small cell lung cancer (abstr). Proc Eur Conf Clin Oncol 1987; 49: 13.
16. 16.Crino L, Tonato M, Darwish S, et al. A randomised trial of three cisplatincontaining regimens in advanced non-small cell lung cancer (NSCLC): A study of the Umbrian Lung Cancer Group. Cancer Chemother Pharmacol 1990; 26: 52-6