Factors affecting local control, distant recurrence and survival in patients with locally advanced bladder cancer treated by definitive radiotherapy or chemoradiotherapy

Öz

OBJECTIVES Treatment results of 34 patients with bladder cancer admitted to Department of Radiation Oncology, Medicine Faculty of Trakya University between October 1997 and June 2005 were retrospectively analyzed. Prognostic factors associated with survival were determined. METHODS Their median age was 69 years (range 44-93). Thirty patients (88%) were male and 4 patients (12%) were female. Histopathological diagnosis was transitional cell carcinoma in 20 (59%) patients. Chemotherapy was administered concomitantly with radiotherapy to the 11 (32.35%) of the patients. The median radiotherapy dose was 62.5 (35-68) Gy. The median follow-up was 22 months (5-76 months). Median survival and median disease-free survival were 14.2 months (3.8-57.5) and 10 months (0-55), respectively. RESULTS Three years loco-regional control, metastasis free survival, disease free survival and overall survival rates were 76.5%, 72.2%, 55% and 41.1%, respectively. Epidermoid carcinoma histopathology (p=0.002), not performing concomitant chemotherapy (p=0.003), applying carboplatin instead of cisplatin with radiotherapy (p=0.004) and not conducting complete TURB (p=0.008) were significant poor prognostic factors on loco-regional control. Undifferentiated cell type (p=0.012) and not performing concomitant chemotherapy (p=0.046) were significant adverse factors on distant metastases. Factors that affect overall survival were tumor in stage T4 (p=0.05), hemoglobin value below 10 g/dl (p=0.032) and not performing concomitant chemo-radiotherapy (p=0.017) and complete TURB (p=0.049). CONCLUSION Complications of radiotherapy were acceptable. For the treatment of muscle invasive locally advanced bladder cancer, RT combined with cisplatin is an acceptable treatment option. Moreover, complete TURB before RT is important both for local control and for survival.

Anahtar Kelimeler

• Urinary Bladder Neoplasms,Cisplatin,Radiotherapy Dosage,Survival Rate,Retrospective Studies,Disease-Free Survival

Küratif radyoterapi veya kemoradyoterapi ile tedavi edilen lokal ileri mesane kanseri tanılı hastalarda lokal kontrol, uzak yineleme ve sağkalımı etkileyen faktörler

Öz

AMAÇ Ekim 1997-Haziran 2005 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı'nda küratif amaçlı radyoterapi veya kemoradyoterapi ile tedavi edilen, mesane kanseri tanılı 34 hastanın tedavi sonuçları geriye dönük olarak değerlendirildi. Sağkalımla ilgili olduğu bilinen prognostik faktörler incelendi. GEREÇ VE YÖNTEM Hastaların 30'u (%88) erkek ve 4'ü (%12) kadındı. Medyan yaş 69 idi (44-93). Patolojik tanı 20 hastada (%59) değişici hücreli karsinomdu. Medyan radyoterapi dozu medyan 62.5 Gy'di ve 11 hastaya (%32) eşzamanlı kemoterapi uygulandı. Medyan takip süresi 22 aydı (5-76 ay). Medyan genel sağkalım süresi ve medyan hastalıksız sağkalım süresi 14.2 ay (3.8-57.5 ay) ve 10 aydı (0-55 ay). BULGULAR Hastaların üç yıllık lokal kontrol, uzak metastazsız sağkalım, hastalıksız sağkalım, ve genel sağkalım oranları sırası ile %76.5, %72.2, %55 ve %41.1 bulundu. Lokal kontrolü olumsuz etkilyen faktörler, patolojik tanının epidermoid karsinom olması (p=0.002), eş-zamanlı kemoterapi uygulanmaması (p=0.003), eş-zamanlı tedavide sisplatin yerine karboplatinli kemoterapi uygulanması (p=0.004) ve tam transüretral rezeksiyon (TUR) yapılamamasıydı (p=0.008). İndifferansiye histoloji (p=0.012) ve eş-zamanlı kemoterapi uygulanmaması (p=0.046) uzak yayılımı etkileyen faktörlerdi. T4 evre (p=0.05), hemoglobin değerinin 10'un altında olması (p=0.032) ve eş-zamanlı kemoterapi uyglanmaması (p=0.017) ve tam TUR yapılamaması (p=0.049) genel sağkalımı olumsuz etkileyen faktörler olarak bulundu. SONUÇ Kas invazyonu yapmış lokal ileri evre mesane kanserinin tedavisinde sisplatin ile kombine radyoterapi (RT) kabul edilebilir bir tedavi şeklidir. Hastalara RT öncesi makroskopik total TUR yapılabilmesi lokal kontrol ve sağkalım için önemlidir. Ancak radyokemoterapi adayı olabilecek hastaların seçiminde sonuçları etkileyebilecek bütün faktörlerin değerlendirilmesi gerekmektedir.

Anahtar Kelimeler

• Mesane kanseri/mortalite/radyoterapi/tedavi, sisplatin/doz, radyoterapi dozu, sağkalım oranı

Kaynakça

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