Postoperative concomitant chemoradiotherapy for gastric cancer at out patient clinic (The preliminary results of protocol)

Öz

OBJECTIVES Adjuvant concomitant chemoradiotherapy has been used at our clinic since February 2000 in the patients with gastric carcinoma. METHODS Thirty-one gastric carcinoma patients (7 females, 24 males; median age 56 years; range 24 to 77 years) have been evaluated between March 2000-August 2003. The most frequent symptom was dispepsy (42%); and the most frequent tumour localisations were cardia, antrum and small curvature as an equal rates (29%). Operation types were total gastrectomy+ lymph node dissection (LND)+splenectomy (29%), distal subtotal gastrectomy+LND (36%), and total gastrectomy+LND (29%). The most frequent histopathological type was adenocarcinoma (58%). Median 21 (0-71) LND removed, and median metastatic lymph node was 5 (0-49). AJCC 1997 staging system was used for clinical staging, and the dispertion: stage II 9 (29%), IIIA 10 (33%), IIIB 5 (16%), stage IV 7 (22%) patients. Total 45 Gy radiotherapy (1.8 Gy/ fraction, 25 fraction) was delivered to the tumour and regional nodes. All patients have been treated with two opposed fields (anteroposterior/ posteroanterior) and with individual blocs. Concomitant chemoradiotherapy was administered as an intravenous continous infusion (225 mg/m2/day 5Fluorourasil (5-FU)) has been given to 20 (65%) patients. RESULTS Median follow up was 19 (4-50) months. All of the living patients were under follow up except one. Early side effects were classified as to RTOG, and late toxicity was evaluated according to EORTC / RTOG toxicity criteria. Six patients in only RT group (n=11), and 12 patients in concomitant chemoradiotherapy group (n=20) had grade I early gastrointestinal symptoms (nausea, vomiting, diarrhoea). Gradeı (n=13) and grade II (n=1) early skin reaction have been observed in RT fields. None of the patients had treatment interruption due to the side effects, and no severe late side effect had been detected. Overall, disease free, locoregional recurrence free, and distant metastasis free survival rates for two years were 64%, 67%, 90%, 79% in respectively. CONCLUSION Concomitant chemoradiotherapy is a tolerable and safe treatment under out patient clinic conditions for gastric carcinoma patients after gross radical resection. New trials including wide case series and long follow up are required for survival, local control and distant metastasis evaluation.

Anahtar Kelimeler

• Stomach Neoplasms,Chemotherapy, Adjuvant,Postoperative Period,Neoplasm Staging,Survival Rate

Mide karsinomlarında poliklinik şartlarında ameliyat sonrası konkomitan kemoradyoterapi uygulaması (Protokol ön sonuçları)

Öz

AMAÇ Merkezimizde Şubat 2000 tarihinde başlatılan bir protokol ile radikal rezeksiyon yapılan mide karsinomlu olgularda konkomitan kemoradyoterapi (KRT) sonuçları değerlendirildi. GEREÇ VE YÖNTEM Mart 2000 ile Ağustos 2003 tarihleri arasında opere mide karsinomu tanısı ile adjuvan tedavi için kliniğimize refere edilen 31 olgu (7 kadın, 24 erkek; medyan (ort.) yaş 56; dağılım 24-77) değerlendirildi. Olgularda en sık başvuru yakınması dispepsi (%42); en sık tümör yerleşim yerleri eşit oranla kardiya, antrum ve küçük kurvaturdu (%29). Dokuz hastaya total gastrektomi+lenf nodu diseksiyonu (LND)+splenektomi (%29), 11 hastaya distal subtotal gastrektomi+LND (%36), 9 hastaya ise total gastrektomi+ LND uygulandı (%29). En sık histopatolojik tür adenokarsinom (%58) idi. Olgulardan ort. 21 adet (0-71) lenf nodu diseke edildi; ort. metastatik LN sayısı 5 (0-49) idi. Evrelemede AJCC 1997 evreleme sistemi kullanıldı. Evrelere göre dağılım; 9 hasta evre II (%29), 10 hasta evre IIIA (%33), 5 hasta evre IIIB (%16), 7 hasta evre IV (%22) idi. Tüm hastalarda tümör yatağına 1.8 Gy fraksiyon dozunda, 25 fraksiyonda, toplam 45 Gy radyoterapi (RT) uygulandı. Tüm hastalar ön-arka karşılıklı iki alanla ve bireysel koruma bloklarıyla tedaviye alındı. Yirmi hastaya (%65) RT ile eşzamanlı olarak sürekli infüzyonla 225 mg/m2/gün 5-Fluorourasil (5-FU) kemoterapisi (KT) uygulandı. BULGULAR Olgularda ort. izlem süresi 19 (4-50) aydı. Yaşayan hastaların biri dışında tümü izlemde idi. Radyoterapiye bağlı olarak gelişen, erken yan etkiler RTOG, geç yan etkiler RTOG/ EORTC yan etki skalasına göre değerlendirildi. Erken yan etki olarak RT sırasında KT uygulanmayanların 6'sında (n=11), konkomitan KRT uygulananların 12'sinde (n=20) derece I gastrointestinal yan etki gözlendi (bulantı, kusma, ishal). Tüm hastaların RT sahası cildi değerlendirildiğinde 13'ünde derece I, 1'inde derece II erken cilt reaksiyonu gözlendi. Hiçbir olguda yan etkiler nedeni ile tedaviye ara verilmedi ve geç dönemde belirgin yan etkiye rastlanmadı. İki yıllık genel (GSK), hastalıksız (HSK), yerel-bölgesel yinelemesiz (YBYSK) ve uzak metastazsız sağkalım (UMSK) oranları sırasıyla %64, %67, %90, %79 olarak saptandı. SONUÇ Mide karsinomlu olgularda, potansiyel radikal rezeksiyon sonrası konkomitan KRT tolere edilebilir ve güvenle ayaktan uygulanabilir bir tedavi yöntemidir. Sağkalım, lokal kontrol ve uzak metastaz değerlendirmeleri için geniş hasta serileri ve uzun dönem izlem sonuçlarına gereksinim vardır.

Anahtar Kelimeler

• Adjuvan kemoradyoterapi, mide kanserleri/ilaç tedavisi/mortalite/radyoterapi/cerrahi, sağkalım oranı

Kaynakça

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