The importance of pretreatment performance status and LDH level in patients with stage III-IV nasopharyngeal carcinoma

Öz

OBJECTIVES To evaluate the prognostic factors in patients treated with radiotherapy for locally advanced nasopharyngeal carcinoma. METHODS Forty-eight patients (37 males, 11 females) treated between September 1999 and September 2007 were assessed retrospectively. RESULTS Ten patients (21%) recurred loco-regionally. Gender (p=0.022), Eastern Cooperative Oncology Group (ECOG) performance status (PS) (p

Anahtar Kelimeler

• -

Evre III-IV nazofarinks kanseri tanılı hastalarda tedavi öncesi performans durumu ve LDH düzeyinin önemi

Öz

AMAÇ Radyoterapi ile tedavi edilen evre III-IV nazofarinks kanserli hastalarda prognostik faktörler incelendi. GEREÇ VE YÖNTEM Eylül 1999-Eylül 2007 tarihleri arasında tedavi edilen 48 hasta (37 erkek, 11 kadın) geriye dönük olarak değerlendirildi. BULGULAR Lokal-bölgesel yineleme 10 (%21) hastada izlendi. Lokal-bölgesel kontrolü etkileyen faktörler; cinsiyet (p=0.022), Eastern Cooperative Oncology Group (ECOG) performans durumu (p < 0.0001), Hb (p=0.0035) ve LDH düzeyidir (p=0.032). Multivariet analizde, sadece performans durumu etkisini korumuştur (p=0.003). On sekiz (%38) hastada uzak metastaz gelişti. Univariet analizde performans durumu (p=0.022), Hb (p=0.002), ALP (p=0.004), LDH düzeyi (p=0.007) ve RT’yi tamamlama (p=0.014) uzak metastaz oluşmasını etkiledi. Multivariet analizde ise sadece LDH düzeyi (p=0.001) etkinliğini korudu. Analiz sırasında 27 (%56) hastan›n hayatını kaybettiği saptandı. Univariet analizde performans durumu (p=0.012), RT’yi tamamlama (p < 0.0001), metastaz oluşması (p=0.018) ve LDH düzeyinin (p=0.018) sağkalımı etkildiği görüldü. Multivariet analizde yalnızca LDH düzeyi anlamlılığını korudu (p=0.026).

Anahtar Kelimeler

• LDH düzeyi, nazofarinks kanseri, performansdurumu, radyoterapi

Kaynakça

1. 1. Chan AT, Teo PM, Johnson PJ. Nasopharyngeal carcinoma. Ann Oncol 2002;13(7):1007-15.
2. 2. Teo PM, Kwan WH, Lee WY, Leung SF, Johnson PJ. Prognosticators determining survival subsequent to distant metastasis from nasopharyngeal carcinoma. Cancer 1996;77(12):2423-31.
3. 3. al-Sarraf M, Pajak TF, Cooper JS, Mohiuddin M, Herskovic A, Ager PJ. Chemo-radiotherapy in patients with locally advanced nasopharyngeal carcinoma: a radiation therapy oncology group study. J Clin Oncol 1990;8(8):1342-51.
4. 4. Cheng SH, Tsai SY, Horng CF, Yen KL, Jian JJ, Chan KY, et al. A prognostic scoring system for locoregional control in nasopharyngeal carcinoma following conformal radiotherapy. Int J Radiat Oncol Biol Phys 2006;66(4):992-1003.
5. 5. Turen S, Ozyar E, Altundag K, Gullu I, Atahan IL. Serum lactate dehydrogenase level is a prognostic factor in patients with locoregionally advanced nasopharyngeal carcinoma treated with chemoradiotherapy. Cancer Invest 2007;25(5):315-21.
6. 6. Dimery IW, Peters LJ, Goepfert H, Morrison WH, Byers RM, Guillory C, et al. Effectiveness of combined induction chemotherapy and radiotherapy in advanced nasopharyngeal carcinoma. J Clin Oncol 1993;11(10):1919-28.
7. 7. Garden AS, Lippman SM, Morrison WH, Glisson BS, Ang KK, Geara F, et al. Does induction chemotherapy have a role in the management of nasopharyngeal carcinoma? Results of treatment in the era of computerized tomography. Int J Radiat Oncol Biol Phys 1996;36(5):1005-12.
8. 8. Geara FB, Glisson BS, Sanguineti G, Tucker SL, Garden AS, Ang KK, et al. Induction chemotherapy followed by radiotherapy versus radiotherapy alone in patients with advanced nasopharyngeal carcinoma: results of a matched cohort study. Cancer 1997;79(7):1279-86.

9. 9. Ma J, Mai HQ, Hong MH, Min HQ, Mao ZD, Cui NJ, et al. Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol 2001;19(5):1350-7.
10. 10. Liaw CC, Wang CH, Huang JS, Kiu MC, Chen JS, Chang HK. Serum lactate dehydrogenase level in patients with nasopharyngeal carcinoma. Acta Oncol 1997;36(2):159-64.
11. 11. Kolev Y, Uetake H, Takagi Y, Sugihara K. Lactate dehydrogenase-5 (LDH-5) expression in human gastric cancer: association with hypoxia-inducible factor (HIF-1alpha) pathway, angiogenic factors production and poor prognosis. Ann Surg Oncol 2008;15(8):2336-44.
12. 12. Swan F Jr, Velasquez WS, Tucker S, Redman JR, Rodriguez MA, McLaughlin P, et al. A new serologic staging system for large-cell lymphomas based on initial beta 2-microglobulin and lactate dehydrogenase levels. J Clin Oncol 1989;7(10):1518-27.
13. 13.Jørgensen LG, Osterlind K, Genollá J, Gomm SA, Hernández JR, Johnson PW, et al. Serum neuron-specific enolase (S-NSE) and the prognosis in small-cell lung cancer (SCLC): a combined multivariable analysis on data from nine centres. Br J Cancer 1996;74(3):463-7.
14. 14. Steyerberg EW, Keizer HJ, Fosså SD, Sleijfer DT, Bajorin DF, Donohue JP, et al. Resection of residual retroperitoneal masses in testicular cancer: evaluation and improvement of selection criteria. The ReHiT study group. Re-analysis of histology in testicular cancer. Br J Cancer 1996;74(9):1492-8.
15. 15.Chatani M, Matayoshi Y, Masaki N. Radiation therapy of nasopharyngeal carcinoma: treatment results and prognostic factors. [Article in Japanese] Nippon Igaku Hoshasen Gakkai Zasshi 1993;53(8):945-52. [Abstract]
16. 16. Saif MW, A.D., et al., Serum alkaline phosphatase level as a prognostic tool in colorectal cancer: A study of 105 patients. J Appl Res 2005;5(1):88-95.
17. 17. Prosnitz RG, Yao B, Farrell CL, Clough R, Brizel DM. Pretreatment anemia is correlated with the reduced effectiveness of radiation and concurrent chemotherapy in advanced head and neck cancer. Int J Radiat Oncol Biol Phys 2005;61(4):1087-95.
18. 18. Fazekas JT, Scott C, Marcial V, Davis LW, Wasserman T, Cooper JS. The role of hemoglobin concentration in the outcome of misonidazole-sensitized radiotherapy of head and neck cancers: based on RTOG trial #79- 15. Int J Radiat Oncol Biol Phys 1989;17(6):1177-81.
19. 19.Brizel DM, Albers ME, Fisher SR, Scher RL, Richtsmeier WJ, Hars V, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998;338(25):1798-804.
20. 20. Yurut-Caloglu, V, Caloglu, M. Treatment of anemia by recombinant human erythropoietin in cancer patients undergoing radiotherapy Asia-Pacific Journal of Clinical Oncology 2008;4(4):199-207.
21. 21. Petrovich Z, Kuisk H, Jose L, Barton RT. Advanced carcinoma of the nasopharynx. Treatment results. Acta Radiol Oncol 1981;20(4):245-51.