PALYATİF AKCİĞER RADYOTERAPİSİ ALMIŞ HASTALARIN TAKİPLERİ: TEK MERKEZ DENEYİMİ

Öz

Giriş: Akciğer kanseri (AK), en sık görülen malign tümörler arasındadır. Gelişmiş ülkelerde her iki cinsiyet için de önemli bir sağlık sorunudur. Evre-4 olan hastalarda kür mümkün değildir. Bu hastalara palyatif radyoterapi (RT), kemoterapi ve destekleyici bakım yapılmaktadır. Bu çalışmada, akciğerlerine palyatif RT almış Evre-4 hastalarda, sağkalım süresi ile bazı biyokimyasal özellikler arası ilişkinin incelenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya 2016 Temmuz, 2022 Mayıs arasında hastanemizde akciğerlerine palyatif RT için başvuran 51 hasta dahil edilmiştir. Hastaların; yaşı, sağkalım süresi, cinsiyeti ve karsinom türü [Küçük hücreli dışı akciğer kanseri (KHDAK) ve küçük hücreli (KHAC)) ile birlikte; Alanin Aminotransferaz, Aspartat Aminotransferaz, Sodyum, Potasyum, Hematokrit, Hemoglobin, Lenfosit, Nötrofil, Platelet, Üre ve Laktat dehidrogenaz, değerleri ölçülmüştür. Bu özellikler için tanımlayıcı istatistikler ile birlikte korelasyon katsayıları hesaplanmıştır. Bulgular: Hastaların tamamı Evre- 4 AK olup, 13 (%25.49) hasta kadın, 38 (%74.50) hasta ise erkektir. 41 (%80.39) hasta KHDAK, 10 (%19.60) hasta KHAK patolojisine sahiptir. Hastaların tamamına akciğerlerine yönelik palyatif RT verilmiştir. KHDAK tanılı hastaların medyan sağkalım süresi 18 hafta iken, KHAK patolojisine sahip hastalarda medyan sağkalım süresi 4 hafta olarak bulunmuştur. Sonuç: Her iki grubu ait genel sağkalım süresi ise 16 hafta olarak bulunmuştur. Akciğerlerine yönelik palyatif RT Evre-4 AC hastalarda, sağkalım süresi ile birlikte bazı biyokimyasal özellikler arası ilişkiler belirlenmiştir. NSCLC grubu hastalarda sağkalım süresi, SCLC grubu hastalardan yaklaşık 4 kat daha yüksek bulundu.

Anahtar Kelimeler

• akciğer kanseri
• radyoterapi,
• sağkalım,
• prognoz

Follow-up of Patients Who Received Palliative Lung Radiotherapy: A Single Center Experience

Abstract

Aim: Lung cancer (LC) is the most common among malignant tumors. Cure is not possible in patients with stage-4. These patients receive palliative radiotherapy (RT), chemotherapy and supportive care. This study aims to examine the relationship between survival time and some biochemical features in stage-4 patients who received palliative RT to their lungs. Methods: 51 patients who applied to our hospital for palliative RT to their lungs between July 2016 and May 2022 were included in the study. All patients; age, survival rate, gender and type of carcinoma [non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC)]; alanine aminotransferase, aspartate amino transferase, sodium, potassium, hematocrit, hemoglobin, lymphocyte, neutrophil, platelet, urea and lactate dehydrogenase values were measured. Correlation coefficients along with descriptive statistics were computed for these features. Resuls: All patients have stage-4 LC. 13 (25.49%) patients are female and 38 (74.50%) patients are male. NSCLC had 41(80.39%) of all patients, SCLC pathology had 10 (19.60%) of all patients.All patients received palliative RT to their lungs. While the median survival time for patients diagnosed with NSCLC was 18 weeks, the median survival time for patients with SCLC pathology was found 4 weeks. Conclusion:The overall survival time for both groups was found 16 weeks. Relationships between survival time and some biochemical properties were determined in patients with stage-4 LC who received palliative RT to the lungs. Survival time in NSCLC group patients was found to be approximately 4 times higher than in SCLC group patients.

Keywords

• lung cancer
• prognosis
• radiotherapy
• survival

Kaynakça

1. 1.Kong F-MS, Zhao J, Wang J, Faivre-Finn C. Radiation dose effect in locally advanced non-small cell lung cancer. J Thorac Dis 2014;6:336–47. [Crossref]
2. 2.TÜRKIYE KANSER İSTATİSTİKLERİ 2017, T.C. Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü, https://hsgm.saglik.gov.tr/depo/birimler/kanser-db/istatistik/Turkiye_Kanser_Istatistikleri_2017.pdf (erişim: 4.10.2022).
3. 3.Ries LAG, Eisner M, Kosary CL, et al. SEER cancer statistics review, 1973–1997. Bethesda: National Cancer Institute; 2000.
4. 4.Poggi MM, Sullivan FJ. Palliative radiotherapy. In: Pass HI, Carbone DP, Johnson DH, et al. Lung cancer: Principles and practice. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 777–793.
5. 5.Spencer K, Parrish R, Barton R, Henry A. Palliative radiotherapy. BMJ 2018;360:k821. [Crossref]
6. 6.Halperin EC, Wazer DE, Perez CA, Brady LW. Perez & Brady’s Principles and Practice Radiation Oncology. 7th ed. New York: Wolters Kluwer; 2019. p.3566-3641.
7. 7.Yang JC, et al. Afatinib versus cisplatin based chemotherapy for EGFR mu¬tation positive lung adenocarcinoma (LUX Lung 3 and LUX Lung 6): analysis of overall survival data from two randomised, phase 3 trials. Lancet Oncol 2015;16:141-151. [Crossref]
8. 8.Camidge DR, et al. Brigatinib versus crizotinib in ALK-positive non-small-cell lung cancer. N Engl J Med 2018;379:2027-2039. [Crossref]

9. 9.Shaw AL, Solomon BJ. Crizotinib in ROS1-rearranged non-small-cell lung cancer. N Engl J Med 2015;372:683-684. [Crossref]
10. 10.Reck M, et al. Pembrolizumab versus chemotherapy for PDL1 positive non-small cell lung cancer. N Engl J Med 2016;375:1823-1833. [Crossref]
11. 11.Mok TSK, et al. Pembrolizumab versus chemotherapy for previously untreated, PD-L1-expressing, locally advanced or metastatic non-small-cell lung cancer (Keynote-042): a randomized open-label, controlled, phase 3 trial. Lancet 2019;393:1819-1830. [Crossref]
12. 12.Gandhi L, et al. Pembrolizumab plus chemotherapy in metastatic non-small-cell lung cancer. N Engl J Med 2018;378:2078-2092. [Crossref]
13. 13.Anger CJ, et al. Carboplatin and pemetrexed with or without pembrolizumab for advanced, nonsquamous non-small cell lung cancer: a randomised, phase 2 cohort of the open label KEYNOTE 021 study. Lancet Oncol 2016;17:1497-1508. [Crossref]
14. 14.Horn L, Spigel DR, Vokes EE, et al. Nivolumab versus docetaxel in previously treated patients with advanced non-small-cell lung cancer: Two-year outcomes from two randomized, open-label, phase III trials (CheckMate017 and CheckMate057). J Clin Oncol 2017;35:3924-3933. [Crossref]
15. 15.Horn L, Mansfield A, Szczęsna A, et al. First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med 2018;379:2220-2229. [Crossref]
16. 16.Fennell DA, Summers Y, Cadranel J, Benepal T, et al. Cisplatin in the modern era: The backbone of first-line chemotherapy for non-small cell lung cancer. Cancer Treat Rev 2016;44:42-50. [Crossref]
17. 17.Zhang G, Yin R, Dai X, Wu G, Qi X, Yu R, Li J, et al. Design, synthesis, and biological evaluation of novel 7-substituted 10,11-methylenedioxy-camptothecin derivatives against drug-resistant small-cell lung cancer in vitro and in vivo. European Journal of Medicinal Chemistry 2022;241:114610. [Crossref]
18. 18.Donatavon Reibnitz BS, Jamie E, Abraham J, Wu M, Samstein R, Matthew D, et al. Safety of combining thoracic radiation therapy with concurrent versus sequential immune checkpoint inhibition. Advances in Radiation Oncology 2018;3:391–398. [Crossref]
19. 19.Slotman BJ, Tinteren Hv, Praag JO, Knegjens JL, Sharouni SYE, Hatton M, et al. Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial. Lancet 2015;385:36-42. [Crossref]
20. 20.Avila VQ, OO KJ, Motta RR, Centeno HM, et al. Use of palliative radiotherapy among patients with metastatic non-small-cell lung cancer in Puerto Rico. BMC Palliative Care 2021;20:127. [Crossref]
21. 21.Narjust Duma N, Davila R, Molina JR. Non-small cell lung cancer: Epidemiology, screening, diagnosis, and treatment. Mayo Clin Proc 2019;94:1623-1640. [Crossref]
22. 22.Muppa P, Siqueira Parrilha Terra SB, Sharma A, Mansfield AS, Aubry MC, Bhinge K, et al. Immune cell infiltration may be a key determinant of long-term survival in small cell lung cancer. Journal of Thoracic Oncology 2019;14:1286-1295. [Crossref]
23. 23.Jumeau R, Vilotte F, Durham AD, Ozsahin ES. Current landscape of palliative radiotherapy for non-small-cell lung cancer. Transl Lung Cancer Res 2019;8:S192-S201. [Crossref]
24. 24.Xu CH, Yu LK, Zhang Y, Xie HY, Hao KK, Hu W, Xia N, Zhan P. Analysis of prognostic factors of non-small cell lung cancer in patients under 40 years of age. Zhonghua Zhong Liu Za Zhi 2012;34:703-705. [Crossref]
25. 25.Garassino MC, et al. Pembrolizumab plus pemetrexed and platinum in nonsquamous non-small cell lung cancer: 5-year outcomes from the phase 3 Keynote-189 study. J Clin Oncol 2023;41:1992-1998. [Crossref]