İleri Evre Kanserli Olgularda Hemoglobin Düzeylerinin Radyoterapi ve Kemoterapiye Verilen Yanıtla İlişkisi

Öz

Türkçe Özet: Amaç: Dokuların yeterli oksijenlenmesi için hemoglobin konsantrasyonu önemlidir. Hemoglobin düzeylerindeki düşüklükler dokuların radyosensitivitesini azaltıyor olabilir. Çalışmada ileri evre kanser olgularında hemoglobin düzeylerinin, öncellikle radyoterapi veya radyoterapi+kemoterapiye verilen yanıtla ilişkisinin olup olmadığının gösterilmesi amaçlandı. Yöntem: Mayıs 1997-Mayıs 1998 tarihleri arasında Çukurova Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı\'nda radyoterapi uygulanan ileri evre 61 olguda hemoglobin düzeylerinin radyoterapi veya radyoterapi+kemoterapiye verilen yanıt ilişkisi prospektif olarak değerlendirildi. Hemoglobin düzeylerinin ölçümleri, tedavinin başlangıcında (I. kontrol), ortasında (II. kontrol), bitiminde (III. kontrol) ve tedaviden sonraki 3. ayda (IV. kontrol) yapıldı. Bulgular: Primer tümör ve lenfatik metastazlarına Co 60 cihazıyla radyoterapi verilen olgularda tedaviye yanıt oranı %27.8 idi. Olgulardan %11.4'ünde tam yanıt, %16.4'ünde kısmi yanıt, %47.6'sında stabil hastalık, %24.6'sında ilerleme saptandı. Olguların 25'ine kemoterapi ve radyoterapi birlikte uygulandı (%40.9). Tedavi yanıtlarına göre gruplar arasında hemoglobin düzeyleri açısından farklılık anlamlı bulundu (p<0.001). Tam yanıt+kısmi yanıt grubu ve stabil hastalık grubu ile ilerleme gösteren grup arasında hemoglobin düzeyleri açısından farklılık anlamlı bulundu (p<0.001). Sonuç: Aneminin, artmış lokal rekürrens ve kısalmış sürvi oranları ile birlikte olduğu belirlendi. Kanserli olgularda radyoterapi veya radyoterapi+kemoterapi uygulanırken aneminin izlenmesinin ve düzeltilmesinin tedavi etkinliğini artırabileceği düşünüldü.

Anahtar Kelimeler

• kanser, hemoglobin, kemoterapi, radyocevap, hipoksi.

İleri Evre Kanserli Olgularda Hemoglobin Düzeylerinin Radyoterapi ve Kemoterapiye Verilen Yanıtla İlişkisi

Öz

AbstractRelationship of Haemoglobin Levels with Response to Radiotherapy and Chemotherapy in Advanced Cancer Cases Aim: Haemoglobin concentration is important for sufficient oxygenisation of tissues. Low levels of haemoglobin might decrease radiosensitivity of tissues. In this study, it was primarily aimed to evaluate a potential relationship between haemoglobin levels and response to the radiotherapy or the combined treatment with radiotherapy + chemotherapy in advanced cancer cases. Methods: Relationship among haemoglobin levels with response to radiotherapy or radiotherapy+chemotherapy were evaluated prospectively in 61 advanced cancer cases at Çukurova University, Medical School, Department of Radiation Oncology from May 1997 to May 1998. Measurement of haemoglobin levels were performed in the beginning (lst control), in the middle (2nd control), in the end of the therapy (3rd control) and 3 months after the therapy (4th control). Results: Response to therapy rate of cases which had radiotherapy with Co 60 for primary tumor and lymphatic metastases were 27.8%. It is found that complete response in 11.4%, partial response in 16.4%, stable in 47.6% and progression in 24.6% of cases. Chemotherapy and radiotherapy performed to 25 of cases (40.9%). As regarding responses to the therapy, differences in haemoglobin levels between groups were found significant (p<0.001). Conclusion: It was determined that anemia is associated with increased local recurrens and shortened survey rates. It was suggested that monitoring and improvement of anemia during the radiotherapy or the combination treatment of radiotherapy with chemotherapy in cancer cases might improve the efficiency of the treatment.

Anahtar Kelimeler

• cancer, haemoglobin, chemotherapy, radioresponse, hypoxia.

Kaynakça

1. Todd HW, Chapman JD. Radiation response modulation. In:
2. Perez CA. Brady LW. Halpcrin E.C. Schmidt—Ulrich RK. eds.
3. Principles and Practice of Radiation Oncology. Philcdelphia:
4. Lippincott Williams Jr. Wilkins.2üü4:663-98.
5. Harrison LB. Shasha D. Homel P. Prevalcnce of anemia in
6. cancer patients undergoing radiotherapy: prognostic
7. significance and treatment. Oncology 2002630): l [-8.
8. Vaupel P. Mayer A. Hypoxia and anemia: effects on tumor

9. biology and treatment resistance. Transfers Clin Biol 1005;I2t|):5-I0.
10. Vaupel P. 'I'hews 0. Hoeckel M. Treatment resistance of
11. solid tumors: role of hypoxia and anemia. Med Oncel
12. C)Ül;llll4):243-59.
13. Harrison L. Blackwell K. Hypoxia and anemia: factors in decreased sensitivity to radiation therapy and chemotherapy? Onmlogist 2004 '.5(9):3 l—4Ü.
14. Harrison LB. Chadha M, Hill RJ. Hu [(. Shasha D. impact of tumor hypoxia and anemia on radiation therapy outcomes. Oncologist 2002:7(6):492-508.
15. Birgegard G. Aapro MS. Bokemeycr C. Dicato M. Drings P .Hamedo J. Kızakowski M. Ludwing H. Pecorelli S. Schmoll H. Schneider M. Schı'ijvers D. Shasha D. Van Belle S. Cancer—related anemia: pathogenesis. prevalence and treatment. Oncology 20:15:68“ ];3—I ].
16. Haugen H. Magnusson B. Svensson M. Mcrcke C. Preradiotherapy hemoglobin level but not microvessel density predicts loeoııegional control and survival in laryngeal cancer treated with primary radical radiotherapy. Clin Cancer Res 2004“. I (KB)???“ J).
17. Schafer U. Micke O., Muller SB. Schuller P. Willich N. Hemoglobin as an independent prognostic factor in the radiotherapy of head and neck tumors. .S'rmhlenrher Onkoı' 2003; 1 îMSlüğî—îfi.
18. Robnett 't'J. Maelıtay M. Hahn SM. Shrager JB. Friedberg .IS, Kaiser LR. Pathological response to preoperative chemoradiation worsens with anemia in non-small cell lung cancer patients. Cancer . 2002:8t3]ı:263ı7.
19. Thomas G. The effect of hemoglobin level on radiotherapy outcomes: the Canadian experience. Semin Oncel ZUÜI ;3[2):bU-5.
20. Muostedt K. Vol-ring M. Von Georgi R. Hemoglobin levels during radiation therapy and their influence on local control and survival of patients with eıtdome1rial carcinoma. Dnr—ol Rep ?.004;l l(3):?l l-T.
21. Quilty PM. Duncan W. The inşuence of hemoglobin level on the regression anıl long terra local control of transitional cell carcinoma ol' the bladder following photon irradiation. lnr J' Radial Onca Biol Fifty: teaming): IMS—42.
22. Altun M. Demiral AN. Meral R. Kaytan F.. Cesar R. Disci R. Dizdar Y. Prognostic signiŞcance of hemoglobin concentration in nasopharyngcal carcinoma: dee.—t treatment-induced anemia have negative effect? In Vivo 2003: “(S):-1833.