Eş zamanlı kemoradyoterapi uygulanan opere edilemeyen lokal ileri evre küçük hücreli dışı akciğer kanserinde indüksiyon ve konsalidasyon kemoterapisinin yeri: retrospektif çalışma

Yıl 2019, , 40 - 46, 31.03.2019

Semiha Urvay , Birsen Yücel

https://doi.org/10.21601/ortadogutipdergisi.467677

Öz

Amaç: Bu
çalışmanın amacı eşzamanlı kemoradyoterapi ile tedavi edilen küçük hücreli dışı
akciğer kanserinde (KHDAK) indüksiyon veya konsalidasyon kemoterapilerinin
yalnızca kemoradyoterapi (KRT) ile karşılaştırıldığında sağkalıma etkinliğinin
araştırılmasıdır.

Gereç ve Yöntemler: Lokal
ileri evre KHDAK tanısı ile eşzamanlı kemoradyoterapi ±
indüksiyon/konsalidasyon tedavisi alan 114 hastanın dosyaları retrospektif
olarak incelendi. İndüksiyon veya konsalidasyon tedavisi olarak platin temelli
ikili kemoterapi rejimi kullanıldı. 60-66 Gy torasik radyoterapi ile eşzamanlı
tek ajan platin( sisplatin veya karboplatin), platin+etoposid veya
platin+taksan içeren kemoterapi protokolleri uygulandı. Sonuçlar: Çalışmaya
dahil edilen 114 hastanın 32 (28%)'si KRT; 54 (47%) 'si indüksiyon ve 28 (25%)'
si konsalidasyon kolundaydı. Tüm hastalar için ortanca sağkalım 21,9±14.0
ay; 2 ve 3 yıllık sağkalım oranları ise %46 ve %33 olarak bulundu. KRT;
indüksiyon ve konsolidasyon kemoterapisi alan 
hastaların ortanca  sağkalımları
sırası ile 29,7±8,8 ay; 23±2,9 ay ve 16,8±3,5 ay olarak saptanmış olup anlamlı
farklılık yoktu( p=0,54). 2 yıllık  
sağkalım oranları  KRT kolu için
53%; indüksiyon kolu için 50% ve konsalidasyon kolu için 32% ( p=0,48) ; 3
yıllık sağkalım oranları ise sırası ile 40%, 33% ve 25% ( p=0,40) olarak
saptanmış olup benzerdi.

Sonuç: Bu
retrospektif çalışmada, eşzamanlı kemoradyoterapiye eklenen  indüksiyon veya konsolidasyon kemoterapisinin
genel sağkalımı uzatmadığı gösterilmiştir. Rezeke edilemeyen evre III KHDAK
için standart tedavi hala eş zamanlı kemoradyoterapidir.

Anahtar Kelimeler

küçük hücreli dışı akciğer kanseri, kemoradyoterapi, indüksiyon, konsalidasyon

Induction or consolidation chemotherapy for unresectable stage ııı non-small-cell lung cancer patients treated with concurrent chemoradiation: a retrospective study

Öz

Aim: The objective of this
study is to demonstrate the efficacy of induction or consolidation chemotherapy
on survival in locally advanced non-small cell lung cancer ( NSCLC) patients
who were treated by curative concurrent chemoradiotherapy (CCRT).

Material and Methods: Patients were randomised to
CCRT, induction chemotherapy followed by CCRT or CCRT followed by consalidation
chemotherapy retrospectively. A platinum-based doublet cytotoxic chemotherapy
regimen used as induction/consalidation. Patients who received 60 Gy or more were included
in the study. These patients had received two or more cycles of platinum-based
chemotherapy concurrently with definitive radiation therapy.

 

Results:  A total of 114 patients were included in the
study. 32 (28%)
patients were in CCRT arm; 54 (47%) patients were in induction arm and 28 (25%)
patients were in consalidation arm.Median overall survival (OS) was found as 21.9±14.0 months
and  2 year and 3-year survival as %46
and 33% in all patients. Median OS did not differ between  arms; with a median OS of 29.7±8.8 months, 23±2.9
months and 16.8±3.5 months in the CCRT arm, in the induction arm  and in the consolidation arm (p:0.54).
The 2 years OS was 53%, 50% and  32% (p:0.48)
and 3 years OS was 40%, 33% and 25%  ( p:0.40)
in the CCRT arm,  the induction arm in
the consalidation arm  without a
significiant difference.

Conclusion: In this retrospective
study, platin-based chemotherapy as induction or consolidation with concurrent
chemoradiotherapy failed to further prolong OS. The standart of care for
unresectable stage III NSCLC  is still concurrent
chemoradiotherapy .

Anahtar Kelimeler

non small cell lung canser, chemoradiotherapy, induction, consalidation

Kaynakça

• 1. Siegel RL, Miller KD, Jemal A. Cancer Statics, 2015. CA Cancer J Clin 2015; 65:5-29.
• 2. Howlader N, Noone AM, Krapcho M et al. SEER Cancer Statistics Review 1975-2012.
• 3. Wahbah M, Boroumand N, Castro C, El-Zeky F, Eltorky M. Changing trends in the distribution of the histologic types of lung cancer: a review of 4,439 cases. Ann Diagn Pathol 2007;11:89-96.
• 4. Yang P, Allen MS, Aubry MC et al. Clinical features of 5628 primary lung cancer patients: Experience at Mayo Clinic from 1997 to 2003. Chest 2005;128:452-62.
• 5. O'Rourke N, Roqué I Figuls M, Farré Bernadó N, Macbeth F. Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev 2010;16: CD002140.
• 6. Curran WJ Jr, Paulus R, Langer CJ et al. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomised phase III trial RTOG 9410.J Natl Cancer Inst .2011;103:1452-60.
• 7. Furuse K, Fukuoka M, Kawahara M et al.Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin,vindesine and cisplatin in unrezectable stage III non-small-cell lung cancer. J Clin Oncol.1999;17:2692.
• 8. Furuse K, Hosoe S, Masuda N. Impact of tumor control on survival in unresectable stage III non-small cell lung cancer (NSCLC) treated with concurrent thoracic radiotherapy and chemotherapy (abstract). Proc Am Soc Clin Oncol 2000.
• 9. Hanna N, Neubauer M, Yiannoutsos C et al: Phase III study of cisplatin, etoposide, and concurrent chest radiation with or without consolidation docetaxel in patients with inoperable stage III non-small cell lung cancer: The Hoosier Oncology Group and U.S. Oncology. J Clin Oncol. 2008; 26: 5755-60.
• 10. Oken MM, Creech RH, Tormey DC et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649-55.
• 11. Belani CP, Choy H, Bonomi P, et al. Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol 2005; 23: 5883.
• 12. Fournel P, Vergnenégre A, Robinet G et al. Induction or consolidation chemotherapy for unresectable stage III non-small-cell lung cancer patients treated with concurrent chemoradiation: a randomised phase II trial GFPC - IFCT 02-01;Eur J Cancer; 2016; 52:181-87
• 13. Vokes EE, Herndon JE 2nd, Kelly MJ et al. Induction chemotherapy followed by chemoradiotherapy compared bt chemoradiotherapy lone for regionally advanced unresectable stahe II Non-small cell lung cancer. Cncer and Leukemia Group B. J Clin Oncol 2007;25:1698
• 14. Ahn JS, Ahn YC, Kim JH et al. Multinational randomised Phase III trial with or without consalidation chemotherapy using docetaxel and cisplatin after concurrent chemoradiation in inoperable stage III Non-small cell lung cancer: KCSG-LU05-04. J Clin Oncol 2015; 20; 33: 2660-66.
• 15. Tsujino K, Kurata T, Yamamato S, et al. Is consolidation chemotherapy after concurrent chemo-radiotherapy beneficial for patients with locally advanced non-small cell lung cancer? A pooled analysis of the literature. J Thorac Oncol 2013;8: 1181-89.
• 16. Blanke C, Anseri R, Mantravadi R et al. Phase III trial of thoracic irridation with or without cisplatin for locally advanced unresectable non-small cell lung cancer: Hoosier Oncology Group protocol. J Clin Oncol 1995;13:1425-29.
• 17. Atagi S, Kawahara M, Yokoyama A et al; Japan Clinical Oncology Group Lung Cancer Study Group. Thoracic radiotherapy with or without daily low-dose carboplatin in elderly patients with non-small-cell lung cancer: a randomised, controlled, phase 3 trial by the Japan Clinical Oncology Group (JCOG0301). Lancet Oncol 2012; 13: 671-78.
• 18. Liang J, Bi N, Wu S et al. Etoposide and cisplatin versus paclitaxel and carboplatin with concurrent thoracic radiotherapy in unresectable stage III non-small cell lung cancer: a multicenter randomized phase III trial. Ann Oncol 2017; 1: 28: 777-83.
• 19. Santana-Davila R, Devisetty K, Szabo A et al. Cisplatin and etoposide versus carboplatin and paclitaxel with concurrent radiotherapy for stage III non-small-cell lung cancer: an analysis of Veterans Health Administration data. J Clin Oncol 2015; 33: 567-74.
• 20. Antonia SJ, Villegas A, Daniel D et al. Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. N Engl J Med 2017; 8.