Otuzbeş Yaş ve Üzeri Germ Hücre Tümörlü Hastaların Demografik Özellikleri ve Tedaviye Cevaplarının Değerlendirilmesi

Öz

Bu retrospektif çalışmada 1990 ve 1998 yıllan arasında İstanbul Üniversitesi Onkoloji Enstitüsünde takip edilmiş olan, 35 yaşının üzerinde germ hücre tümörlü 28 hasta tedavi morbiditesi ve sağkalım açısından değerlendirildi. Medyan yaş 41 (35-61 yaş) idi. Dört hastada tedavi öncesi normal alfa-feto protein (AFP) düzeyi ile seminom, 24 hastada da seminom-dışı tümör vardı. 26 hastada primer tümör yeri testis, 2 hastada ise ekstra-gonadal (mediyasten, rektum ve mesane) idi. Uluslararası konsensüs risk gruplanna göre, hastalann %57’si iyi riskli, %28’i orta riskli ve %14 u kötü riskli grupta yer alıyordu. AJCC yeni TNM evreleme sistemine göre, hastaların %14ü evre la, %21’i evre Ib, %7’si evre ila, %3 u evre Ilb, %10ü evre IIc, %14Ü evre Ula, %14ü evre Illb ve %10’u evre IIIc idi. Tedavi sonunda 15 hastada tam cevap, 8 hastada kısmi cevap elde edildi. Medyan takip süresi 28 ay (3-88 ay) idi. Medyan hastalıksız sağkalım ve genel sağkalım süresi 29 ay (1-83 ay) ile 33 ay (3-88 ay) idi. Takip sırasında 7 hasta öldü; 4 hastada ölüm sebebi germ hücreli tümördü. Grad 3/4 akciğer toksisitesi 4 (% 14) hastada görüldü. Grad 3/4 mukozit 4 (%14) hastada gelişti. Hastaların 2’sinde (%7) febril nötropeni meydana geldi. Grad 3/4 anemi 3 (%10) hastada, nötropeni 2 (%7) hastada meydana geldi. Tedavi toksisitesine bağlı ölüm olmadı. Bir hastada doz indirimi yapıldı. Sonuç olarak, germ hücre tümörlü 35 yaş ve üzeri hastalarda % 14 akciğer toksisitesi ve %25 mortalite oldukça anlamlı bulundu.

Anahtar Kelimeler

• Germ hücreli tümör
• yaş
• mortalite

Evaluation of Demographic Status and Response to Treatment of Patients with Germ Cell Tumor at the Age of 35 or Older

Öz

In this retrospective study, 28 patients with germ cell tumor over 35 years of age fol-lowed-up in the Istanbul University, Institute of Oncology between years 1990 and 1998, were evaluated with regard to treatment morbidity and survival. The ages ranged from 35 to 61, with a median of 42 years. Four patients had pure seminoma with normal pretreatment AFP levels, and 24 patients had nonseminomatous tumors. Twenty-six patients with nonseminomatous tumors had a testis site, and two had an extragonadal primary site (mediastinum, rectum and bladder). According to International Consensus Prognostic Classification, 57% of patients had good-risk; 28% intermediate-risk, and 14% poor-risk disease. According to AJCC new TNM staging system, 14% of patients were stage la; 21% Ib, 7% stage 2a, 3% stage 2b, 10% stage 2c, 14% stage 3a, 14% stage 3b, and 10% stage 3c, respectively. 15 patients achieved complete response and 8 patients had partial response. The median follow-up was 28 months (range: 3-88 months). The median disease-free survival and overall survival were 29 months (range: 1-83 months) and 33 months (range: 3-88 months), respectively. Seven patients have died; the death was disease related in 4 patients. Grade 3/4 pulmonary toxicity was recorded in 4 (14%) patients. 4 (14%) patients had grade 3/4 mucositis. Neutropenic fever occurred in 2 (7%) patients. Grade 3/4 anemia and neutropenia occurred in 3 patients (10%) and 2 patients (7%), respectively. There were no toxic deaths. Dose reduction was done in one patient. In conclusion, patients with at the age of 35 or older with germ cell tumor (% 14 pulmonary toxicity and 25% mortality) were quite significant.

Anahtar Kelimeler

• Germ cell tumors
• age
• mortality

Kaynakça

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