Metastatik safra kesesi kanserinde kemoterapinin yeri: Retrospektif değerlendirme

Şener Cihan; Nalan Babacan; Hatice Odabaş; Nebi Demirci; Nuriye Özdemir; Doğan Yazılıtaş

doi:10.7197/cmj.v36i4.5000071499

EN TR

Metastatik safra kesesi kanserinde kemoterapinin yeri: Retrospektif değerlendirme

Öz

Özet

Amaç. Safra kesesi kanseri sıklıkla ileri evrede teşhis edilen ve prognozu kötü olan bir kanser türüdür. Literatürde safra kesesi kanseri tedavisi ile ilgili çalışmalar sınırlıdır. Bilgilerin çoğu karaciğer, pankreas ve diğer safra yolları kanserlerini de içeren çalışmalardan elde edilmiştir. Metastatik hastalıkta standart bir tedavi yaklaşım olmamakla birlikte çeşitli kemoterapötikler kullanılmaktadır. Çalışmamızda metastatik safra kesesi kanserinde kemoterapinin sağkalım üzerine etkisi araştırılmıştır. Yöntem. Metastatik safra kesesi kanserli 32 hastanın dosyaları retrospektif olarak incelenmiştir. Hastaların sağkalım süreleri kemoterapi alıp almamalarına göre değerlendirilmiştir. Bulgular: Kemoterapi alan 14 (%43,8) hastaların hem progresyonsuz hem de genel sağkalım verileri kemoterapi almayan 18 (%56,2) hastalara göre daha uzun ve istatistiksel olarak da anlamlı idi (p<0,001). Kemoterapi alan hastalarda progresyonsuz sağkalım 20 ± 2,9 (%14,3-25,7 CI) hafta, genel sağkalım 36 ± 11,2 (%14-58 CI) hafta idi. Kemoterapi almayan hastalarda ise progresyonsuz sağkalım 4 ± 0,4 (%3,2-4,8 CI) hafta ve genel sağkalım ise 12 ± 2,8 (%6,5 x 17,5 CI) hafta olarak bulundu. Gemsitabin/sisplatin ve sisplatin/5-fluorourasil kombinasyonları en sık kullanılan rejimlerdi. Sonuç. Çalışmamız neticesinde metastatik safra kesesi kanserinde uygun hasta seçiminde kemoterapinin sağkalım üzerinde olumlu etkisi olduğu gösterilmiştir.

Anahtar sözcükler: Safra kesesi kanseri, ileri evre, kemoterapi, sağkalım

Abstract

Aim. Gallbladder cancer (GBC) is often diagnosed at advanced stage and prognosis is very poor. Information about the treatment of gallbladder cancer in the literature is limited. Most of the information were obtained from studies which involving liver, pancreas and other bile duct cancer. There is no standard therapy for metastatic disease. Various chemotherapeutic agents are used in the metastatic disease. In our study, effect of chemotherapy on survival in metastatic gallbladder cancer were investigated. Methods. Medical records of 32 patients with metastatic gallbladder cancer were evaluated retrospectively. Result. Both overall survival and progression free survival was longer in 14 (43.8%) patients receiving chemotherapy. This diversity was statistically significant (p<0.001). Progression-free survival was 20 ± 2.9 (14.3-25.7% CI) weeks and overall survival was 36 ± 11.2 (14-58% Cl) weeks in the patients receiving chemotherapy. On the other hand progression-free survival was 4 ± 0.4 (3.2-4.8% CI) weeks and overall survival was 12 ± 2.8 (6.5 x 17.5% CI) weeks in patients that didn’t receive chemotherapy. Gemcitabine/cisplatin and cisplatin/5-fluorouracil combinations were the most commonly used regimens. Conclusion. This study suggests that the positive effect of chemotherapy on survival in metastatic gallbladder cancer.

Keywords: Gallbladder cancer, advanced stage, chemotherapy, survival

Anahtar Kelimeler

Safra kesesi kanseri, ileri evre, kemoterapi, sağkalım

Kaynakça

Pitt HA, Dooley WC, Yeo CJ, Cameron JL. Malignancies of the biliary tree. Curr Probl Surg 1995; 32: 1-90.
Greenlee RT, Hill-Harmon MB, Murray T, Thun M. Cancer statistics, 2001. CA Cancer J Clin 2001; 51: 15-36.
Piehler JM, Crichlow RW. Primary carcinoma of the gallbladder. Surg Gynecol Obstet 1978; 147:9 29.
Cunningham CC, Zibari GB, Johnston LW. Primary carcinoma of the gall bladder: A review of our experience. J La State Med Soc 2002; 154: 196-9.
Sumiyoshi K, Nagai E, Chijiiwa K. Pathology of carcinoma of the gallbladder. World J Surg 1991; 15: 315-21.
Chao TC, Greager JA. Primary carcinoma of the gallbladder. J Surg Oncol 1991; 46: 215-21.
Perpetuo MO, Valdivieso M, Heilbrun LK, Nelson RS, Connor T, Bodey GP. Natural history study of gallbladder cancer: A review of 36 years experience at MD. Anderson Cancer Center. Cancer 1978; 42: 330-5.
Takada T, Kato H, Matsushiro T, Nimura Y, Nagakawa T, Nakayama T. Comparison of 5-fluorouracil, doxorubicin, and mitomycin with 5-fluorouracil alone in the treatment of pancreatic-biliary carcinomas. Oncology 1994; 51: 396- 400.

Okusaka T, Ishii H, Funakoshi A, Yamao K, Ohkawa S, Saito S, Saito H, Tsuyuguchi T. Phase II study of single agent gemcitabine in patients with advanced biliary tract cancer. Cancer Chemother Pharmacol 2006; 57: 647-53.
Sharma A, Bedi R, Shukla NK. Does chemotherapy improves survival in gall bladder cancer? J Clin Oncol 2004; 22: 363.
Hsu C, Shen Y-C, Yang C-H, Yeh KH, Lu YS, Hsu CH, Liu HT, Li CC, Chen JS, Wu CY, Cheng AL. Weekly gemcitabine plus 24 hour infusion of 5- fluourouracil/ leucovorin for locally advanced or metastatic carcinoma of biliary tract. Br J Cancer 2004; 90: 1715-9.
Kaneoka Y, Yamaguchi A, Isogai M, Harada T, Suzuki M. Hepatoduodenal ligament invasion by gallbladder carcinoma: Histologic patterns and surgical recommendation. World J Surg 2003; 27: 260.
Lin LL, Picus J, Drebin JA, Linehan DC, Solis J, Strasberg SM. A phase II study of alternating cycles of split course radiation therapy and gemcitabine chemotherapy for inoperable pancreatic or biliary tract carcinoma. Am J Clin Oncol 2005; 28: 234.
Ammori JB, Colletti LM, Zalupski MM, Eckhauser FE, Greenson JK, Dimick J. Surgical resection following radiation therapy with concurrent gemcitabine in patients with previously unresectable adenocarcinoma of the pancreas. JGastrointest Surg 2003; 7: 766.
Patt YZ, Hassan MM, Lozano RD, Waugh KA, Hoque AM, Frome AI, Lahoti S, Ellis L, Vauthey JN, Curley SA, Schnirer II, Raijman I. Phase II trial of cisplatin, interferon alpha-2b, doxorubicin, and 5-fluorouracil for biliary tract cancer. Clin Cancer Res 2001; 7: 3375.
Patt YZ, Hassan MM, Aguayo A, Nooka AK, Lozano RD, Curley SA, Vauthey JN, Ellis LM, Schnirer II, Wolff RA, Charnsangavej C, Brown TD. Oral capecitabine for the treatment of hepatocellular carcinoma, cholangiocarcinoma, and gallbladder carcinoma. Cancer 2004; 101: 578.
Tsavaris N, Kosmas C, Gouveris P, Gennatas K, Polyzos A, Mouratidou D, Tsipras H, Margaris H, Papastratis G, Tzima E, Papadoniou N, Karatzas G,Papalambros E. Weekly gemcitabine for the treatment of biliary tract and gallbladder cancer. Invest New Drugs 2004; 22: 193.
Gallardo J, Rubio B, Villanueva L, Barajas O. Gallbladder cancer, a different disease that needs individual trials. J Clin Oncol 2005; 23: 7753.
Sharma A, Dwary AD, Mohanti BK, Deo SV, Pal S, Sreenivas V, Raina V, Shukla NK, Thulkar S, Garg P, Chaudhary SP. Best supportive care compared with chemotherapy for unresectable gall bladder cancer: A randomized controlled study. J Clin Oncol 2010; 28: 4581.
Ducreux M, Rougier P, Fandi A, Zarba J, Armand JP. Effective treatment of advanced biliary tract carcinoma using 5-fluorouracil continuous infusion with cisplatin. Ann Oncol 1998; 9: 653.
Riechelmann RP, Townsley CA, Chin SN, Pond GR, Knox JJ. Expanded phase II trial of gemcitabine and capecitabine for advanced biliary cancer. Cancer 2007; 110: 1307.
Knox JJ, Hedley D, Oza A, Feld R, Siu LL, Chen E, Nematollahi M, Pond GR, Zhang J, Moore MJ. Combining gemcitabine and capecitabine in patients with advanced biliary cancer: A phase II trial. J Clin Oncol 2005; 23: 2332.
Iqbal S, McCoy H, Lenz HJ. A Phase II trial of gemcitabine and capecitabine in patients (pts) with unresectable or metastatic gallbladder cancer or cholangiocarcinoma (abstract). J Clin Oncol 2006; 24: 211.
Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, Madhusudan S, Iveson T, Hughes S, Pereira SP, Roughton M, Bridgewater J. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 2010; 362: 1273.
Eckel F, Schmid RM. Chemotherapy in advanced biliary tract carcinoma: A pooled analysis of clinical trials. Br J Cancer 2007; 96: 896.
Cho JY, Nam JS, Park MS, Yu JS, Paik YH, Lee SJ. A Phase II study of capecitabine combined with gemcitabine in patients with advanced gallbladder carcinoma. Yonsei Med J 2005; 46: 526.
Iyer RV, Gibbs J, Kuvshinoff B, Fakih M, Kepner J, Soehnlein N. A phase II study of gemcitabine and capecitabine in advanced cholangiocarcinoma and carcinoma of the gallbladder: A single-institution prospective study. Ann Surg Oncol 2007; 14: 3202.

Ayrıntılar

Birincil Dil

Türkçe

Konular

-

Bölüm

-

Yazarlar

Nalan Babacan

Yayımlanma Tarihi

21 Ekim 2014

Gönderilme Tarihi

21 Ekim 2014

Kabul Tarihi

-

Yayımlandığı Sayı

Yıl 2014 Cilt: 36 Sayı: 4

DOI

https://doi.org/10.7197/cmj.v36i4.5000071499

IZ

https://izlik.org/JA27CB25BF

Kaynak Göster

RIS / Bibtex

AMA

1.Cihan Ş, Babacan N, Odabaş H, Demirci N, Özdemir N, Yazılıtaş D. Metastatik safra kesesi kanserinde kemoterapinin yeri: Retrospektif değerlendirme. CMJ. 2014;36(4):479-485. doi:10.7197/cmj.v36i4.5000071499