Lokal ileri (Evre IIIA ve IIIB) küçük hücreli dışı akciğer kanserinde definitif kemoradyoterapi ile cerrahi sonuçlarının karşılaştırılması: Tek merkez deneyimi
Öz
Amaç: Literatürde evre III küçük hücreli dışı
akciğer kanseri (KHDAK) tedavisi ile ilgili tartışmalar halen sürmektedir.
Radyoterapi ve cerrahideki gelişmeler ile evre III KHDAK gerçek yaşamdaki
verilerin değerlendirilmesi önem arz etmektedir. Evre IIIA ve IIIB lokal ileri
KHDAK’nde tedavi yaklaşımlarının ve gerçek yaşam verilerinin değerlendirilmesi
amaçlanmıştır.
Yöntem: Şubat 2016 – Mayıs 2018 tarihleri
arasında Gazi Üniversitesi Tıp Fakültesi Medikal Onkoloji kliniğinde takip
edilen lokal ileri evre IIIA ve IIIB KHDAK 47 hastanın dosyaları retrospektif
olarak değerlendirildi.
Bulgular: Primer tedavi olarak 27 (%57) hasta
definitif kemoradyoterapi (KRT), 20 (%43) hastaya cerrahi tedavisi
uygulanmıştı. KRT uygulanan hastaların, performans durumunun (p=0.010) istatistiksel
olarak anlamlı derecede daha kötüydü, aktif sigara içiminin (p=0.033) daha
fazla olduğu ve daha ileri lenf nodu evresine (p=0.052) sahip olduğu
görülmüştür. Tek değişkenli analizde lenf nodu durumu (p=0.011), hastaların
performans durumu (p=0.0247) ve hastaların tedavi modalitesi (p=0.001) sağ
kalımı etkileyen prognostik faktörler olarak tespit edilmiştir. Hastaların 1
yıllık genel sağ kalım oranları ve medyan sağ kalımı, cerrahi uygulanan grupta
sırasıyla 85% ve 23 ay, definitif KRT uygulananlarda 41% ve 10 ay olarak tespit
edilmiştir. Çok değişkenli analizde cerrahi yapılması KRT’ye göre bağımsız daha
iyi prognostik faktör olarak belirlenmiştir (HR: 2.72, 95% CI: 1.27-5.82,
p=0.010).
Sonuç: Evre III KHDAK hasta grubunda klinik
deneyimimiz sonucunda rezektabl olan hastaların sonuçlarının daha iyi olduğu
görülmektedir. Mediasten lenf nodu tutulum bölgesi özellikle N3 lenf nodu
bölgesi ve hasta performansı evre III KHDAK’ inde prognozu belirleyen önemli
faktörlerdendir.
Anahtar Kelimeler
Kaynakça
- Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424.
- Govindan R, Bogart J, Vokes EE. Locally advanced non-small cell lung cancer: the past, present, and future. J Thorac Oncol. 2008;3:917–28.
- Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classifi cation of malignant tumours. J Thorac Oncol 2007; 2: 706–14.
- National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer. Version 3.2019. Fort Washington, Pa: National Comprehensive Cancer Network, 2018.
- Furuse K, Fukuoka M, Kawahara M, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycim, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol 1999; 17:2692-9.
- Shien K, Toyooka S, Kiura K, Matsuo K, Soh J, Yamane M, et al. Induction chemoradiotherapy followed by surgical resection for clinical T3 or T4 locally advanced non-small cell lung cancer. Ann Surg Oncol. 2012;19:2685–92.
- Lococo F, Cesario A, Margaritora S, Dall’Armi V, Nachira D, Cusumano G, et al. Induction therapy followed by surgery for T3-T4/N0 non-small cell lung cancer: long-term results. Ann Thorac Surg. 2012;93:1633–40.
- Toyooka S, Kiura K, Takemoto M, Oto T, Takigawa N, Fujiwara T, et al. Long-term outcome of induction chemoradiotherapy with docetaxel and cisplatin followed by surgery for non-small-cell lung cancer with mediastinal lymph node metastasis. Interact Cardiovasc Thorac Surg. 2012;14:565–9.
- Katakami N, Tada H, Mitsudomi T, et al. A phase 3 study of induction treatment with concurrent chemoradiotherapy versus chemotherapy before surgery in patients with pathologically confi rmed N2 stage IIIA nonsmall cell lung cancer (WJTOG9903). Cancer 2012; 118: 6126–35.
- Girard N, Mornex F, Douillard JY, et al. Is neoadjuvant chemoradiotherapy a feasible strategy for stage IIIA-N2 non-small cell lung cancer? Mature results of the randomized IFCT-0101 phase II trial. Lung Cancer 2010; 69: 86–93.
- Mountain CF. A new international staging system for lung cancer. Chest 1986; 89(suppl 4):255-83.
- Li J, Dai CH, Yu LC, et al. Result of trimodality therapy in patients with stage IIIA (N2-bulky) and stage IIIB non-small-cell lung cancer. Clin Lung Cancer. 2009 Sep;10(5):353-9.
- Pless M, Stupp R, Ris HB, et al. Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial. Lancet 2015; 386: 1049-56.
- Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet 2009; 374: 379–86.
- van Meerbeeck JP, Kramer GW, Van Schil PE, et al. Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non-small-cell lung cancer. J Natl Cancer Inst 2007; 99: 442–50.
Comparison of definitive chemoradiotherapy and surgical results in local advanced (stage IIIa and IIIb) non-small cell lung cancer: single-center experience
Öz
Objective: Discussions regarding the
treatment of stage III non-small cell lung cancer (NSCLC) are still ongoing in
the literature. It is important to evaluate the developments in radiotherapy
and surgery along with the data in real life regarding stage III NSCLC. The aim
of this study is to evaluate the treatment approaches and real-life data in
stage IIIA and IIIB local advanced NSCLC.
Method: The files of 47 patients with
local advanced stage IIIA and IIIB NSCLC, who were followed up in the Gazi
University Faculty of Medicine, Medical Oncology Clinic between February 2016
and May 2018, were retrospectively evaluated.
Results: As the primary treatment,
definitive chemoradiotherapy (CRT) to 27 (57%) patients and surgical treatment
to 20 (43%) patients were applied. It was observed that the performance status
(p=0.010) of the patients who underwent CRT was statistically significantly
worse, active smoking (p=0.033) was higher, and had a more advanced lymph node
stage (p=0.052). In the univariate analysis, it was determined that lymph node
status (p=0.011), performance status of the patients (p=0.0247), and treatment
modality of patients (p=0.001) were the prognostic factors affecting survival.
The 1-year overall survival rates and median survival of the patients were 85%
and 23 months in the surgical group respectively, and 41% and 10 months in the
definitive CRT group. In the multivariate analysis, surgery was found to be a
better independent prognostic factor than CRT (HR: 2.72, 95% CI: 1.27-5.82,
p=0.010).
Conclusions: It was
observed that the results of the patients, who were found to be respectable as
a result of the clinical experience in stage III NSCLC patient group, were
better. The mediastinal lymph node involvement site, especially N3 lymph node
site, and the patient performance are among the important factors that
determine the prognosis in stage III NSCLC.
Anahtar Kelimeler
Kaynakça
- Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424.
- Govindan R, Bogart J, Vokes EE. Locally advanced non-small cell lung cancer: the past, present, and future. J Thorac Oncol. 2008;3:917–28.
- Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classifi cation of malignant tumours. J Thorac Oncol 2007; 2: 706–14.
- National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer. Version 3.2019. Fort Washington, Pa: National Comprehensive Cancer Network, 2018.
- Furuse K, Fukuoka M, Kawahara M, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycim, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol 1999; 17:2692-9.
- Shien K, Toyooka S, Kiura K, Matsuo K, Soh J, Yamane M, et al. Induction chemoradiotherapy followed by surgical resection for clinical T3 or T4 locally advanced non-small cell lung cancer. Ann Surg Oncol. 2012;19:2685–92.
- Lococo F, Cesario A, Margaritora S, Dall’Armi V, Nachira D, Cusumano G, et al. Induction therapy followed by surgery for T3-T4/N0 non-small cell lung cancer: long-term results. Ann Thorac Surg. 2012;93:1633–40.
- Toyooka S, Kiura K, Takemoto M, Oto T, Takigawa N, Fujiwara T, et al. Long-term outcome of induction chemoradiotherapy with docetaxel and cisplatin followed by surgery for non-small-cell lung cancer with mediastinal lymph node metastasis. Interact Cardiovasc Thorac Surg. 2012;14:565–9.
- Katakami N, Tada H, Mitsudomi T, et al. A phase 3 study of induction treatment with concurrent chemoradiotherapy versus chemotherapy before surgery in patients with pathologically confi rmed N2 stage IIIA nonsmall cell lung cancer (WJTOG9903). Cancer 2012; 118: 6126–35.
- Girard N, Mornex F, Douillard JY, et al. Is neoadjuvant chemoradiotherapy a feasible strategy for stage IIIA-N2 non-small cell lung cancer? Mature results of the randomized IFCT-0101 phase II trial. Lung Cancer 2010; 69: 86–93.
- Mountain CF. A new international staging system for lung cancer. Chest 1986; 89(suppl 4):255-83.
- Li J, Dai CH, Yu LC, et al. Result of trimodality therapy in patients with stage IIIA (N2-bulky) and stage IIIB non-small-cell lung cancer. Clin Lung Cancer. 2009 Sep;10(5):353-9.
- Pless M, Stupp R, Ris HB, et al. Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial. Lancet 2015; 386: 1049-56.
- Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet 2009; 374: 379–86.
- van Meerbeeck JP, Kramer GW, Van Schil PE, et al. Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non-small-cell lung cancer. J Natl Cancer Inst 2007; 99: 442–50.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Dahili Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Mart 2019 |
| Kabul Tarihi | 26 Mart 2019 |
| Yayımlandığı Sayı | Yıl 2019 |