Meme kanserli hastalarda lokal bölgesel nüks üzerine radyoterapi zamanlamasının prognostik faktör olarak araştırılması
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2008
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info:eu-repo/semantics/openAccess
Özet
Meme kanseri kadınlar arasında en sık görülen malign tümördür. Multimodel tedavisinde radyoterapi, primer ve adjuvan tedavide yer alır. Radyoterapi meme koruyucu cerrahi veya mastektomi sonrası lokal bölgesel kontrol ve sağkalımı arttırmaktadır. Adjuvan tedaviler sonrasında nükslerin dörtte üçü ilk beş yılda ortaya çıkmaktadır. Trakya Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı'nda yapılan çalışmamızın amacı operasyon ile radyoterapi başlangıcı arasındaki sürenin lokal nüks ve sağkalımlar üzerine etkisini belirlemekti.1999- 2006 yılları arasında Trakya Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı'na başvuran meme kanseri tanısı patolojik olarak verifiye edilmiş, cerrahi sonrası adjuvan kemoterapi, radyoterapi ve reseptör durumuna göre hormon tedavisi alan veya almayan, non-metastatik 371 olgu retrospektif olarak incelendi. Nüks eden hastalarda operasyon ve radyoterapi başlaması arasında geçen süre ortanca 5 ay, (ortalama 4.5 ay) bulundu. Ortanca 42.4 aylık (ortalama 54.8 ay) takibinde 19 (%5.1) olguda lokal bölgesel nüks gelişmiştir. Nüksler 10 (%52.6) olguda toraks cidarında, 6 (%31.6) olguda bölgesel lenfatiklerde, 3 (%15.8) olguda hem bölgesel lenfatiklerde hem de tümör lojunda birlikte saptandı. Operasyon ile nüks arasında geçen süre ortanca 29.2 ay (ortalama 36.8 ay) olarak bulundu. Nüks eden hastalarda operasyon ve radyoterapi başlaması arasında geçen süre ortalama 4.5 ay idi (ortanca 4.5, aralık 1.3-6.4).Operasyon ile radyoterapi başlangıcı arasındaki sürenin tüm grubta nüks üzerine olan etkisine bakıldığında p değeri sınırda olmakla birlikte istatistiksel olarak anlamlılık saptanmadı (p=0.052). Ancak bu sürenin tüm hasta grubunda hastalıksız ve genel sağkalım üzerine olan etkisi tek başına analiz edildiğinde; gerek hastalıksız sağkalım (r= -0.211, p < 0.0001), gerekse genel sağkalım (r =-0.203, p<0.0001) ile negatif yönde anlamlı korelasyon gösterdiği saptanmıştır. Tüm grubta (371 olgu) 5 ve 10 yıllık hastalıksız sağkalımlar %70.8 ve %47.4, 5 ve 10 yıllık genel sağkalımlar %81 ve %49.4 bulunmuştur.Cox regresyon analizinde hastalıksız sağkalımı etkileyen faktörler olarak lenfovasküler invazyon (p=0.04), progesteron reseptör (p<0.001) ve aksiller tutulum durumu (p=0.032) bulunmuştur. Genel sağkalımı etkileyen faktörler olarak hormonoterapi (p=0.049) ve aksiller tutulum durumu (p=0.011) saptanmıştır. Cox regresyon analizinde diğer prognostik faktörler ile operasyon radyoterapi arasındaki süre analize sokulduğunda sağkalımları etkileyen prognostik faktörler arasında yer almadığı görülmüştür. Anahtar Kelimeler: Meme kanseri, Lokal bölgesel nüks, Operasyon radyoterapi zamanlaması
Breast cancer is the most frequent malignant tumor among women. Radiotherapy is used both in primary and adjuvant therapy in multimodal treatment. Radiotherapy following breast conserving surgery or mastectomy increases locoregional control and survival. Three fourths of the recurrences following adjuvant treatment occur in first five years. The aim of our study at Trakya University Medical Faculty Department of Radiation Oncology is to determine the effect of the period between surgery and beginning of radiation therapy over locoregional failure and survival. Between 1999-2006, non-metastatic 371 patients who admitted to Radiation Oncology Department, Trakya University Medical Faculty, with pathologically verified breast cancer, who received adjuvant chemotherapy, radiotherapy, hormonotherapy according to their receptor status following surgery were retrospectively reviewed. The time between surgery and beginning of radiation therapy in patients with recurrence was median 5 months (mean 4.5 months). Locoregional failure was observed in 19 patients with median 42.4 months (mean 54.8 months) follow up. Ten (52.6%) patients had locoregional failure at chest wall, six (31.6%) patients had in the regional lymphatic nodes, and three (15.8%) patients had both at tumor bed and in the regional lymphatic nodes. The time between operation and locoregional failure was median 29.2 months (mean 36.8 months). The time between operation and radiation therapy in patients with locoregional failure was median 4.5 months (mean 4.5 months). When the effect of time between the operation and beginning of radiation therapy over locoregional failure in all group is considered, although p value was at the limit, it was statistically not significant (p=0.052). However, when the effect of this period over disease-free survival and overall survival in all patient group is analyzed; it is found to have a negative correlation both with disease-free survival (r=-0.211, p<0.0001) and overall survival (r=-0.203, p<0.0001). In all patient group (371 patients), 5 and 10-year disease-free survivals were 70.8% and 47.4%, 5 and 10-year overall survivals were 81% and 49.4%. In Cox's regression analysis, lymphovascular invasion (p=0.04), progesterone receptor (p<0.001), and axillary nodal involvement status (p=0.032) were predictive factors for disease-free survival. Hormonotherapy (p=0.049), and axillary nodal involvement status (p=0.011) were predictive factors for overall survival. When time between operation and beginning of radiation therapy was put in together with other prognostic factors for Cox's regression analysis, it was seen that it did not affect the disease-free and overall survivals. Key Words: Breast cancer, Locoregional recurrence, Surgery radiotherapy interval
Breast cancer is the most frequent malignant tumor among women. Radiotherapy is used both in primary and adjuvant therapy in multimodal treatment. Radiotherapy following breast conserving surgery or mastectomy increases locoregional control and survival. Three fourths of the recurrences following adjuvant treatment occur in first five years. The aim of our study at Trakya University Medical Faculty Department of Radiation Oncology is to determine the effect of the period between surgery and beginning of radiation therapy over locoregional failure and survival. Between 1999-2006, non-metastatic 371 patients who admitted to Radiation Oncology Department, Trakya University Medical Faculty, with pathologically verified breast cancer, who received adjuvant chemotherapy, radiotherapy, hormonotherapy according to their receptor status following surgery were retrospectively reviewed. The time between surgery and beginning of radiation therapy in patients with recurrence was median 5 months (mean 4.5 months). Locoregional failure was observed in 19 patients with median 42.4 months (mean 54.8 months) follow up. Ten (52.6%) patients had locoregional failure at chest wall, six (31.6%) patients had in the regional lymphatic nodes, and three (15.8%) patients had both at tumor bed and in the regional lymphatic nodes. The time between operation and locoregional failure was median 29.2 months (mean 36.8 months). The time between operation and radiation therapy in patients with locoregional failure was median 4.5 months (mean 4.5 months). When the effect of time between the operation and beginning of radiation therapy over locoregional failure in all group is considered, although p value was at the limit, it was statistically not significant (p=0.052). However, when the effect of this period over disease-free survival and overall survival in all patient group is analyzed; it is found to have a negative correlation both with disease-free survival (r=-0.211, p<0.0001) and overall survival (r=-0.203, p<0.0001). In all patient group (371 patients), 5 and 10-year disease-free survivals were 70.8% and 47.4%, 5 and 10-year overall survivals were 81% and 49.4%. In Cox's regression analysis, lymphovascular invasion (p=0.04), progesterone receptor (p<0.001), and axillary nodal involvement status (p=0.032) were predictive factors for disease-free survival. Hormonotherapy (p=0.049), and axillary nodal involvement status (p=0.011) were predictive factors for overall survival. When time between operation and beginning of radiation therapy was put in together with other prognostic factors for Cox's regression analysis, it was seen that it did not affect the disease-free and overall survivals. Key Words: Breast cancer, Locoregional recurrence, Surgery radiotherapy interval
Açıklama
Anahtar Kelimeler
Onkoloji, Oncology
