Küratif radyoterapi ve/veya kemoterapi gören mesane kanseri tanılı hastalarda lokla kontrol ve sağkalıma etkili prognostik faktörlerin analizi
Küçük Resim Yok
Tarih
2017
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada kas invaziv mesane kanseri tanısı ile küratif radyoterapi veya kemoradyoterapi uygulanmış hastaların tedavi sonuçlarının geriye dönük olarak değerlendirilmesi amaçlanmıştır. Çalışmaya 60 hasta dahil edilmiştir. Medyan takip süresi 30 (5-111) aydır. 5 yıllık lokal kontrol oranı %63,6 ve genel sağkalım %43'dür. Radyoterapi öncesi maksimal trans-üretral rezeksiyon yapılan hastalarda 5 yıllık lokal kontrol istatistiksel anlamlı oranda artmıştı (5 yıl: %79,3 vs %51,6; p=0,032). 5 yıllık genel sağkalım oranları maksimal trans-üretral rezeksiyon yapılanlarda %68,9 yapılmayanlarda ise %29,1'di. Çok değişkenli analizde de maksimal trans-üretral rezeksiyonun lokal kontrole etkili bir prognostik faktör olduğu belirlendi (p=0,029). Tedavi öncesi Hb değeri ?10 g/dl olan hastalar anemik kabul edildi. Tek değişkenli analizde, tedavi öncesi Hb ?10 g/dl olan hastalarda hem lokal kontrol (p=0,001) hem de genel sağkalım (p<0,0001) istatistiksel anlamlı oranda azalmıştı. Çok değişkenli analizde anlamlılık sadece lokal kontrol oranı için elde edildi (p=0,01). Tümör evresi (evre 2, 3, 4a) tek değişkenli analizde genel sağkalıma etkili bir prognostik faktör iken, çok değişkenli analizde anlamlılık yoktu (p=0,023; %83 vs %29). 12 (%20) hastada radyolojik lenf nodu pozitif hastalık mevcuttu. Lenf nodu evresi, tek değişkenli analizde, hem lokal kontrol (%76,9 vs %27,2; p=0,017) hem de genel sağkalıma (%52,5 vs <%5; p=0,015) etkili bir prognostik faktördü. Evrelerine göre bakıldığında 25 hastada evre 2 (%42), 16 hastada evre 3 (%27), 19 hastada ise evre 4 (%31) hastalık bulunduğu görülmektedir. Tek değişkenli analizde evrenin lokal kontrole etkisi gözlenmezken, genel sağkalımı (p=0,039) istatistiksel anlamlı oranda etkilediği tespit edildi. 39 (%65) hastanın tedavisi ?50 gün tamamlanmıştır. Çok değişkenli analiz yapıldığında, RT süresinin, hem lokal kontrolü (p<0,0001) hem de genel sağkalımı (p=0,038) etkileyen bağımsız değişken olduğu görüldü. Hidronefroz olmayan hastaların 5 yıllık lokal kontrol (p<0,0001) ve genel sağkalım oranları sırasıyla %76,6 ve %69,9 olmasına rağmen, hidronefroz olanlarda sırasıyla %15 ve %5'dir. Çok değişkenli analizde hidronefroz varlığının genel sağkalımı istatistiksel anlamlı oranda kötüleştirdiği görüldü (p<0,0001). Her iki tedavi modalitesinde de tedavi iyi tolere edildi. 5 (%8) hastanın toksisite nedeniyle tedaviyi tamamlayamadığı görülmektedir. Derece IV toksisite hiçbir hastada görülmedi. Beklendiği gibi en sık genito-üriner yan etki gözlendi. Derece I-II genito-üriner ve derece I-II gastrointestinal yan etki sırasıyla 46 (%77) hastada ve 6 (%19) hastada görüldü.
This studies aimed to evaluate retrospectievly outcomes of muscle-invazive bladder cancer patients treated with curative radiotherapy or chemoradiotherapy. 60 patients are included in this study. Median follow-up duration is 30 (5-111) month. 5 year overall local control rate was 63,6% and overall survival was 43%. 5 year local control rate of patients who underwent maximal trans urethal resection of bladder tumor prior to radiotherapy was increased significantly compared to those who had non-maximal trans urethal resection of bladder tumor (%79,3 vs %51,6; p=0,032). The 5-year overall survival of patients with maximal- trans urethal resection of bladder tumor was 69,8% and 29,1% for non-maximal trans urethal resection of bladder tumor patients. The completeness of trans urethal resection of bladder tumor was found as an effective prognostic factor for local control rate in multivariate analysis (p=0,029). Patients with pre-treatment hemoglobin levels ? 10 g/dl were accepted as anemic. In univariate analysis, both local control rate (p=0,001) and overall survival (p<0,0001) were significantly reduced in anemic patients. In multivariate analysis the significance was obtained only for local control rate (p=0,01). Tumor stage (stage 2, 3, 4a) was found as an important prognostic factor in univariate analysis (p=0,023; 83% vs 29%) but not in multivariate analysis. 12 patients (20%) had radiological pelvic lymph node positive disease. Clinical node stage was another important prognostic factor in univariate analysis, both for local control rate (76,9% vs 27,2%; p=0,017) and also for overall survival (52,5% vs 5%; p=0,015). In regard to clinical staging, 25 patients (42%) had stage 2 disease, 16 patients (27%) had stage 3 disease and 19 patients (31%) had stage 4 disease. Overall survival was significantly affected by stage (p=0,039) while local control rate was not affected. The total treatment time of 39 patients was completed ?50 days. In multivariate analysis, duration of radiotherapy was an independent variable that affected both local control rate (p<0,0001) and overall survival (p=0,038). 5-year overall survival and local control rate were 5% and 15% respectively for patients with hydronephrosis, while they were 69,9% (p<0,0001) and 76,6% (p<0,0001) respectively for those without hydronephrosis. In multivariate analysis, the presence of hydronephrosis significantly decreased overall survival (p<0,0001). Both of the treatment modality were generally well tolerated by the patients. Only 5 patients (%8) were unable to complete the treatment due to toxicity. Grade IV toxicity was not observed in any patient. Most frequent side effects were on the genito-urinary system, as expected. Grade I-II acute genito-urinary and gastro-intestinal toxicity were noticed on 46 (77%) and 6 (19%) of the patients, respectively.
This studies aimed to evaluate retrospectievly outcomes of muscle-invazive bladder cancer patients treated with curative radiotherapy or chemoradiotherapy. 60 patients are included in this study. Median follow-up duration is 30 (5-111) month. 5 year overall local control rate was 63,6% and overall survival was 43%. 5 year local control rate of patients who underwent maximal trans urethal resection of bladder tumor prior to radiotherapy was increased significantly compared to those who had non-maximal trans urethal resection of bladder tumor (%79,3 vs %51,6; p=0,032). The 5-year overall survival of patients with maximal- trans urethal resection of bladder tumor was 69,8% and 29,1% for non-maximal trans urethal resection of bladder tumor patients. The completeness of trans urethal resection of bladder tumor was found as an effective prognostic factor for local control rate in multivariate analysis (p=0,029). Patients with pre-treatment hemoglobin levels ? 10 g/dl were accepted as anemic. In univariate analysis, both local control rate (p=0,001) and overall survival (p<0,0001) were significantly reduced in anemic patients. In multivariate analysis the significance was obtained only for local control rate (p=0,01). Tumor stage (stage 2, 3, 4a) was found as an important prognostic factor in univariate analysis (p=0,023; 83% vs 29%) but not in multivariate analysis. 12 patients (20%) had radiological pelvic lymph node positive disease. Clinical node stage was another important prognostic factor in univariate analysis, both for local control rate (76,9% vs 27,2%; p=0,017) and also for overall survival (52,5% vs 5%; p=0,015). In regard to clinical staging, 25 patients (42%) had stage 2 disease, 16 patients (27%) had stage 3 disease and 19 patients (31%) had stage 4 disease. Overall survival was significantly affected by stage (p=0,039) while local control rate was not affected. The total treatment time of 39 patients was completed ?50 days. In multivariate analysis, duration of radiotherapy was an independent variable that affected both local control rate (p<0,0001) and overall survival (p=0,038). 5-year overall survival and local control rate were 5% and 15% respectively for patients with hydronephrosis, while they were 69,9% (p<0,0001) and 76,6% (p<0,0001) respectively for those without hydronephrosis. In multivariate analysis, the presence of hydronephrosis significantly decreased overall survival (p<0,0001). Both of the treatment modality were generally well tolerated by the patients. Only 5 patients (%8) were unable to complete the treatment due to toxicity. Grade IV toxicity was not observed in any patient. Most frequent side effects were on the genito-urinary system, as expected. Grade I-II acute genito-urinary and gastro-intestinal toxicity were noticed on 46 (77%) and 6 (19%) of the patients, respectively.
Açıklama
Tıpta Uzmanlık
Anahtar Kelimeler
Onkoloji, Oncology
