Lokal İleri ve Metastatik Küçük Hücreli Dışı Akciğer Kanseri Hastalarının Değerlendirilmesi Marmara Üniversitesi Deneyimi

Lokal İleri ve Metastatik Küçük Hücreli Dışı Akciğer Kanseri Hastalarının Değerlendirilmesi Marmara Üniversitesi DeneyimiDr. P. Fulden YUMUK1, Dr. M. Salih İYİKESİCİ1, Dr. Mahmut GÜMÜŞ1, Dr. Mehmet ALİUSTAOĞLU1, Dr. Faysal DANE1, Dr. Gül BAŞARAN1, Dr. Meltem EKENEL1, Dr. Ufuk ABACIOĞLU2, Dr. N. Serdar TURHAL11Marmara Üniversitesi Tıp Fakültesi, Medikal Onkoloji Bilim Dalı, İstanbul2Marmara Üniversitesi Tıp Fakültesi, Radyasyon Onkolojisi ABD, İstanbulNisan 1997 ile Şubat 2004 tarihleri arasında onkoloji kliniğimizde tedavi alan 175 KHDAK tanılı hasta retrospektif incelendi. Tüm hastaların performans durumu (PD)≤2'ydi. İlk seçim tedavi olarak 138 hasta cisplatin içeren bir kombinasyon rejimini radyolojik yanıta bağlı olarak 3-6 kür aldı. Torasik radyoterapi evre IIIB hastalarında ilk seçim kemoterapi sonrasında ve semptomatik evre IV hastalarda palyatif amaçla yapıldı. Uygun olan evre IIIA hastalar (%8.6) opere edildi. Medyan yaş 60 ve 132 hasta erkekti. PD %77.5 hastada 0'dı. Sırasıyla 16/39/120 hastanın evreleri IIIA/IIIB/IV'dü. Kırksekiz hastaya lokal radyoterapi yapıldı. Ortanca 11 aylık (1-63 ay) izlemde medyan genel sağkalım (GS) süresi 13±1ay, 1-yıllık GS oranı %51 iken medyan progresyona kadar geçen süre 3ay, 1-yıllık progresyonsuz sağkalım oranı %16'ydı. Kadınların, iyi PD olanların, cerrahi ve primer radyoterapi yapılabilecek hastaların daha uzun GS'ı olduğu görüldü (sırasıyla, p=0.005, p=0.0001, p=0.044 ve p=0.0002). Aynı değişkenler bağımsız prognostik faktörler olarak belirlendi. Kliniğimizin sonuçları dünya literatürü ile uyumludur.Anahtar Kelimeler :&nbsp;Küçük hücreli dışı akciğer kanseri; Antineoplastik kombine kemoterapi protokolleri; Sağkalım analiziOUTCOME OF LOCALLY ADVANCED AND METASTATIC NON-SMALL CELL LUNG CANCER PATIENTS - MARMARA UNIVERSITY EXPERIENCEDr. P. Fulden YUMUK1, Dr. M. Salih İYİKESİCİ1, Dr. Mahmut GÜMÜŞ1, Dr. Mehmet ALİUSTAOĞLU1, Dr. Faysal DANE1, Dr. Gül BAŞARAN1, Dr. Meltem EKENEL1, Dr. Ufuk ABACIOĞLU2, Dr. N. Serdar TURHAL11Marmara Üniversitesi Tıp Fakültesi, Medikal Onkoloji Bilim Dalı, İstanbul2Marmara Üniversitesi Tıp Fakültesi, Radyasyon Onkolojisi ABD, İstanbulTreatment outcomes of the 175 advanced and metastatic NSCLC patients who were given chemotherapy since April 1997 were retrospectively evaluated. In 138 patients, a platinum analogue was used in combination with etoposide, vinorelbine, paclitaxel, docetaxel or gemcitabine. The thoracic radiotherapy was given to stage IIIB patients after completion of first line chemotherapy and to symptomatic stage IV patients with palliative intent. Eligible stage IIIA patients (8.6%) were operated. Median age was 60 and 132 patients were male. Performance status was 0 in 77.5% and stage was IIIA/IIIB/IV in 16/39/120 patients. Forty-eight patients received local RT. At a median follow-up of 11 months, median overall survival (OS) was 13 months, 1-year OS ratio was 51%. Women, patients with good performance status, having resectable tumors and who received local radiotherapy lived significantly longer (p=0.005, p=0.0001, p=0.044 and p=0.0002, respectively). The independent factors influencing the OS were identical. Our results are consistent with the world literature.Anahtar Kelimeler :&nbsp;Carcinoma, Non-Small-Cell Lung; Antineoplastic Combined Chemotherapy Protocols; Survival Analysis</p

Prognostic factors in medically inoperable early stage lung cancer patients treated with stereotactic ablative radiation therapy (SABR): Turkish Radiation Oncology Society Multicentric Study

Objective We identified factors influencing outcomes in patients with medically inoperable early stage lung cancer (MIESLC) treated with stereotactic ablative radiation therapy (SABR) at 14 centers in Turkey. Materials and Methods We retrospectively analyzed 431 patients with stage I-II MIESLC treated with SABR from 2009 through 2017. Age; sex; performance score; imaging technique; tumor histology and size; disease stage radiation dose, fraction and biologically effective dose with an alpha/beta ratio of 10 (BED10); tumor location and treatment center were evaluated for associations with overall survival (OS), local control (LC) and toxicity. Results Median follow-up time was 27 months (range 1-115); median SABR dose was 54 Gy (range 30-70) given in a median three fractions (range 1-10); median BED(10)was 151 Gy (range 48-180). Tumors were peripheral in 285 patients (66.1%), central in 69 (16%) and 100 Gy (P = .011), adenocarcinoma (P = .025) and complete response on first evaluation (P = .007) predicted favorable LC. BED10> 120 Gy (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.1-3.2,P = .019) and tumor size ( 120 Gy was needed for better LC and OS for large, non-adenocarcinoma tumors

The correlates of benefit from neoadjuvant chemotherapy before surgery in non-small-cell lung cancer: a metaregression analysis

Background: Although neoadjuvant chemotherapy (NCT) is widely used, it is not clear which subgroup of locally advanced non-small-cell lung cancer (NSCLC) patients should be treated with this approach, and if a particular benefit associated with NCT exists. In this study, we aimed to investigate the potential correlates of benefit from NCT in patients with NSCLC.Methods: All randomized clinical trials (RCTs) utilizing a NCT arm (without radiotherapy) versus a control arm before surgery were included for metaregression analysis. All regression analyses were weighed for trial size. Separate analyses were conducted for trials recruiting patients with different stages of disease. Previously published measures of treatment efficacy were used for the purpose of this study, regardless of being published in full text or abstract form.Results: A total of 14 RCTs, consisting of 3,615 patients, were selected. Histology, stage, various characteristics of the NCT protocol, and different trial features including trial quality score were not associated with the benefit of NCT. However, in trials of stage 3 disease only, there was a greater benefit in terms of reduction in mortality from NCT, if protocols with three chemotherapeutics were used (B = -0.18, t = -5.25, P = 0.006).Conclusions: We think that patients with stage 3 NSCLC are served better with NCT before surgery if protocols with three chemotherapy agents or equally effective combinations are used. In addition, the effect of neoadjuvant chemotherapy is consistent with regard to disease and patient characteristics. This finding should be tested in future RCTs or individual patient data meta-analyses. © 2012 Bozcuk et al.; licensee BioMed Central Ltd

Dealing with the gray zones in the management of gastric cancer: The consensus statement of the Istanbul Group

The geographical location and differences in tumor biology significantly change the management of gastric cancer. The prevalence of gastric cancer ranks fifth and sixth among men and women, respectively, in Turkey. The international guidelines from the Eastern and Western countries fail to manage a considerable amount of inconclusive issues in the management of gastric cancer. The uncertainties lead to significant heterogeneities in clinical practice, lack of homogeneous data collection, and subsequently, diverse outcomes