Nazofarinks karsinomlarında neoadjuvan kemoterapi sonrası eksternal radyoterapi ve HDR brakiterapi

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.ÖZET Ağustos 1993-Ağustos 1994 tarihleri arasında 19 nazofarinks karsinomlu (N2-3 veya indiferan tip) olgu neoadjuvan KT, eksternal RT ve ir- 192 HDR brakiterapi protokolüne alınmıştır. Neoadjuvan KT üçer hatla arayla siklofosfamid 500 mg/m2, epirubisin 70-90 mg/m2, sisplatin 100 mg/m2 dozunda, 3 kür olarak uygulanmıştır. Eksternal RT, son KT küründen 3 hafta sonra, 2 Gy/gün olmak üzere, nazofarinks ve komşu yapıları, parafaringeal lenfatikleri ve tüm servikal lenfatikleri kapsayacak şekilde. T 1-2 olgularda primer bögeye toplam 60 Gy, T3-4 olgularda 70 Gy dozunda uygulanmış, palpabl lenf nodu bölgelerine 60 Gy'den sonra 10 Gy elektron boostu eklenmiştir. Lenf nodu tutulumu olmayan olgularda supraklaviktiler bölge 0.5 cm derinlikte 50 Gy, tutulumu olanlarda 60 Gy dozunda ışınlanmıştır. İntrakaviter brakiterapi "boost"u eksternal RT'den 1-2 hafta sonra Tl-2 olgularda 5 Gy'lik 3 uygulama (15 Gy), T3 ve eksternal RT sonrası yapılan direkt nazofarinks bakısında kalıntı tümörü olan T4 olgulara 5 Gy'lik 2 uygulama (10 Gy) şeklinde yapılmıştır. Akut toksisite değerlendirmesi RTOG ve WHO kriterlerine göre KT ve RT için ayrı olarak yapılmış olup, olguların hiçbirinde hayatı tehdit edici derece IV akut toksisite bulgusuna rastlanmamıştır. KT sırasında olguların tümünde derece. I-III bulantı-kusma ve alopesi, %52.6'sında derece I - 1 1 1 lökopeni görülürken, hiçbirinde kardiyak ve renal toksisiteye rastlanmamıştır. Eksternal RT sırasında olguların tümünde derece I-Il cilt toksisitesi, derece I-III mukozit ve %68.4'ünde derece I-II lökopeni ortaya çıkmıştır. KT sonrası yapılan primer tümör yanıtı değerlendirmesinde tam yanıt oranı % î 5.8, kısmi yanıt oranı %78.9 iken RT sonrasında tam yanıt oranı %84.2 olarak gözlenmiş, nodal yanıtlar ayrı ele alındığında KT sonrası %29.4 olan tam yanıt oranı RT sonrası %88.2'ye yükselmiştir. Brakiterapi "boost"u68 uygulanan 15 olguda lokal kontrol oranı %93.3 olarak bulunmuştur. KT başlangıcından itibaren hesaplanan 10 aylık median (5-13 ay) takip süresince olguların hiçbirinde lokal-bölgesel nüks, kalıntı hastalığın progresyonu ve uzak metastaz tespit edilmemişti

Neoadjuvant Radiotherapy/Chemoradiotherapy in Locally Advanced Non-Small Cell Lung Cancer

WOS: 000351489300001PubMed ID: 25759765Locally advanced non-small cell lung cancer (NSCLC) consists of a heterogeneous group of patients, and the optimal treatment is still controversial. The current standard of care is concurrent chemoradiotherapy. The prognosis is still poor, with high rates of local and distant failure despite multimodality treatment. One of the efforts to improve outcomes in these patients is to use neoadjuvant treatment to improve resectability, and downstaging the nodal disease, which has a clear impact on prognosis. Radiotherapy as the sole neoadjuvant modality has been used historically without any survival benefit, but with increased toxicity. After the demonstrating a survival benefit by combining radiotherapy and chemotherapy, phase II studies were started to determine the neoadjuvant administration of these two modalities together. Although the results of these studies revealed a heterogeneous postinduction pathologic complete response, tumor and nodal downstaging can be achieved at the cost of a slightly higher morbidity and mortality. Subsequent phase III trials also failed to show a survival benefit to surgery, but indicated that there may be a subset of patients with locally advanced disease who can benefit from resection unless pneumonectomy is not provided. In order to increase the efficacy of radiotherapy, hyperfractionated-accelerated schedules have been used with promising complete pathologic response rates, which might improve prognosis. Recently, studies applying high radiotherapy doses in the neoadjuvant setting demonstrated the safety of resection after radiotherapy, with high nodal clearance rates and encouraging long-term survival results. In conclusion, neoadjuvant treatment of locally advanced NSCLC is one of the most challenging issues in the treatment of this disease, but it can be offered to appropriately selected patients, and should be done by a multidisciplinary team. Individual risk profiles, definite role of radiotherapy with optimal timing, and dose need to be clarified by carefully designed clinical trials

Invited Editorial on '' the timing of surgery after neoadjuvant chemoradiation in locally advanced non-small cell lung cancer ''

WOS: 000398131900096PubMed ID: 2844952

Lymphopaenia and accidental splenic doses: Do they have any prognostic value for locally advanced gastric cancer patients treated with radiochemotherapy?

WOS: 000507492700007PubMed: 31992955Aim of the study: To determine the effect of chemoradiotherapy (CRT)-induced lymphopaenia, and irradiated splenic volume and splenic doses on ontological outcomes in patients with locally advanced gastric cancer (LAGC). Material and methods: A consecutive cohort of 52 patients with LAGC treated between 2005 and December 2016 was included. the absolute neutrophil, lymphocyte, and platelet counts were recorded prior to any treatment (baseline), just after the completion of CRT, and 2-6 weeks after the completion of CRT (control evaluation). Results: the median follow-up time was 30 months (range, 8-130). the incidence of severe lymphopaenia was only 1% at control evaluation, but it was 93% after CRT (p 20% (p = 35 Gy was a significant poor prognostic factor for OS and recurrence-free survival (RFS) (p = 0.042 and p = 0.50, respectively). Maximum splenic dose >= 58 Gy effected OS unfavourably (p = 0.050). Volumetric modulated arc therapy (VMAT), intravenous CT, and age >= 65 years were significant predictors for subsequent severe lymphopaenia. Conclusions: Severe lymphopaenia could not be accepted as a predictive or prognostic factor for LAGC. Mean and maximum splenic doses should be kept on mind while evaluating the treatment dose-volume histograms (DVHs). Patient age, IV usage of concomitant CT agent, and RT technique can influence the ALC. Disease-related factors such as stage and MDLN ratio were the most important factors

MOLECULAR PROGNOSTIC FACTORS IN NON-SMALL CELL LUNG CANCER PATIENTS WHO RECEIVED CURATIVE RADIOTHERAPY AND CHEMOTHERAPY

WOS: 00029176980012