Erişkin glioblastoma multiforme tanılı hastalarda radyoterapi ve eşzamanlı temozolomide sonuçları ve prognostik kriterler
Results of radiotherapy and concurrent temozolomide in adult glioblastoma multiforme and prognostic criteria
Yazar: ERTUĞRUL TEKÇE
Danışman: YRD. DOÇ. DR. EVRİM BAYMAN
Eskişehir Osmangazi Üniversitesi / Tıp Fakültesi / Radyasyon Onkolojisi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2012
Konu: Onkoloji = Oncology ; Radyoloji ve Nükleer Tıp = Radiology and Nuclear Medicine
Dizin: Antineoplastik ajanlar = Antineoplastic agents ; Glioblastoma = Glioblastoma ; Prognoz = Prognosis ; Radyoterapi = Radiotherapy

Özet:
Haziran 2006-Kasım 2011 tarihleri arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Radyasyon Onkolojisi Anabilim Dalı'nda radyoterapi uygulanan toplam 80 glioblastoma multiforme tanılı hasta retrospektif değerlendirildi. Hastaların medyan yaşı 57(29-83) olup 62'si(%77.5) 50 yaş ve üzerinde, 18'i(%22.5) 50 yaş altında tanı almıştı. Erkek:Kadın oranı 1.96:1 idi. Karnofsky performans skoru 70 ve üzerinde olan hasta 41(%51.3), 70 altında olan 39(%48.7) kişiydi. Biyopsi yapılan 10(%12.5), subtotal eksizyon yapılan 47(%58.8), gross total eksizyon yapılan 23(%28.8) hasta mevcuttu. Radyoterapi dozu 60 Gy olan 58(%72.5), 30 Gy uygulanan 22(%27.5) hastaydı. Radyoterapi ile eşzamanlı Temozolomide alanların almayanlara oranı 52(%65)/28(%35) idi. RPA gruplarına göre incelendiğinde 3. grupta 4(%5), 4. grupta 28(%35), 5. grupta 30(%37.5) ve 6. grupta 18(%22.5) hasta mevcuttu. Karnofsky performans skoru 70 ve üzerinde olan hastaların medyan genel sağkalımı 20.9 ay, 70 altında olanların ise 8.9 aydı(p=0.000). Uygulanan radyoterapi dozu 60 Gy olan hastalarda sağkalım 17.5 ay, 30 Gy uygulananlarda 6.8 aydı(p=0.000). Radyoterapi sonrası stabil yanıt veya progresyonu olan hastalarda medyan genel sağkalım 14.4 ay, parsiyel yanıt görülenlerde 21.7 ay bulundu(p=0.018). Radyoterapi sonrası adjuvan en az 1 kür Temozolomide uygulanan hastalarda medyan genel sağkalım 20.3 ay, hiç uygulanmayanlarda 9.4 ay bulundu(p=0.000). Mevcut literatür ile uyumlu olarak Karnofsky performans skoru, adjuvan Temozolomide uygulaması sağkalıma etkili faktörler olup, RPA gruplarına göre sağkalım 3. grupta 31.5 ay, 4. grupta 21 ay, 5. grupta 11.3 ay ve 6. grupta 7.8 aydır(p=0.000).Anahtar Kelimeler: Glioblastoma multiforme, Temozolomide, radyoterapi

Abstract:
multiforme diagnosed patients who attended and received radiotherapy in Eskisehir Osmangazi University School of Medicine, Department of Radiation Oncology between June 2006 and November 2011 have been evaluated retrospectively. Median age was 57(29-83) and 62(%77.5) of patients were of age 50 and over and 18(%22.5) were under the age of 50. Ratio of male:female was 1.96:1. Number of patients with Karnofsky performance status 70 and over were 41(%51.3) and 39(%48.7) were under 70. There were 10(%12.5) patients who underwent biopsy-only, 47(%58.8) who were subtotally excised and 23(%28.8) gross totally excised. Patients receiving 60 Gy were 58(%72.5) and 30 Gy were 22(%27.5). Ratio of number of patients who were administered concurrent Temozolomide and who weren?t was 52(%65)/28(%35). As to RPA group standardization 4(%5) patients were in 3rd, 28(%35) of in 4th, 30(%37.5) of in 5th and 18(%22.5) of in 6th group. Median overall survival of patients with Karnofsky performans status 70 and over was 20.9, and under 70 was 8.9 months(p=0.000). Overall survival rates were 17.5 months and 6.8 months in whom were administered 60 and 30 Gy respectively(p=0.000). 14.4 and 21.7 months were found as median survival in who had stable or progressive disease after radiotherapy and with partial response(p=0.018). Patients who were administered minimum 1 cycle of adjuvant Temozolomide after radiotherapy had a survival of 20.3 months, while others had 9.4 months(p=0.000). In correspondence with the current literature, overall survival was correlated with Karnofsky performance status and adjuvant Temozolomide administiration and median survival of RPA group 3, 4, 5, 6 was 31.5, 21, 11.3, 7.8 months, respectively(p=0.000).Key Words: Glioblastoma multiforme, Temozolomide, radiotherapy