Malign mezotelyomalı olguların retrospektif olarak değerlendirilmesi
Retrospectively assessment of malignant mesothelioma cases, Firat University Medical School thesis of internal medicine
Yazar: İSMAİL ERBAŞ
Danışman: DOÇ. DR. EMİN TAMER ELKIRAN
Fırat Üniversitesi / Tıp Fakültesi / İç Hastalıkları Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2010
Konu: Onkoloji = Oncology
Dizin: Antineoplastik ajanlar = Antineoplastic agents ; Komplikasyonlar = Complications ; Mezotelyoma = Mesothelioma ; Neoplazmlar = Neoplasms ; Retrospektif çalışmalar = Retrospective studies

Özet:
2003 ? 2010 tarihleri arasında Fırat Üniversitesi Medikal Onkoloji Bölümü'nde plevral ve peritoneal malign mezotelyoma tanısı ile takip ve tedavi edilen 49 erişkin olguya ait dosyalar retrospektif olarak incelendi. Olguların demografik ve klinik özellikleri, kemoterapiye (KT) bağlı toksisiteler, tedaviye ait yanıt ve prognostik faktörler araştırıldı. Olguların 28'i erkek, 21'i kadın, erkek/kadın oranı 1.33/1 idi. Tüm olguların ortalama yaşları 58±12 idi. Olguların en sık başvuru şikayeti göğüs ağrısı ve dispne idi. Olguların 30'nda (%61.2) asbest maruziyetinin olduğu, 2 olguda (%4.1) asbest maruziyetinin olmadığı, 17'sinde (%34.7) ise asbest maruziyeti olup olmadığı bilinmiyordu. Olguların 19'u (% 38.8) ev hanımı, 13'ü (%26.5) işçi, 5'i (%10.2) çiftçi, 12'si (%24.5) diğer mesleklerde çalışıyorlardı. Patoloji sonuçlarına göre 30 (%61.2) olguda epiteloid tip, 19 (%39.8) olguda alt grubu belirtilmemişti. Olguların 9'u (%18.4) erken evrede olduğu için cerrahi uygulandı. Cerrahi yapılan 9 olgunun 6'sına KT uygulandı. 49 olgunun 41'ine birinci basamak tedavi uygulandı. Birinci basamak tedavi olarak Sisplatin /karboplatin+pemetrexet 21olguda (%42.9), Sisplatin / karboplatin+ gemsitabine 13 olguya (%26.5), tek başına pemetrexet 4 olguya, (%8.2) tek başına gemsitabine (% 2) kemoterapi protokolleri verildi. Birinci basamak KT ye yanıt olarak 18 olguda (%36.7) progresyon, 6 olguda (%12.2) parsiyel yanıt, 11 olguda (% 22.4) stabil hastalık, 2 olguda (%4.1) tam yanıt, progresyon saptanan performansı iyi olan 8 olguya (%16.3) ikinci basamak kemoterapi uygulandı. İkinci basamak tedavi olarak tek ajan pemetrexet alan 4 olgu (% 8.2), tek ajan Gemsitabine alan 3 olgu (%6.1) gemsitabine+sisplatin alan 1 olgu (%2) olarak tespit edildi. KT yan etkileri arasında en sık bulantı, kusma ve hematolojik toksisite saptandı.Grade 1-2 bulantı ve kusma 30 olguda, grade 3-4 bulantı kusma ise 12 olguda gözlendi. KT uygulanan olguların yan etkiler olarak 4 olguda trombositopeni ve 2 olguda nötropeni gelişti. Palyatif amaçlı olarak 14 (%28.6) Olguya radyoterapi uygulandı. Tedavi alan olguların ortalama yaşam süresi 20 ay iken tedavi almayan olgularda 13 ay olarak tespit edildi (p=0.05).Anahtar kelimeler: Malign mezotelyoma, kemoterapi, kemoterapi yan etkisi

Abstract:
The files belongs to 49 adult cases who they were followed with malignant pleural and peritoneal mesothelioma diagnosis at Fırat University Medical Oncology Clinic between 2003 and 2010 were assessed retrospectively. Theirs demographic and clinic characteristics, toxicity duo to antineoplastic drug, respons to therapy and prognostic factors were investigated. Twenty eighth cases were male mean age was 60, 21 cases were female and mean age was 56, (male /female rate was 1.33/1), all of cases mean age was 58±12. Angina pectoris and dyspnea were the most frequent symptoms of cases. Thirty cases (61.2%) had story of exposure to asbestos, two cases (4.1%) had not story of exposure to asbestos, 19 cases were not interrogated about asbestos exposure. 19 (38.8%) cases were housekeeper, 13 (26.5%) cases were worker, 5 (10.2%) cases were farmer, 12 (24.5%) cases were other profession. According to pathologic results 30 (61.2%) cases were epitheloid type, in 19 (39.8) cases subgroup were not identified. In 19 (18.4) cases surgery treatment were applied by reason of early stage. Six of 9 surgery treatment applied cases were given antineoplastic drug treatment. Forty one of 49 cases were applied first step treatment. Cisplatine /carboplatine+ gemcytabine was given to 13 cases (26.5%), cysplatine /carboplatine + pemetrexet was given to 21 (42.9%) cases, only pemetreksed and only gemcytabine was given to 4 (8.2%) and 1 (2%) cases as first step treatment respectively. In 18 (36.7%) cases progression, in 6 (12.2 %) cases partial response, in 11 (22.4%) cases stabil disease, in 2 (4.1%) cases complet response were seen. Second step chemotherapy was administered to 8 (16.3%) cases who establish progression and their performans status were good. It was ascertained that 3 (6.1%) cases took only gemcytabine, 4 (8.2%) cases took only pemetrexet, 1 (2%) case took gemcytabine+ cysplatine as second step treatment. The most frequent seen adverse effects duo to chemotherapy were nausea, womitting, and haemototoxicity. Grade 1-2 nausea and womitting developed in 30 cases. Grade 3-4 nausea and womitting developed in 12 cases. When evaluated other adverse effects duo to chemothrapy, in 4 cases trombocytopenia, and in 2 cases neutropenia developed. Radiotherapy was applied to 14 (28.6%) cases as palliation purpose. While mean life span was 20 months in treatment cases, it was 13 months in non-treatment cases.(p=0.05)Key words: Malignant mesothelioma, chemotherapy, chemotherapy adverse effect