Click here to load reader

MİDE KANSERİ TEDAVİSİNDE RADYOTERAPİ UYGULAYALIM MI? _mide_rt.pdf · PDF filemİde kanserİ tedavİsİnde radyoterapİ uygulayalim mi? ... seer verİ tabani . ... mİde kanserİ

  • View
    234

  • Download
    0

Embed Size (px)

Text of MİDE KANSERİ TEDAVİSİNDE RADYOTERAPİ UYGULAYALIM MI? _mide_rt.pdf · PDF filemİde...

  • MDE KANSER TEDAVSNDE

    RADYOTERAP UYGULAYALIM MI?

    Dr. Meltem Nala Andrieu Ankara niversitesi Tp Fakltesi

    Radyasyon Onkolojisi AD

  • Mide kanserleri genellikle tan annda ileri evrede

    Lokal ileri mide kanserinde tek bana cerrahi tedavi ile lokal-

    blgesel nks (nksler en sk tm yata, blgesel lenfatikler ve

    anastomozda), sakalm

    Adjuvan KT ile ok sayda randomize alma ve metaanaliz

    sonucunda adj. KTnin lehine bir trend var, yarar az (N+ lerde)

    Adjuvan RT ile prognozda anlaml fark yok

    Adjuvan ezamanl KRT

  • INT0116/SWOG 9008

    1991-1998 aras, 556 hasta, faz III randomize

    IB-IV M0 mide ve gastrozefagial bileke tm (%20)

    Postop 1 kr KT, 2 kr RT ile ezamanl , 2 kr RT sonras KT

    425 mg / m2/gn 5 FU , lkovorin 20 mg/m2/ gn 5 gn

  • P=.003

  • ELETR Rezeksiyon %54 D0, %36 D1, %10 D2

    Chemoradiation of resected gastric cancer:

    A 10-year follow-up of the phase III trial INT0116 (SWOG 9008) ,2009

    survival (HR=1.32, p=.004) and disease free survival (HR=1.51, p

  • An observational study suggesting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection

    with D2 nodal dissection for adenocarcinoma of the stomach.

    Kim S, Lim DH, Lee J, Kang WK, MacDonald JS, Park CH, Park SH, Lee SH, Kim K, Park JO, Kim WS, Jung CW, Park YS, Im YH, Sohn TS, Noh JH, Heo JS, Kim YI,

    Park CK, Park K. IJROBP 2005

    544 hasta D2 rezeksiyon + KRT

    446 hasta D2 rezeksiyon

    The CRT was associated with increases in the median duration of relapse-free survival (75.6 months vs. 52.7 months; hazard ratio for relapse, 0.80, p = 0.0160). CONCLUSION: Our results highly suggest that the postoperative KRT in D2-resected gastric-cancer patients can prolong survival and decrease recurrence.

  • SEER VER TABANI

    1995-99 2000-04 P

    Adj. RT %6.5 %13.3 0.0001

    3-yl sakalm

    %32.2 %34.5 0.004

  • T3-T4 tm

    Lenf nodu (+)

    CS (+)

    Yksek riskli

    lokal ileri evre

    hastalarda

    Adj. KRT sakalm anlaml

    ADJ KRT STANDART TEDAVDR

  • EVET EVET EVET EVET EVET EVET

    MDE KANSER TEDAVSNDE

    RADYOTERAP UYGULAYALIM MI?

  • Hastalarn en etkili tedaviye ulama hakkn korumalyz

  • Postop mortalite %6.5 vs %13

    Postop morbidite %28 vs %46

  • Postop mortalite %4 vs %10 p=.004

    Postop morbidite %25 vs %43 p.001

    5-yl survi %45 vs %47

  • Cochrane Database Syst Rev. 2012 Jan 18;1:CD001964. WITHDRAWN: Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. McCulloch P, Nita ME, Kazi H, Gama-Rodrigues JJ.

    AUTHORS' CONCLUSIONS: D2 dissection carries increased mortality risks

    associated with spleen and pancreas resection, and probably with inexperience and low

    casevolumes. Randomised studies show no evidence of overall survival benefit, but

    possible benefit in T3+ tumours. These results may be confounded by surgical

    learning curves and poor surgeon compliance. Non-randomised comparisons suggest a

    possible survival benefit for D2 in intermediate UICC stages. Observational

    studies show high 5 year survival and low operative mortality after D2 dissection

    in experienced units, and poor results after D1 dissection in non-specialist

    units. Further studies, with precautions to eliminate learning curve effects,

    contamination and non-compliance, are needed to evaluate D2 dissection in

    intermediate stage gastric cancer.

  • Birok seride D2 ve D2+ rezeksiyon ile anlaml sakalm faydas

    bulunamam

    D2 rez + KRT ile tek bana D2ye gre sonularda anlaml iyileme var

    Mide kanserinin sk grld uzakdou lkelerinde geni rezeksiyon

    (rn. D2) rutin

    Batda (ABDde mide ca 10 kat ) D2 rez. sadece zellemi

    merkezlerde (ou hastada D1)

    Bat serilerinde D2 rez. morbidite ve mortalitesi

    Mide kanserinde geni rezeksiyon iin byk hasta serileri ile cerrahi

    deneyim ok nemli

    lkemizde bu konuda zellemi deneyimli cerrah says

    ? ? ?

  • BU KANITLAR DORULTUSUNDA

    GEN CERRAH REZEKSYON

    ADJUVAN KEMORADYOTERAPYE

    ALTERNATF OLAMAZ !!!

  • Neoadj KT, adj KRTden daha m baarl ??

    Adjuvan KRT ile neoadj KTyi karlatran randomize alma yok

    KTye ezamanl RT eklenmesi ile sonular daha m iyi ??

    EVET, Adj KRT sonular adj KT ye gre ok daha baarl

    Neoadj KT ile ezamanl KRT daha da m iyi olur ??

    NEDEN OLMASIN.....

  • NEOADJUVAN KT TEK BAINA

    NEOADJUVAN VEYA ADJUVAN

    EZAMANLI KEMORADYOTERAPYE

    ALTERNATF OLAMAZ !!!

  • Mide kanserli hastalar iin

    en kaliteli yaam

    lokal kontroln saland

    uzun sreli yaamdr

  • Adj KRT vermek geni rezeksiyona ve neoadj. KTye hakszlk

    deildir. Multidisipliner kombine tedavi en etkili yntemdir.

  • SONU

    LER EVRE MDE KANSERNN TEDAVSNDE

    RADYOTERAPNN

    KESNLKLE YER VARDIR

    EVET

    MDE KANSER TEDAVSNDE RADYOTERAP UYGULAYALIM MI?Slide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10ELETRRezeksiyon %54 D0, %36 D1, %10 D2Slide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22Slide Number 23EVETEVETEVETEVETEVETEVETSlide Number 25Slide Number 26Slide Number 27Slide Number 28Slide Number 29Slide Number 30Slide Number 31Slide Number 32Slide Number 33Slide Number 34Slide Number 35Slide Number 36Slide Number 37Slide Number 38Slide Number 39Slide Number 40Slide Number 41Slide Number 42Slide Number 43Slide Number 44Slide Number 45Slide Number 46Slide Number 47SONU

Search related