Prognostic factors in cervix cancer

Purpose: Our aim was to study, in Cervix cancer patients, retrorespectively, the prognostic factors in relation with the ratio between survival and local-recurrence. Material & Method: Some 108 pateients were chosen, from among 166 who were treated at Si§li Etfal Hospital between 1992- 2002 and had been followed-up at our clinic for 6 or more months.Median Age: 52 (22-88).Histological Diagnosis: 96 patients were squamous cell ca, 20 patients were adenocarcinoma and 2 patients were small cell Ca. Stages: 13 patients were stage IB, 14 were stage HA, 25 were IIB, 6 were IIIA, 31 were IIIB, 12 were IVA-IVB. All patients were received radiotherapy with Co60. Stage IB and HA patients were received radiotherapy as adjuvant after radical hysterectomy. Stage IIB-IV patients were received radiotherapy alone or concomitant with chemotherapy.External radiotherapy was given to 50 Gy (1.8-2 Gy/fr), parametria! boost 10 Gy was given to patients with parametriaI invasion (n=37).ICRT (Intracav.it.er. radiotherapy) 20-25 Gy was given after external radiotherapy. Results: General Survival Rate in relation with stages are: 47.3 months for stage IB, 31.5 months for stage 11 A. 26.5 months for stage IIB, 23.9 months for stage HI A, 22.3 months for stage IIIB, 19 months for stage IVA and 9 months for stage IVB. 39 patients had recurrence at their follow-ups. 41 % of the recurences happened with patients (+) lymph node. All of 9 patients with pataaortic lymph node métastasés at diagnosis had recurrence. 6 patients had bone, 4 patients had liver, 3 patients had lung and / patients had colon métastasés during follow-up. Discussion: Pelvic lymph node métastasés at diagnosis is the major prognostic factor (p=().()l). Patients with paraaortic lymph node métastasés prognosis is worse. Age and hystopcithologic type are less important in prognosis. Radiotherapy with concomitant chemotherapy have positive effect on prognosis with high risk patients (p=0.05).

Serviks kanserli hastalarda prognostik faktörler

Amaç: Çalýþmanýn aman serviks kanserli hastalarda, Cerrahi ve Radyoterapi sonrasý genel saðkalým ve pelvik kontrol oranlarýný etkileyen prognostik faktörlerin geriye dönük olarak incelenmesidir.
Gereç ve Yöntem: 1992-2002 tarihleri arasýnda Þiþli Etfal Eðitim ve Araþtýrma Hastanesi. Radyasyon Onkolojisi Kliniði Serviks kanseri tedavi protokolüne göre tedavi edilmiþ 166 hastadan 6 ay ve daha uzun takip edilen 108’i çalýþmaya alýnmýþtýr. Medyan yaþ 52(22-80)‘din Histopatolojik taný. 96 olguda skuamoz hücreli. 10 olguda adenoakrsinom. 2 olguda küçük hücreli karsinom þeklindedir. 13 olgu evre IB. 14 olgu, evre HA. 25 olgu evre 1IB. 6 olgu evre IIIA. 31 olgu evre IIIB, 12 olgu evre IVA-IVB, 7 olgu da baþvuru sýrasýnda niiks hastalýklýdýr. Evre IB-IIA hastalara cerrahi sonrasý adjuvant olarak. evre IIB-IVA hastalar ise inop olarak deðerlendirilerek Co 60 cihazý ile, 50 Gy (t.8-2 Gy/fr) eksternal radyoterapi yapýlmýþ, ÝCRT dozu (20 Gy) Bý akiterapi Ünitesi bulunan bir merkeze yönlendirilerek tamamlanmýþtýr. Parametrium tutulumu olan olgularda (n=37) tutulu tarafa boost okýrak 10 Gy uygulanmýþtýr. Seçilmiþ vakalarda (n-26) konkomitan kemo- terapi (haftalýk cisplatin 35 nýg/nû) uygulanmýþtýr.
Sonuç: Evrelere göre genel saðladým: evrelB’de 47.3 ay, evre HA, 31.5 ay. evrellB 26.5 ay. evrelllA 23.9 ay, evrellIB 22.3 ay, evre IVA / 9 ay, evrelVB 9 ay dýr (p-().00l). 39 olguda takip sýrasýnda pelvik niiks geliþmiþtir. Taný sýrasýnda pelvik lenf nodu tutulumu olan 33 olgunun, 15’inde (%45) takip sýrasýnda nüks geliþmiþtir. Nükslerin %4I‘I lenf ýýodu tutulumu (+) olan hastalarda geliþmiþtir. Taýýý sýrasýnda paraaortik lenf nodu tutulumu olan 9 hastanýn tamamýnda tedavi sonrasý takipte nüks gözlenmiþtir. 6 olguda kemik, 4 olguda karaciðer, 3 olguda akciðer ve 1 olguda kolonda metastaz saptanmýþtýr.
Tartýþma: Baþlangýçta lenf nodýý tutulum olmasý pelvik nüks riskini artýran önemli bir prognostic faktördür (p-O.OJ). Paraaortik lenf ýýodu tutulumu kötii prognoz ile iliþkilidir. Yaþ ve histopatolojik tipin prognoz üzerine etkileri anlamlý deðidir. Yüksek riskli hastalarda radyoterapiye cisplatin bazlý kemoterapi eklenmesi, tek baþýna radyoterapi ile kýyaslandýðýnda prognozu olumlu etkilemektedir (p-0.05).