METASTATİK MİDE KANSERLİ YAŞLI HASTALARDA KEMOTERAPİNİN ETKİNLİĞİ VE TOLERABİLİTESİ

EFFICACY AND TOLERABILITY OF CHEMOTHERAPY IN ELDERLY PATIENTS WITH METASTATIC GASTRIC CANCER

Mehmet Naci ALDEMİR, Nilgün YILDIRIM, Mehmet BİLİCİ, Kerim ÇAYIR, Melih ŞİMSEK, Salim BAŞOL TEKİN, Harun YETİMOĞLU, Mehmet TÜRKELİ

Abstract

Introduction: Elderly patients are under-represented in the clinical trials of patients with metastatic gastric cancer (GC); therefore, the efficacy and tolerability of palliative chemotherapy areunclear in these patients. We aimed to assess the efficacy and tolerability of first-line palliativechemotherapy in elderly patients (age >=70 years) with metastatic GC.Materials and Method: From 2005 to 2014, 89 patients with metastatic GC who were 70years and older and were treated with at least two cycles of systemic chemotherapy as first-linetreatment were included retrospectively. Disease and patient characteristics, prognostic factors,treatment response, grade 3-4 toxicity related to treatment, progression free survival (PFS), andoverall survival (OS) were evaluated.Results: Of the 89 patients, 65 (73%) were males; median age was 74 (70-84) years. Themedian follow-up period was 7 months (min-max: 2-57 months), median PFS was 5 months(95% CI: 3.7-6.3), and median OS was 7 months (95 % CI: 5.2-8.9). The disease was controlled in 43.8% patients, whereas progression was observed in 56.2% patients. Univariate analysisshowed that the Eastern Cooperative Oncology Group (ECOG) performance status, number ofchemotherapy cycles, and response to the first line chemotherapy had a significant effect on PFSand OS; liver metastasis had an effect only on PFS; lung metastasis had an effect only on OS. Conclusion: Fewer chemotherapy cycles, lung metastasis, liver metastasis, and poor ECOGperformance scores were found to be poor prognostic factors.

Özet

Giriş: Yaşlı hastalar klinik çalışmalara alınmadığından metastatik mide kanseri (MK) olan hastalarda kemoterapinin etkinliği ve tolerabilitesi konusunda bilgiler yetersizdir. Bu çalışmada 70 yaşve üstü metastatik MK hastalarında ilk seride verilen palyatif kemoterapinin etkinliğini ve tolerabilitesini araştırmayı amaçladık.Gereç ve Yöntem: 2005-2014 yılları arasında, >=70 yaş, ilk seride en az iki kür kemoterapialan 89 hasta retrospektif incelendi. Hasta özellikleri, prognostik faktörler, tedavi cevabı, grad 34 toksisite, progresyonsuz-sağkalım (PSK) ve genel-sağkalım (GS) değerlendirildi.Bulgular: 89 hastanın 65 (%73)'i erkekti ve medyan yaş 74 'dü. Medyan takip süresi 7 ay (min-max:2-57ay), PSK 5 ay (%95GA:3,7-6,3) ve GS 7 ay (%95GA:5,2-8,9)'dı. Hastalıkkontrolü %43,8'inde sağlanmasına rağmen %52,2'sinde progresyon görüldü. Tek değişkenli analizde Eastern Cooperative Oncology Group (ECOG) performans skoru, kemoterapi siklusu ve alınan cevap etkindi. Karaciğer metastazı PSK'da, akciğer metastazı ise GS'da etkindi. Sonuç: Düşük kemoterapi siklusu, akciğer veya karaciğer metastazı ve kötü performans skoru olumsuz prognostik faktörlerdi.