Klinički ishod i neželjena dejstva primene istovremene hemioradioterapije u lečenju lokalno uznapredovalog inoperabilnog nemikrocelularnog karcinoma pluća: naša iskustva
Sažetak
Uvod/Cilj. Godišnje se u svetu dijagnostikuje oko 1,8 miliona novoobolelih, a umre oko 1,6 miliona obolelih od karcinoma pluća. Uprkos poboljšanjima u lečenju tokom prethodnih decenija, preživljavanje bolesnika sa karcinomom pluća je i dalje loše. Petogodišnja stopa preživljavanja je oko 50% za bolesnike sa lokalizovanom bolešću, 20% za bolesnike sa regionalno uznapredovalom bolešću, 2% za bolesnike sa metastatskom bolešću, a za sve stadijume oko 14%. Srednje preživljavanje bolesnika sa nelečenim nesitnoćelijskim karcinomom pluća (NSCLC) u odmaklom stadijumu bolesti je četiri do pet meseci, a na godišnjem nivou stopa preživljavanje iznosi svega 10%. Cilj rada bio je da se utvrdi efikasnost i toksičnost istovremene hemioradioterapije (CHRT) kod odabranih bolesnika sa uznapredovalim inoperabilnim NSCLC. Metode. Studija je obuhvatila analizu podataka 31 bolesnika oba pola, koje je
uputio Konzilijum za maligne bolesti pluća na Odeljenje radioterapije Vojnomedicinske akademije u Beogradu, kod kojih je dijagnostikovan i patohistološki verifikovan NSCLC u III inoperabilnom stadijumu radi sprovođenja konkomitantne CHRT. Po isteku tri meseca od sprovedene terapije zračenjem (RT) vršena je procena odgovora tumora na RT primenom multislajsne kompjuterizovane tomografije (MSCT) grudnog koša i gornjeg abdomena po kriterijumu Response Evaluation Criteria in Solid Tumors (RECIST) verzija 1.1. Po istom kriterijumu vršena je i procena preživljavanja do progresije bolesti (PFS) i ukupno preživljavanje bolesnika (OS) svaka tri meseca tokom prve dve godine, zatim na 6 meseci ili do pojave simptoma bolesti. Rezultati. Medijana PFS iznosila je 13 meseci, a medijana OS 20 meseci. Tokom i neposredno nakon RT, neželjeni događaj gradusa 2 ili većeg imalo je 9 (29%) bolesnika. Zaključak. Primena istovremene CHRT kod bolesnika koji su u trećem stadijumu lokalno uznapredovalog inoperabilnog NSCLC daje dobru mogućnost za povoljan terapijski ishod, uz prihvatljiv stepen akutne i kasne toksičnosti i predstavlja standardni terapijski pristup za odabrane bolesnike u tom stadijumu bolesti.
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