Metastatik Küçük Hücreli Dışı Akciğer Kanseri
Özet
Küçük hücreli dışı akciğer kanseri (KHDAK) kansere bağlı ölümün en önemli sebeplerinden birisi olup etiyolojide sigara dışında; arsenik, asbest, berilyum, kadmiyum, krom, kömür dumanı, dizel dumanı, nikel, silika, is ve uranyum gibi etkenlerde yer almaktadır (10-12). KHDAK’ ler nonskuamöz (çoğu adenokarsinom olmakla beraber, büyük hücreli karsinom ve diğer tipler) ve skuamöz (epidermoid) olmak üzere iki ana gruba ayrılmaktadır (16). Bazı prognostik faktörler KHDAK’de sağ kalımı belirler. İyi prognostik faktörler arasında; tanı anında erken evre olması, iyi performans durumu (ECOG 0-1), kadın cinsiyet ve kilo kaybının %5’den az olması yer almaktadır (17). FDA tarafından karşılanan hedefe yönelik tedavilerin verilebilmesi için; metastatik adenokarsinom, büyük hücreli karsinom ve NOS olarak bilinen alt tip adlandırılamayan hastalara moleküler testlerin yapılması önerilmektedir. Metastatik skuamöz hücreli karsinomlu hastalarda da bu testler düşünülebilir (18-19). Adenokarsinom alt tipi için yapılan 5 yıllık survi analizinde; lokal hastalıkta %70.1, bölgesel lenf nodu tutulumu olanlarda %44.7, uzak oran metastazı olanlarda ise %9.6 olarak saptanmıştır (22). Tedavi seçenekleri arasında; cerrahi, radyoterapi ve sistemik tedavi yer almaktadır. Evre I ve II de cerrahi, evre IIIA da neoadjuvan (ameliyat öncesi) tedavi sonrası operasyon için tekrar değerlendirilmesi, evre IIIB-C de kemoradyoterapi ve evre IV hastalıkta ise sistemik tedavi uygulanması önerilmektedir (25). Metastatik KHDAK de platin bazlı kombinasyon tedavisinin, hedefe yönelik tedavi veya immünoterapiye uygun olmayan ileri evre ve küratif tedavisi mümkün olmayan hastalar için en iyi destek tedaviden daha üstün olduğunu göstermektedir (27). Klavuzlar ileri evre ve metastatik hastalık için birinci basamak sistemik tedavi alan hastaların BT taraması ile tümör yanıtı açısından değerlendirilmesini önermektedir. Yanıt değerlendirmesi için ilk tedavinin 2.siklusu sonrası ve daha sonra bilinen veya yüksek riskli hastalık bölgelerinin BT'si (kontrastlı veya kontrastsız) çekilerek yada klinik olarak şüphelenildiğinde her 2 ila 4 siklusta bir görüntüleme yapılmalıdır (29).
Non-small cell lung cancer (NSCLC) is one of the most important causes of cancer-related deaths and in addition to smoking, factors such as arsenic, asbestos, beryllium, cadmium, chromium, coal smoke, diesel smoke, nickel, silica, soot and uranium are also involved in the etiology (10-12). NSCLCs are divided into two main groups as nonsquamous (mostly adenocarcinoma, but also large cell carcinoma and other types) and squamous (epidermoid) (16). Some prognostic factors determine survival in NSCLC. Good prognostic factors include early stage at diagnosis, good performance status (ECOG 0-1), female gender and weight loss of less than 5% (17). In order to provide targeted therapies approved by the FDA, molecular testing is recommended for patients with metastatic adenocarcinoma, large cell carcinoma and NOS, the subtype of which cannot be named. These tests may also be considered in patients with metastatic squamous cell carcinoma (18-19). In a 5-year survival analysis for the adenocarcinoma subtype, it was found to be 70.1% in local disease, 44.7% in those with regional lymph node involvement, and 9.6% in those with distant metastasis (22). Treatment options include surgery, radiotherapy, and systemic therapy. Surgery is recommended for stage I and II, neoadjuvant (preoperative) treatment followed by reevaluation for surgery in stage IIIA, chemoradiotherapy in stage IIIB-C, and systemic therapy in stage IV disease (25). In metastatic NSCLC, platinum-based combination therapy is shown to be superior to best supportive care for advanced-stage patients who are not eligible for targeted therapy or immunotherapy and who cannot be curatively treated (27). Guidelines recommend that patients receiving first-line systemic therapy for advanced-stage and metastatic disease should be evaluated for tumor response with CT scan. Imaging should be performed after the second cycle of initial treatment for response assessment and then every 2 to 4 cycles with CT (with or without contrast) of known or high-risk disease sites or when clinically suspected (29).
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