Mesna-doxorubisin-ifosfamid-dakarbazin (MAID) ile tedavi edilen Yumuşak doku sarkom hastalarımızın uzun dönem takip sonuçları: Tek merkez deneyimi

Year 2019, Volume: 7 Issue: 3, 271 - 278, 18.12.2019

Cem Mirili , Semra Paydas , Mahmut Buyuksimsek , Mert Tohumcuoglu Abdullah Evren Yetisir Ali Ogul

Abstract

Amaç

Yumuşak
doku sarkomları (STS) erişkin kanserlerin %1 ini oluşturan agresif
kanserlerdendir. Temel tedavisi cerrahi rezeksiyon olmakla beraber kemoterapi
ve radyoterapide uygun hastalarda kullanılmaktadır. Doxorubisin temelli
tedaviler en sık kullanılan kemoterapi rejimleridir ancak bu rejimlerle ilgili
gerçek hayat verisi ülkemizde çok azdır. Bizde bu sebeple
mesna-doxorubisin-ifosfamid-dakarbazin içeren MAID rejimi başlangıç tedavisi
olarak alan STS olgularımızın yaşam sürelerini tespit etmek ve prognostik
olabilecek klinik ve demografik özellikleri ortaya çıkarmak istedik.

Materyal
ve Metod

Çukurova Üniversitesi Tıp Fakültesi Tıbbi
Onkoloji Anabilim Dalı'nda 2007-2016 yılları arasında Yumuşak doku sarkomu
tanısı alan ve başlangıç tedavisi olarak MAID rejimi uygulanan 45 hasta
retrospektif olarak çalışmaya dahil edildi. Genel sağkalım (OS) ve
progresyonsuz sağkalım (PFS) ile klinikopatolojik parametreler arasındaki
ilişkiler Kaplan-Meier eğrileri kullanılarak analiz edildi ve log-rank testi
ile karşılaştırıldı. Tek değişkenli ve çok değişkenli analiz PFS ve OS için
prognostik faktörleri tespit etmek amacıyla kullanılmıştır.

Bulgular

Hastalarımızın
median yaşı 49 olup en sık görülen alttip undiferansiye pleomorfik karsinom
(%37,8) ardından liposarkom (%17,8), leiomyosarkom (%13,3) gelmektedir ve
olguların %62,2 si extremite lokalizasyonunda saptanmıştır. Evrelerine göre
%15,6 evre 1-2, %53,3 ü evre 3 ve %31,1 i evre 4 olarak ayrılmışlardı.
Hastaların median PFS ve OS 17 ay ve 39 ay olup 5 yıllık PFS ve OS oranları %14
ve %32,5 dur. Yaş, cinisyet ve grade in prognostik önemi saptanmamış olup
univariate analizlere göre mitoz, nekroz, AJCC TNM evresi ve cerrahi hem PFS
hem de OS için prognostiktir. Bununla beraber multivariate analizlere göre
sadece AJCC TNM evresi hem PFS hem de OS için bağımsız prognostik faktördür.

Sonuç

Başlangıç tedavisi
olarak MAID kemoterapisi alan olgularda PFS ve OS için tek bağımsız prognostik
faktör AJCC TNM evredir.

Keywords

Yumuşak doku sarkomu, prognostik faktörler, , doxorubisin

Long-term Outcome of Soft Tissue Sarcomas Treated with Mesna-Doxorubicin-Ifosfamid-Dacarbazine regimen (MAID): A Retrospective Study from a Single Institution

Abstract

Objective

Soft
tissue sarcomas (STSs) account 1% of adult cancers. Essential treatment is
surgery but chemotherapy and/or radiotherapy are frequently used due to
aggressive behaviour or incomplete surgery. Doxorubicin-based regimens are the
most frequently used chemotherapy combinations but real life data with these
agents are relatively limited in our country. 
Here we wanted to present clinico-demographic and prognostic features of
STS sarcoma cases treated by MAID regimen containing
mesna-doxorubicin-ifosfamide-dacarbazin.

Material
and Method

Forty five cases with STS treated
with MAID regimen as initial therapy
and followed between
2007-2016 in Cukurova University Medical Faculty Department of Medical Oncology
were analyzed retrospectively. Associations between clinical and
histopathological parameters with overall survival (OS) and progression free
survival (PFS) were analyzed using Kaplan- Meier curves and compared by the
log-rank test. Univariate and multivariate analyses were used to assess their
prognostic values for PFS and OS.

Results

The
median age of our patients was 49 and the most common subtypes were
undifferentiated pleomorphic carcinoma (37.8%) followed by liposarcoma (17.8%),
leiomyosarcoma (13.3%) and 62.2% of the cases were found in the extremity
localization. According to their AJCC TNM stages, 15.6% were stage 1-2, 53.3%
were stage 3 and 31.1% were stage 4. The median PFS and OS were 17 months and
39 months, and the 5-year PFS and OS rates were 14% and 32.5%. Prognostic
significance of age, sex, and grade was not determined, but univariate analyzes
indicated that mitosis, necrosis, AJCC TNM stage and surgery were prognostic
for both PFS and OS. However, according to multivariate analyzes, only the AJCC
TNM stage is an independent prognostic factor for both PFS and OS.

Conclusion

AJCC TNM is the only
independent prognostic factor for both PFS and OS in patients with STS
receiving MAID chemotherapy as initial therapy

Keywords

Soft tissue sarcoma, prognosis, , doxorubicine

References

• 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30
• 2. Ducimetière F, Lurkin A, Ranchère-Vince D, Decouvelaere AV, Péoc'h M, Istier L, et al. Incidence of sarcoma histotypes and molecular subtypes in a prospective epidemiological study with central pathology review and molecular testing. PloS one. 2011;6(8):e20294.
• 3. Borden EC, Baker LH, Bell RS, Bramwell V, Demetri GD, Eisenberg BL, et al. Soft tissue sarcomas of adults: state of the translational science. Clin Cancer Res. 2003;9(6): 1941-1956.
• 4. Colombo C, Randall RL, Andtbacka RHI, Gronchi A. Surgery in soft tissue sarcoma: more conservative in extremities, more extended in the retroperitoneum. Expert Rev Anticancer Ther. 2012;12(8):1079–1087.
• 5. Crago AM, Brennan MF. Principles in management of soft tissue sarcoma. Adv Surg. 2015;49:107–122
• 6. Koliou P, Karavasilis V, Theochari M, Pollack SM, Jones RL, Thway K. Advances in the treatment of soft tissue sarcoma: Focus on eribulin. Cancer Manag Res. 2018;10:207-216
• 7. Jain A, Sajeevan KV, Babu KG, Lakshmaiah KC. Chemotherapy in adult soft tissue sarcoma. Indian J Cancer. 2009;46(4):274-87
• 8. Ratan R, Patel SR. Chemotherapy for soft tissue sarcoma. Cancer. 2016;122(19), 2952-2960.
• 9. Schöffski P, Cornillie J, Wozniak A, Li H, Hompes D. Soft tissue sarcoma: an update on systemic treatment options for patients with advanced disease. Oncol Res Treat. 2014;37(6): 355-362.
• 10. Gortzak E, Azzarelli A, Buesa J, Bramwell VHC, Van Coevorden F, Van Geel AN, et al. A randomised phase II study on neo-adjuvant chemotherapy for ‘high-risk’adult soft-tissue sarcoma. Eur J Cancer, 2001:37(9):1096-1103.
• 11. DeLaney TF, Spiro IJ, Suit HD, Gebhardt MC, Hornicek FJ, Mankin HJ, et al. Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue sarcomas. Int J Radiat Oncol Biol Phys. 2003;56(4):1117-1127.
• 12. Sarcoma Meta-analysis Collaboration. (1997). Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Lancet. 1997;350(9092): 1647-1654.
• 13. Han K, Sun Y, Zhang J, Tang L, Wang Z, Zhao H, et al. Retrospective clinical analysis of MAID protocol as first-line treatment on 137 metastatic soft-tissue sarcomas patients. The Chinese-German Journal of Clinical Oncology. 2012;11(2):117-120.
• 14. Antman K, Crowley J, Balcerzak SP, Rivkin SE, Weiss GR, Elias A, et al. An intergroup phase III randomized study of doxorubicin and dacarbazine with or without ifosfamide and mesna in advanced soft tissue and bone sarcomas. J Clin Oncol 1993;11:1276-1285
• 15. Marshall S, Nakano K, Sugiura Y, Taira S, Ono M, Tomomatsu J, et al. Outcome for Advanced or Metastatic Soft Tissue Sarcoma of Nonextremities Treated with Doxorubicin-Based Chemotherapy: A Retrospective Study from a Single Cancer Institution. Sarcoma. 2018;8926598
• 16. Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, et al. SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.
• 17. Hoang NT, Acevedo LA, Mann MJ, Tolani B. A review of soft-tissue sarcomas: translation of biological advances into treatment measures. Cancer Manag Res. 2018;10:1089-1114.
• 18. El-Jabbour JN, Akhtar SS, Kerr GR, McLaren KM, Smyth JF, Rodger A, et al. Prognostic factors for survival in soft tissue sarcoma. Br J Cancer. 1990;62(5):857-861.
• 19. Vraa S, Keller J, Nielsen OS, Sneppen O, Jurik AG, Jensen OM. Prognostic factors in soft tissue sarcomas: the Aarhus experience Eur J Cancer. 1998;34(12): 1876-1882