Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi
Yıl: 2020 Cilt: 43 Sayı: 2 Sayfa Aralığı: 117 - 122 Metin Dili: Türkçe DOI: 10.34087/cbusbed.594329 İndeks Tarihi: 23-12-2020
Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi
Öz: Giriş ve Amaç: Evre IB-IIA Serviks kanseri tanılı hastaların yarıdan fazlası primer cerrahi sonrası adjuvanradyoterapiye ihtiyaç duymaktadır. Özellikle büyük tümör boyutu varlığında tedavide definitif radyoterapi önerilir.Evre III hastalarda ise definitif kemoradyoterapi standart yaklaşım olarak önerilmekte iken klinik uygulamada primermodalite olarak cerrahi halen kullanılmaktadır. Bu çalışmada kliniğimizde FIGO 2018’e göre Evre IB-III servikskanseri tanısı ile definitif veya adjuvan radyoterapi uygulanmış hastaların tedavi sonuçlarının karşılaştırmalıdeğerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: 2011-2019 yıllarında kliniğimizde serviks kanseri tanısı ile definitif radyoterapi (DRT)uygulanan 28 hasta ve adjuvan radyoterapi (ART) uygulanan 20 hasta çalışmaya dahil edildi. DRT ve ART hastagruplarının özellikleri Ki-Kare testi ile, genel sağkalım (GS) ve progresyonsuz sağkalım (PSK) değerlendirmeleriKaplan-Meier analizi ve log-rank testi ile, çok değişkenli analizler ise Cox regresyon analizi ile yapıldı.Bulgular: Medyan 39,6 ay (0,5-90,5) takip süresi sonunda 33 hasta hayattaydı. DRT ve ART gruplarında GS sırasıyla39,65 ay ve 42,46 ay; PSK sırasıyla 26,10 ay ve 22,93 ay ve 3 yıllık sağkalım oranları sırasıyla %79,6 ve %72,2 idi.İki grup arasında GS ve PSK açısından istatistiksel olarak anlamlı fark tespit edilmedi (p=0.936, p=0,756). Çokdeğişkenli analiz sonuçlarında ECOG durumunun GS üzerinde, tümör boyutunun ise PSK üzerinde istatistikselanlamlı etkisi bulundu (sırasıyla p=0,009, p=0,044). Tedavi modalitesinin ise PSK (p=0,724) veya GS (p=0,908)üzerinde istatistiksel olarak anlamlı bir etkisi gösterilmedi.Sonuç: Hastaların GS, PSK ve 3 yıllık sağkalım sonuçları literatür ile uyumludur. Evre IB-III serviks kanserindedefinitif radyoterapi ve postoperatif adjuvan radyoterapi benzer sağkalım sonuçlarına sahiptir. Adjuvan radyoterapiyeihtiyaç duyacak hastalarda definitif radyoterapi tercih edilmesi düşünülmelidir.
Anahtar Kelime: Derin Beyin Stimulatörü Uygulanan Hastalarda Skalp Bloğu ve İnfiltrasyon Anestezisinde Methemoglobinemi Riski
Öz: Skalp bloğu gibi kanlanması yüksek olan bölgelerde lokal anesteziklerin uygulanması, emilim hızının ve intravasküler enjeksiyon riskinin yüksekliği nedeniyle methemoglobinemi gibi lokal anesteziklerin sistemik etkilerine karşı daha hassastır. Çalışmamızda, özellikle Parkinson olmak üzere nörolojik hastalıklara bağlı derin beyin stimülatörü (DBS) yerleştirilen hastalarda skalp bloğu sonrası methemoglobin değerlerini retrospektif inceleyerek methemoglobinemi riskini değerlendirmeyi amaçladık.Çalışmaya DBS için Ocak 2017 ve Aralık 2018 tarihleri arasında başvuran, 18 yaş üstü ve rejyonel anestezi uygulanan 41 hasta dahil edildi. Hastalara skalp bloğu (n: 10) ve infiltrasyon anestezisi (n: 31) uygulandı. Hastaların yaş, Amerikan Anesteziyologlar Derneği fiziksel sınıflaması (ASA), cinsiyet, DBS endikasyonu, skalp bloğu / infiltrasyon anestezisi, arteriyel kan gazında pH, pO2, Spo2, en yüksek methemoglobin düzeyleri ve klinik semptomlar istatistiksel olarak analiz edildi.DBS endikasyonları 29 hastada Parkinson hastalığı, diğerleri hiper-reaktivite, distoni ve titremeydi. Ayrıca 33 hasta ASA Sınıf II olarak sınıflandırıldı. Skalp bloğu yapılan 2 hastada ve infiltrasyon anestezisi uygulanan 6 hastada MeHb düzeyi% 2’nin üzerindeydi. Ancak skalp bloğu ve infiltrasyon anestezisi arasında methemoglobin düzeylerinde istatiksel olarak anlamlı bir fark gözlenmedi.Skalp gibi kanlanmanın yüksek olduğu bölgelerde klinik bulgu olmadan, lokal anestezi uygulamalarında methemoglobinemia gelişme riski nedeniyle dikkatli olunmalıdır
Anahtar Kelime: Risk of Methemoglobinemia in Scalp Block and İnfiltration Anesthesia in Patients Undergoing Deep Brain Stimulation
Öz: The application of local anesthetics in areas with a high blood supply, such as scalp block, is more susceptible to systemiceffects of local anesthetics such as methemoglobinemia because of the high absorption rate and the risk of intravascular injection.In this study, we aimed to evaluate the risk of methemoglobinemia by reviewing methemoglobin values after scalp block in patientswith a deep brain stimulation (DBS) due to neurological diseases, especially Parkinson’s.The study included 41 patients aged >18years who were admitted between January 2017 and December 2018 for DBS and underwent regional anesthesia (n = 41). Patientswere administered scalp block (n = 10) and infiltration anesthesia (n = 31). Using data from the patients’ medical records, westatistically analyzed the patients’ age, American Society of Anesthesiologists (ASA) status, gender, DBS indication, scalpblock/infiltration anesthesia, highest methemoglobin level in arterial blood gas, pH, pO2, SpO2, and clinical symptoms.Theindications for DBS were Parkinson’s disease in 29 patients hyperreactivity, dystonia and tremor in the remaining patients.Furthermore, 33 patients were classified as ASA class II. The methemoglobinemia level was >2% in two patients who underwentscalp block and six patients who underwent infiltration anesthesia. However, there was no statistically significant difference inmethemoglobin levels between scalp and infiltration anesthesia.In areas with high blood flow, such as the scalp, caution should beexercised in administering local anesthesia because of the patient’s risk of developing methemoglobinemia, although there are noclinical findings on this topic.
Anahtar Kelime: Comparative Evaluation of Definitive and Adjuvant Radiotherapy Results in Stage IB-III Cervical Cancer
Öz: Objective: More than half of stage IB-IIA cervical carcinoma patients need adjuvant radiotherapy. Especially in cases with large tumors definitive radiotherapy is preferred. In stage III although definitive chemoradiotherapy is accepted as standard of care, surgery has still a non–negligible utilization in clinical practice. In this study we aimed to evaluate and compare the survival outcome of stage IB-III by FIGO 2018 cervical carcinoma patients after definitive or adjuvant radiotherapy. Materials and Methods: 28 patients who underwent definitive radiotherapy (DRT) and 20 patients who underwent adjuvant radiotherapy (ART) in our clinic between 2011-2019 were enrolled in the study. DRT and ART groups were compared with Chi-square test in terms of clinicopathological features. Overall (OS) and progression free survival (PFS) were evaluated via Kaplan-Meier analysis and log-rank test. Multivariate analysis was performed by Cox regression.Results: After a follow up period of median 39,6 (0,5-90,5) months, 33 patients were alive. In the DRT group OS, PFS and 3 years OS were 39,65 months, 26,10 months and 79,6% respectively where in the ART group they were calculated as 42,46 months, 22,93 months and 72,2% respectively. The difference between 2 groups in terms of OS and PFS was not statistically significant (p=0,936 and p=0,756). Multivariate analysis revealed a statistical significance for ECOG on OS and tumor size on PFS (p=0,009, p=0,044). However, the influence of treatment modality was not statistically significant on PFS (p=0,724) or OS (p=0,908). Conclusion: OS, PFS and 3 years OS results of our sample were compatible with previous literature. For stage IB-III cervical cancer, definitive radiotherapy and postoperative adjuvant radiotherapy have similar survival results. Definitive radiotherapy should be considered in patients who would need adjuvant radiotherapy.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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| APA | Kaymak Z, Onay M, Ozkan E, HARBELİOĞLU M, Vural M, Ekemen S (2020). Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi. , 117 - 122. 10.34087/cbusbed.594329 |
| Chicago | Kaymak Zumrut Arda,Onay Meryem,Ozkan E. Elif,HARBELİOĞLU MEHMET ALİ,Vural Murat,Ekemen Serdar Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi. (2020): 117 - 122. 10.34087/cbusbed.594329 |
| MLA | Kaymak Zumrut Arda,Onay Meryem,Ozkan E. Elif,HARBELİOĞLU MEHMET ALİ,Vural Murat,Ekemen Serdar Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi. , 2020, ss.117 - 122. 10.34087/cbusbed.594329 |
| AMA | Kaymak Z,Onay M,Ozkan E,HARBELİOĞLU M,Vural M,Ekemen S Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi. . 2020; 117 - 122. 10.34087/cbusbed.594329 |
| Vancouver | Kaymak Z,Onay M,Ozkan E,HARBELİOĞLU M,Vural M,Ekemen S Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi. . 2020; 117 - 122. 10.34087/cbusbed.594329 |
| IEEE | Kaymak Z,Onay M,Ozkan E,HARBELİOĞLU M,Vural M,Ekemen S "Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi." , ss.117 - 122, 2020. 10.34087/cbusbed.594329 |
| ISNAD | Kaymak, Zumrut Arda vd. "Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi". (2020), 117-122. https://doi.org/10.34087/cbusbed.594329 |
| APA | Kaymak Z, Onay M, Ozkan E, HARBELİOĞLU M, Vural M, Ekemen S (2020). Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 43(2), 117 - 122. 10.34087/cbusbed.594329 |
| Chicago | Kaymak Zumrut Arda,Onay Meryem,Ozkan E. Elif,HARBELİOĞLU MEHMET ALİ,Vural Murat,Ekemen Serdar Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 43, no.2 (2020): 117 - 122. 10.34087/cbusbed.594329 |
| MLA | Kaymak Zumrut Arda,Onay Meryem,Ozkan E. Elif,HARBELİOĞLU MEHMET ALİ,Vural Murat,Ekemen Serdar Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, vol.43, no.2, 2020, ss.117 - 122. 10.34087/cbusbed.594329 |
| AMA | Kaymak Z,Onay M,Ozkan E,HARBELİOĞLU M,Vural M,Ekemen S Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2020; 43(2): 117 - 122. 10.34087/cbusbed.594329 |
| Vancouver | Kaymak Z,Onay M,Ozkan E,HARBELİOĞLU M,Vural M,Ekemen S Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2020; 43(2): 117 - 122. 10.34087/cbusbed.594329 |
| IEEE | Kaymak Z,Onay M,Ozkan E,HARBELİOĞLU M,Vural M,Ekemen S "Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi." Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 43, ss.117 - 122, 2020. 10.34087/cbusbed.594329 |
| ISNAD | Kaymak, Zumrut Arda vd. "Evre IB-III Serviks Kanserinde Definitif ve Adjuvan Radyoterapi Sonuçlarının Karşılaştırmalı Değerlendirilmesi". Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 43/2 (2020), 117-122. https://doi.org/10.34087/cbusbed.594329 |
