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Öğe The comparison of weekly and three-weekly cisplatin chemotherapy concurrent with radiotherapy in patients with previously untreated inoperable non-metastatic squamous cell carcinoma of the head and neck(Springer, 2009) Uygun, Kazim; Bilici, Ahmet; Karagol, Hakan; Caloglu, Murat; Cicin, Irfan; Aksu, Gorkem; Fayda, MerdanSeveral studies have shown that the concurrent administration of chemotherapy (CHT) and radiotherapy (RT) is superior to RT alone in patients with inoperable non-metastatic squamous cell carcinoma of the head and neck (InSCCHN). We compared the efficacy and safety profile of RT and concurrent cisplatin CHT given in two different schedules to patients with previously untreated InSCCHN. Fifty patients with previously untreated InSCCHN admitted to our oncology department were included in the study. Thirty of 50 (60%) patients with a younger age or good performance status (PS) (ECOG 0-1) received cisplatin 100 mg/m(2) on a 21-day schedule (group A). Other 20 (40%) patients with older age or poor PS (ECOG 2) received cisplatin 40 mg/m(2) on a 7-day schedule (group B). Each of the 50 patients received concurrent conventional dose RT according to primer tumor location. The median follow-up is 12 months for group A and 12.5 months for group B. Twenty-eight (93.3%) patients in group A and 18 (90%) in group B were evaluable for response. The complete response rate was 50% in group A and 40% in group B (P > 0.05). The objective response rate was 92% in group A and 90% in group B (P > 0.05). All grade 3-4 toxic events were seen in 16 (53.3%) of group A patients and 8 (40%) of group B patients (P > 0.05). Comparison between two treatment modalities appears to result in statistically similar response rates and adverse event profile. A randomized phase III trial is required to confirm the safety and efficacy of weekly cisplatin therapy in patients with poor PS and/or older age at diagnosis.Öğe The efficiency of single agent docetaxel in patients with platinum-refractory non-small cell lung carcinoma(Humana Press Inc, 2008) Uygun, Kazim; Aksu, Gorkem; Cicin, Irfan; Karagol, Hakan; Kocak, Zafer; Fayda, Merdan; Binici, AhmetBackground To evaluate the efficiency of docetaxel as second line chemotherapy in patients with platinum-refractory non-small cell lung carcinoma (NSCLC). Patients and methods Fifty-two patients with locally advanced or metastatic NSCLC who had platinum-refractory disease (progressed through or within 3 months of completion of first line therapy) and an Eastern Cooperative Oncology Group performance (ECOG) status 0-2 were treated with second-line chemotherapy consisting of single agent docetaxel (100 mg/m2, intravenously, on day 1 of a 21-day cycle). The median number of treatment cycles was 4 (2-6). Disease-free (DFS) and overall survival (OS), response rates and toxicity were evaluated. Results The median progression-free survival of patients was 3 months (95% CI: 0.01-5.99) and overall survival was 7.2 months (95% CI: 2.2-9.5). One-year overall survival rate was 29%. Disease control (complete response, partial response, or stable disease) was achieved in 25 patients (48%) and overall response rate was 13% (7 patients). There were no complete responses. Seventeen patients (33%) had stable disease and twenty-seven patients (52%) had progressive disease. Age, gender, stage at diagnosis (IIIB vs. IV), performance status at initiation of second-line therapy (0-1 vs. 2) histopathological type (epidermoid vs. others), grade, LDH, albumin, weight loss were evaluated as prognostic factors; however, none of these had a significant affect on survivals. The protocol was well tolerated and there were no toxic deaths. Grade III-IV anemia was present in 8 patients (15%) and thrombopenia in 12 (23%) patients. The most frequent grade 3-4 toxicities were leucopenia (52%) and neutropenia (48%). Febril neutropenia occurred in 14 patients (26%). No patients experienced grade III-IV mucositis and diarrhea. Totally, the need of a dose reduction was about 25% and treatment delay (4-9 days) occurred in 5 patients (10%) and 7 patients (13%), respectively, because of toxicity. Conclusions Second-line chemotherapy with single-agent docetaxel offers a small but significant survival advantage with acceptable toxicity for patients with advanced NSCLC who have platinum-refractory disease.Öğe RADIOTHERAPY AS THE PRIMARY AND PALLIATIVE TREATMENT FOR PATIENTS AGED 75 AND OVER WITH LOCALLY ADVANCED AND METASTATIC NON-SMALL CELL LUNG CANCER: ANALYSIS OF 45 CASES WITH A REVIEW OF THE LITERATURE(Marmara Univ, Fac Medicine, 2008) Aksu, Gorkem; Fayda, Merdan; Saynak, Mert; Saglamer, Esra Kaytan; Oral, Ethem Nezih; Kizir, Ahmet; Karadeniz, AhmetAim: To evaluate the prognostic factors and treatment results of Turkish patients aged 75 and over with locally advanced and metastatic non-small cell lung cancer (NSCLC). Patients and Methods: Forty-five patients >= 75 years were evaluated. The median age was 78 (75-93). Thirty-four patients (75%) had stage IIIB and 11 patients had stage IV disease (25%). Fourteen patients (41%) with stage IIIB disease were treated with curative radiotherapy (RT), 18 patients (52%) with palliative RT and 2 patients (5%) were treated with only chemotherapy (CT). Results: The one-year survival rate was 37%. The overall median survival was 12.7 months in stage IIIB and 7.67 months in stage IV. In univariate analysis, advanced stage (p=0.0006), performance status (p=0.056), absence of radiotherapy (p=0.0008) and weight loss (p=0.0053) adversely affected survival. In multivariate analysis only stage IV was found to be a statistically significant independent poor prognostic factor (p=0.0025 HR=0.2760 (0.12-0.60) 95% confidence interval). Conclusion: In Turkish patients, with NSCLC, aged 75 or over, stage IV disease was associated with poor prognosis. The higher radiotherapy doses did not improve survival in patients with stage IIIB disease and the prognosis with only radiotherapy is similar to the results of chemoradiation in the literature in this age group.Öğe Radiotherapy as the primary and palliatıve treatment for 75 years and older patients with locally advanced and metastatic non-small cell lung cancer: Analysis of 45 cases wıth a review of the literature(2008) Aksu, Görkem; Fayda, Merdan; Saynak, Mert; Sağlamer, Esra Kaytan; Oral, Ethem Nezih; Kizir, Ahmet; Karadeniz, AhmetAmaç: Lokal ileri veya metastatik KHDAK tanılı hastalarda prognostik faktörler ve tedavi sonuçlarının değerlendirilmesi Hastalar ve Metod: 75 yaş ve üzeri toplam 45 KHDAK tanılı hasta değerlendirildi. Medyan yaş 78 idi (75-93). Otuz dört hasta Evre IIIB (75%), 11 hasta (25%) ise Evre IV olarak evrelendirildi. Evre IIIB tanılı hastaların 14 tanesine (41%) küratif Radyoterapi (RT), 18 hastaya (52%) palyatif RT uygulanırken, 2 hasta (5%) sadece kemoterapi (KT) aldı.Bulgular: Bir yıllık genel sağkalım oranı %37 olarak tespit edildi. Medyan sağkalım; Evre IIIB hastalarda 12.7 ay olarak bulunurken, Evre IV hastalarda 7.67 ay olarak gözlendi. Tek değişkenli analizde, ileri evre (p= 0.0006), performans durumu (p=0.056), RT uygulanmaması (p=0.0008) ve kilo kaybı (p=0.0053) sağkalımı olumsuz olarak etkileyen faktörler olarak tespit edildi. Çoklu değişkenli analizde ise; sadece Evre IV hastalık, anlamlı kötü prognostik faktör olarak bulundu (p=0.0025 HR=0.2760 (0.12-0.60) 95% güvenlik aralığı).Sonuç: ? 75 yaş KHDAK tanılı Türk hastalarda, evre IV hastalığın kötü prognozla ilişkili olduğu saptandı. Evre IIIB hastalıkta ise, küratif RT dozlarının sağkalımı iyileştiremediği ancak, tek başına RT ile elde edilen sağkalımın, bu yaş hasta grubunda literatürde kemoradyoterapi ile elde edilen sonuçlara benzer olduğu tespit edildi.
