Respir Case Rep. 2013; 2(3): 130-134 | DOI: 10.5505/respircase.2013.74946

Tedavi kararý, tedavi sonucu ve seyri özellikli lokal ileri evre küçük hücre dýþý akciðer kanseri olgusu

Evrim Eylem Akpýnar, Derya Hoþgün, Meral Gülhan
Ufuk Üniversitesi, Göðüs Hastalýklarý Anabilim Dalý, Ankara, Türkiye

Küçük hücreli dýþý akciðer kanseri (KHDAK) tüm akciðer kanserli olgularýn % 85’inden fazlasýný oluþturur. Bu olgularýn yaklaþýk üçte biri lokal ileri evre olgulardýr. Bu evredeki olgular çok heterojen bir gruptur ve bu nedenle tedavi planlamasý daha zor ve özelliklidir. Bu olgularda genel tedavi yaklaþýmý kemoradyoterapi olmakla beraber, tedavi kararý olgu bazýnda dikkatle ele alýnmalýdýr. Pemetreksed, timidilat sentazýn ve diðer folat baðýmlý enzimlerin potent inhibitörü olan sitotoksik bir ajandýr. Nonskuamoz KHDAK’de, faz III çalýþmalarla, önce ikinci daha sonra birinci basamak ve son olarak da idame tedavide etkinliði gösterilmiþtir. Bu makalede, adenokarsinom hücre tipine sahip, klinik evresi IIIA3 olarak belirlenen, multipl komorbiditeleri olan, bu nedenle tedavi planlamasý baþlangýçta ve progresyonda güçlükler taþýyan, buna karþýn taný konduktan sonra 4 yýl geçmesine raðmen halen metabolik tam yanýtta olan bir KHDAK olgusu sunulmuþtur. Tedavisi standart olmayan lokal ileri evre olgularda tedavi yaklaþýmý gözden geçirilmiþ ve ikinci basamakda pemetreksed tedavisine uzun süreli metabolik tam yanýt vurgulanmýþtýr.

Anahtar Kelimeler: Küçük hücre dýþý akciðer kanseri, pemetrexed, saðkalým, tedavi

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A case of locally advanced non-small cell lung cancer with an unusual decision of treatment, the result of treatment and course

Evrim Eylem Akpýnar, Derya Hoþgün, Meral Gülhan
Ufuk University, Department Of Chest Diseases, Ankara, Turkey

Non-small cell lung cancer (NSCLC) constitutes 85% of lung cancer. One-third of these cases are locally advanced. The patients who in this stage are heterogeneous, and thus their plan of treatment is unique. Although standard treatment is combined chemoradiotherapy in these patients, the decision of treatment should be evaluated carefully for each patient. Pemetrexed is a cytotoxic agent, potent inhibitor of thymidylate synthetase and other folate-dependent enzymes. Phase III studies showed its effectiveness in the first and second line treatment of non-squamous NSCLC. In this report, a case of NSCLC with adenocarcinoma subtype who staged clinically as stage IIIA3 and had multiple co-morbidities was presented. For this reason, his initial treatment plan and treatment in progression resulted in difficulties. Nevertheless, the patient has maintained complete metabolic response after four years. The treatment approach to this group of patients was overviewed and long-term and complete response to pemetrexed in second-line treatment was emphasized.

Keywords: Non-small cell lung cancer, pemetrexed, survival, treatment

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