engleski

Chemotherapy in patients with nonresectable cancer of the biliary system or advanced gallblader cancer : do elderly have benefit at all?

Adenocarcinomas of the bile ducts (BSCa) and gallblader (GBCa) are highly malignant neoplasms with a very poor prognosis. Chemotherapy (cht) plays only a palliative role and responses are transient without prolonged survival. Aim of the study was to evaluate effectiveness of gemcitabine(G) and cisplatin(CP) combination protocol in achieving Clinical Benefit Response(CBR) for patients (pts) with nonresectable BSCa and with advanced GBCa and to evaluate the differences between younger and elderly patients. For this type of tumors we took 60 years as bordeline for elderly. During five years period we cured 38 patients with BSCa and GBCa with mean age of 52, 4+4, 8 years. There was 23 females with mean age of 50, 2+3, 8 years, and 15 men with mean age 53, 7+4, 3 years. In the group of elderly there was 9 females with mean age of 61, 8+2, 9 years, and 6 men with mean age of 62, 4+2, 9 years. 25 patients (65, 8%) had locally advanced disease and 13 patients (34, 2%) metastatic disease. Patients achieved G 1000 mg/m2 intravenous once per week for seven times. CP 100 mg/m2 iv was administered at day 1, 15, 29 and 43. Number of applicated cycles was 1-10 (median 4 cycles). Partial response rate achieved 22 patients-57, 9%. 36 patients-94, 7% achieved CBR. Pain measured at VAS scale before cht was 5, 1 and after 1st cht cycle 2, 1. Karnofsky Performance Status before chemotherapy was 62, 4%, and after 1st cycle 78, 8%. Median duration Clinical Benefit was 21 weeks. 29 patients (76, 3%) developed fatigue gradus II-III (WHO) ; 20 patients (52, 6%) expressed nausea gradus II (WHO) ; elderly had stronger fatigue (gradus III) versus younger ; also more serious leucopenia and trombocitopenia (gradus III) than younger (gradus II). There was no difference between younger and elderly patients in number of applicated cycles ; also no difference in achieving partial response rate and CBR. There was difference in developing side effects ; elderly had more serious fatigue, leucopenia and trombocitopenia than younger. This results indicate that the treatment of GBCa and BSCa with gemcitabine and cisplatinum is effective and well tolerated also to elderly patients and leads to Clinical Benefit for both groups. The role of chemotherapy in this malignancies is palliation and achieving better Quality of Life more than prolonging survival time.

chemotherapy; nonresectable cancer of the biliary system or advanced gallblader cancer; elderly

Rad je kao poster prezentiran i na skupovima: - 8th International Conference on Geriatric Oncology : Cancer in the elderly, održanom od 21.-22.11.2003., Rim, Italija ; knjiga sažetaka, str. 82-82 ; - Gastrointestinal Cancers Symposium "Multidisciplinary approaches to Gastrointestinal Malignancies and Premalignancies", održanom od 27.-29.01.2005., Florida, SAD ; objavljen u knjizi sažetaka / Steven M. Grunberg (ur.) ; 2005., str. 116-116 ; - 17th MASCC International Symposium, održanom od 30.06.-02.07.2005., Ženeva, Švicarska ; Knjiga sažetaka u: Supportive Care in Cancer 13 (2005) (6) ; 03-011 ; str. 410-411 ; www.springerlink.com/content/p54783734h287352/fulltext.pdf ; - World Congresss of Gastroenterology, održanom od 10.-14.09.2005., Montreal, Kanada ; Knjiga sažetaka u: Canadian Journal of gastroenterology 19 (2005) (Suppl C) ; R.0864