Oldehinkel, E. (Edwin) (2013) Volledigheid en toxiciteit van adjuvante chemotherapie bij patiënten met colorectaal carcinoom: een retrospectieve analyse van 78 patiënten. thesis, Medicine.
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Abstract
Background: Colorectal cancer is one of the most common malignancies in the Netherlands, with over 10.000 new patients every year. Patients with high risk colorectal cancer are treated with adjuvant chemotherapy after surgical resection of the primary tumor. This chemotherapy consists of eight cycles capecitabine monotherapy or eight cycles capecitabine combined with oxaliplatin (CapOx). The toxicity of this treatment often is a limiting factor for the completion of the treatment. Current insights are based on patient populations from trials with strict in- and exclusion criteria. Purpose: This study is conducted to gain insight about the toxicity that occurs during chemotherapeutic treatment in patient populations in the daily practice. The primary goal is to evaluate the proportion of patients that complete the treatment as planned. Secondary goals are to identify the consequences of the toxicity for the treatment (delay, dose reduction and withdrawal) and to evaluate the reasons for changing or early withdrawal of the treatment. Methods: The study is a retrospective analysis of patients who started adjuvant treatment for colorectal carcinoma in the Isala Klinieken between January 2009 and June 2012. The toxicity is graded according the ‘Common Terminology Criteria for Adverse Events, version 4.03’ (June 2010). The proportion of patients that complete the treatment as planned were compared between capecitabine monotherapy and CapOx. The forms of toxicity were compared between chemotherapy (CapOx vs capecitabine monotherapy), sex (male vs female) and age (<65 vs ≥65). Results: A total of 78 patients were included, 63 received CapOx , the other 15 received capecitabine monotherapy. Only 8 (12.7%) patients treated with CapOx completed treatment as planned. Of the patients treated with capecitabine monotherapie 4 (26.7%) completed the treatment. The most common forms of toxicity (grade 1-4) in the patients treated with CapOx, were neurotoxicity (92.2%), nausea (79.4%) and anaemia (74.6%). Hand-foot-syndrome (60.0%), diarrhoea (53.3%) and nausea (40.0%) were the most common forms of toxicity in patients treated with capecitabine. The most common grade 3/4 toxicity in patients treated with CapOx were nausea (14.3%) and neurotoxicity (12.7%). Diarrhoea (26.6%) and nausea (20.0%) were most common in patients treated with capecitabine monotherapy. Grade 1-4 bone marrow toxicity, neurotoxicity and nausea were significantly higher with CapOx compared to capecitabine monotherapy. Grade 1-4 thrombocytopenia was significantly higher in men compared to women, grade 3 hand-foot-syndrome was significantly higher in women. Grade 1-4 nausea was significantly higher in older patients compared to younger patients. Conclusion: Compared with two fase III studies (Cassidy et al, 2008 and Schmoll et al, 2007), the proportion of patients in our study that complete the treatment as planned was low. The toxicity is comparable with data from other studies. A possible explanation for the low proportion of patients that complete the treatment, is that the oncologists in our hospital consider a different definition of unacceptable toxicity such as occurrence of combinations of low grade toxicities within one patient. Another explanation could be that other forms of toxicity, which are not well documented play a roll in altering the treatment.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Tascilar, Dr. M. |
| Supervisor name: | Tascilar, Dr. M. internist-oncoloog and Afdeling Interne Geneeskunde and Isala klinieken, Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:50 |
| Last Modified: | 25 Jun 2020 10:50 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1117 |
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