İntraperitoneal kemoterapi
DESCRIPTION
İntraperitoneal Kemoterapi. Dr. Demir ÖZBAŞAR. Yerel-Bölgesel Kemoterapi ( Loco - Regional Chemotherapy ). Etki = C x T. Etki = C x T. Klirens ( Clearance ). IP kemoterapi de ilaç penetrasyonu. Ek yararı?. EOC de en etkili ilaçların IP ve plasma konsantrasyonları oranı. IP vs IV. - PowerPoint PPT PresentationTRANSCRIPT
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İntraperitoneal Kemoterapiİntraperitoneal Kemoterapi
Dr. Demir ÖZBAŞAR
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Yerel-Bölgesel KemoterapiYerel-Bölgesel Kemoterapi( Loco-Regional Chemotherapy )( Loco-Regional Chemotherapy )
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Etki = C x TEtki = C x T
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Etki = C x TEtki = C x T
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Klirens (Clearance)Klirens (Clearance)
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IP kemoterapi de ilaç IP kemoterapi de ilaç penetrasyonupenetrasyonu
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Ek yararı?Ek yararı?
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EOC de en etkili ilaçların EOC de en etkili ilaçların IP ve plasma konsantrasyonları IP ve plasma konsantrasyonları
oranıoranı
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IP vs IVIP vs IV
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Ancak?Ancak?
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SGO 2013SGO 2013
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Bu çalışmada önemli bir Bu çalışmada önemli bir tespittespit
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Second-Line KemoterapiSecond-Line Kemoterapi
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O Halde?O Halde?
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Yeni yöntemlerYeni yöntemler
Ve ciddi bir ihtimalVe ciddi bir ihtimal
HIPECHIPEC
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Neden Hipertermi?Neden Hipertermi?
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Hipertermi ve NeoplaziHipertermi ve Neoplazi
Steller MA, Cancer Chemo Pharm, 1999; Knox JD, Exp Cell Res, 1991
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UygulamaUygulama
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Gerekli ekipmanGerekli ekipman
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İşlemİşlem
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Zaman ve SıcaklıkZaman ve Sıcaklık
Vertrees R, SGO, 2006
43°C
41°C
0 120Zaman (dk)
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Tekrar gerekli mi?Tekrar gerekli mi?
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AvantajlarıAvantajları
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Barsak rezeksiyonlarında Barsak rezeksiyonlarında kullanımkullanım
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UygulamalarımızUygulamalarımız
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SonuçSonuç
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Işık Tutan Gölgede Kalır!Işık Tutan Gölgede Kalır!
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Milli Mücadele'nin başlamasının 90. yıldönümü dolayısıyla bestelenen““DirilişDiriliş” ” marşı, değerli sanatçımız
Can Atilla'nın önderliğinde, Sayın Suna KanHanımefendi'nin de katkı yaptığı bir marş olarak
ortaya çıktı. Atilla marşın içinde çok önemliKan'ın çaldığı keman Atatürk'ü temsil ediyor.
Koronun seslendirdiği bölümler,Kurtuluş Savaşısırasında Türk ulusunun çektiği acıları,
sıkıntıları aktarıyor. Orkestra ise milli mücadele dönemini anlatıyor" dedi
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Rejim 1Rejim 1
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Rejim 2Rejim 2
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Rejim 3Rejim 3
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CarboplatinCarboplatin
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CarboplatinCarboplatin
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Cisplatin vs CarboplatinCisplatin vs Carboplatin
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demirözbaşar
Over Ca Evre III <1cm
Cisplatin 100 mg/m² IVSioklofosfamid 600 mg/m² IV
21 gün, 6 kür
Cisplatin 100 mg/m² IPSioklofosfamid 600 mg/m² IV
21 gün, 6 kür
RANDOMİZASYON
GOG GOG ## 104 104
Second-Look LaparotomiAlberts DS, NEJM, 1996
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demirözbaşar
Over Ca Evre III <1cm
Paklitaksel 135mg/m² IVCisplatin 75mg/m² IV
21 gün, 6 kür
Carboplatin AUC=9x2 IVTakiben
Paklitaksel 135mg/m² IVCisplatin 75mg/m² IP
21 gün, 6 kür
RANDOMİZASYON
GOG GOG ## 114 114
Markman M, JCO, 2001
Second-Look Laparotomi
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demirözbaşar
GOG GOG ## 172 172
Over Ca Evre III Optimal ≤1cm
Paklitaksel 135 mg/m²=24 st IVCisplatin 75 mg/m² IP D2Paklitaksel 60 mg/m² IP D821 gün, 6 kür
Second-Look Laparotomi (planlanan hastalara)
RANDOMİZASYON
BRCA tayini ve DNA banking
Paklitaksel 135 mg/m² IVCisplatin 75 mg/m² IV21 gün, 6 kür
Armstrong D, NEJM, 2006
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demirözbaşar
GOG GOG ## 104-SWOG 104-SWOG ## 8501: Sonuç 8501: Sonuç
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demirözbaşar
GOG GOG ## 114 114
IV - IP’nin teknik karşılaştırması değildir Çalışmanın yorumu oldukça zordur
İlk çalışmada optimal cerrahi tedavi için ≤1 cm kullanılmıştır (GOG, 1993)
OS iyileşmesi• Carboplatin (AUC= 9)?
IP grubunda daha fazla toksisite IP grubunda hastaların %20’si 2 siklustan
daha az tedavi aldı
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demirözbaşar
GOG GOG ## 172: Sonuç 172: Sonuç
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demirözbaşar
GOG GOG ## 172 172
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