Malıgn Karaciğer Lezyonlarına Yaklaşımda Sistemik Onkolojik Tedavinin Önemi
Özet
Hepatobiliyer kanserler, primer karaciğer malignitelerinin en sık görülen türü olan hepatosellüler karsinom (HCC) ve daha nadir görülen biliyer kanserlerden oluşmaktadır. Genellikle kronik karaciğer hastalığı zemininde gelişen HCC, erken evrede saptanırsa cerrahi rezeksiyon veya karaciğer transplantasyonu ile tedavi edilebilirken; cerrahi şansı olmayan hastalar için radyofrekans ablasyon (RFA), transarteriyel kemoembolizasyon (TAKE) gibi lokal tedaviler uygulanır. İleri evre HCC vakalarında ise kemorefrakter özellik nedeniyle klasik sitotoksik tedaviler yerine Atezolizumab+Bevacizumab kombinasyonu, Sorafenib ve Lenvatinib gibi hedefe yönelik tirozin kinaz inhibitörleri ile immünoterapiler birinci basamakta tercih edilmektedir. Genç yaşta ve non-sirotik zeminde gelişen fibrolamellar karsinom (FLC) ise normal AFP seviyeleri ve yüksek lenf nodu metastazı riski ile tipik HCC'den ayrılır ve birincil tedavisi agresif cerrahi rezeksiyondur. Safra kesesi kanserlerini içeren biliyer tümörler ise genellikle ileri evrede obstrüktif sarılık gibi semptomlarla teşhis edilir; erken evrede cerrahi kür şansı sunsa da metastatik veya lokal ileri hastalıkta kapesitabin bazlı adjuvan tedaviler ya da gemsitabin+sisplatin kombinasyonu gibi palyatif kemoterapiler standart yaklaşımı oluşturur.
Hepatobiliary cancers predominantly consist of hepatocellular carcinoma (HCC)—the most common primary liver malignancy—and rarer biliary tract cancers. HCC typically develops on the background of chronic liver disease, offering a high chance of cure via surgical resection or transplantation if diagnosed early, while localized therapies like RFA, TACE, or SIRT are utilized for non-surgical candidates. Due to the chemo-refractory nature of advanced HCC, standard cytotoxic treatments are replaced by targeted therapies and immunotherapies, including the first-line combinations of Atezolizumab+Bevacizumab, Sorafenib, or Lenvatinib. Fibrolamellar carcinoma (FLC), a distinct subtype appearing in younger populations without cirrhosis, is characterized by normal AFP levels and higher lymph node involvement, requiring aggressive surgical resection as its primary curative approach. Biliary tumors, including gallbladder cancer, are highly fatal and often diagnosed at late stages with symptoms like obstructive jaundice. Although early-stage detection allows for surgical cure, management of locally advanced or metastatic biliary disease relies on adjuvant capecitabine or palliative chemotherapy regimens, primarily gemcitabine plus cisplatin.
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