Pankreas Tümörlerinde Adjuvan Tedavinin Yeri
Özet
Pankreas duktal adenokanseri, yüksek mortalite oranıyla en ölümcül onkolojik maligniteler arasında yer almakta ve hastaların yarısı tanı anında metastatik evrede bulunmaktadır. Erken evrede, vasküler invazyonu bulunmayan hastalarda uygulanan cerrahi müdahale tek küratif tedavi seçeneğidir. Cerrahi operasyonun ardından, genel durumları uygun olan hastalarda postoperatif üçüncü ayda başlanan ve 6 ay boyunca iki haftada bir uygulanan modifiye FOLFIRINOX rejimi ilk seçenek adjuvan tedavi olarak kabul edilir. İleri yaşta veya kombine tedavileri tolere edemeyecek durumda olan hastalarda ise gemsitabin ± kapesitabin kombinasyonu tercih edilmektedir. Lokal ileri inoperabl vakalarda indüksiyon tedavisi olarak gemsitabin + nab-paklitaksel veya FOLFIRINOX protokolleri uygulanırken, metastatik evredeki hastaların yaşam süresini uzatmak ve semptom kontrolü sağlamak amacıyla sistemik kemoterapiye başvurulmaktadır. Ayrıca, platin hassasiyeti bulunan germline veya somatik BRCA 1/2 mutasyonlu metastatik hastaların idame tedavisinde PARP inhibitörü olaparib progresyonsuz sağkalıma katkı sunmaktadır. Multidisipliner yaklaşımlar, tedavi yanıtlarının takibinde ve akciğer gibi izole metakron metastazların yönetiminde kritik önem taşımaktadır.
Pancreatic ductal adenocarcinoma ranks among the most fatal oncological malignancies with a high mortality rate, and half of the patients are diagnosed at a metastatic stage. In the early stages, surgical resection remains the only curative treatment option for patients without vascular invasion. Following successful surgery, a 6-month course of modified FOLFIRINOX, administered every two weeks starting from the third postoperative month, is considered the first-line adjuvant therapy for fit patients. For patients over 75 years of age or those unable to tolerate combination regimens, gemcitabine ± capecitabine is the recommended alternative adjuvant option. In locally advanced inoperable cases, induction therapies consisting of gemcitabine + nab-paclitaxel or FOLFIRINOX are utilized, whereas systemic chemotherapy is preferred in the metastatic stage to extend survival and manage cancer-related symptoms. Furthermore, the PARP inhibitor olaparib provides a significant progression-free survival benefit as maintenance therapy for platinum-sensitive metastatic patients harboring germline or somatic BRCA 1/2 mutations. Multidisciplinary approaches remain critical for evaluating treatment responses and managing isolated metachronous metastases such as pulmonary lesions.
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