Pankreas Cerrahisinde İntraoperatif Patolojik İncelemenin Yeri
Özet
Pankreas kanseri, düşük sağkalım oranları ve yüksek nüks sıklığı ile en ölümcül malignitelerden biri olmaya devam etmektedir. Cerrahi rezeksiyon tek potansiyel tedavi yöntemi olsa da, tanı anında hastaların yalnızca %15-20'si ameliyata uygundur ve R0 rezeksiyonundan sonra bile lokal nüks oranları %50-80 gibi yüksek seviyelerdedir. Bu durum, standart cerrahi sınırların ötesindeki gizli mikrometastazlardan ve sinir pleksus invazyonlarından kaynaklanmaktadır. Konvansiyonel eksternal ışın radyasyon tedavisi (EIRT), çevredeki kritik organların doz tolerans sınırları nedeniyle tümör yatağına istenen dozda ışınlama uygulayamaz. İntraoperatif Radyasyon Tedavisi (İORT) ise ameliyat sırasında doğrudan tümör yatağına tek ve yüksek dozda radyasyon verilmesini sağlayarak bu sınırlamayı aşar. Risk altındaki hassas komşu dokular cerrahi olarak radyasyon alanından uzaklaştırılabildiği için terapötik indeks artar ve radyotoksisite riski azalır. Klinik çalışmalar, İORT'nin standart neoadjuvan veya destekleyici tedavilere eklenmesinin, rezektabl ve lokal olarak ilerlemiş hastalıklarda ameliyat komplikasyonlarını artırmadan lokal tümör kontrolünü önemli ölçüde iyileştirdiğini ve özellikle rezeke edilemeyen hastalarda hastaların %75-90'ında tam ağrı giderimi sağladığını göstermektedir.
Pancreatic cancer remains one of the most lethal malignancies, characterized by low survival rates and a high frequency of recurrence. Although surgical resection offers the only potential cure, only 15-20% of patients are resectable at the time of diagnosis, and local failure rates remain as high as 50-80% even after curative R0 resection. This challenge stems from occult micrometastases and neural plexus invasions that extend beyond standard surgical margins. Conventional external beam radiation therapy (EIRT) is strictly limited in delivering definitive doses due to the radiation tolerance thresholds of surrounding critical organs. Intraoperative Radiation Therapy (IORT) overcomes this barrier by delivering a single, high dose of radiation directly to the tumor bed during surgery. Since sensitive adjacent organs at risk can be surgically displaced out of the radiation field, the therapeutic index is maximized while radiotoxicity is minimized. Clinical data demonstrate that integrating IORT into standard neoadjuvant or supportive regimens significantly enhances local tumor control in both resectable and locally advanced disease without increasing perioperative complications, while achieving complete pain relief in 75-90% of unresectable cases.
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