Oligometastatik Meme Kanserinde Cerrahi Tedavi
Özet
Oligometastatik meme kanseri (OMMK), polimetastatik hastalıktan farklı olarak beş veya daha az metastatik odakta sınırlı organ tutulumu ile seyreden, daha iyi prognoza ve sağkalım sonuçlarına sahip bir ara evreyi tanımlar. Bu hastalık grubunda lokal tedavilerin, özellikle primer tümör cerrahisinin ve metastazektominin sağkalım ile progresyona etkileri halen tartışmalıdır. Literatürdeki retrospektif çalışmalar oligometastatik olgularda primer tümörün cerrahi rezeksiyonunun sağkalım avantajı sunduğunu gösterse de, ECOG-ACRIN 2108 ve ABCSG-28 gibi prospektif randomize klinik araştırmalar sistemik tedaviye cerrahi eklenmesinin genel sağkalımda anlamlı bir fark yaratmadığını ortaya koymuştur. Buna karşın, Türkiye’de yürütülen çok merkezli MF07-01 çalışmasının 10 yıllık uzun dönem takibinde cerrahi kolunda genel sağkalımın anlamlı derecede daha yüksek olduğu bildirilmiştir. İzole karaciğer ve akciğer metastazlarına yönelik uygulanan metastazektomi operasyonlarının ise seçilmiş uygun olgularda ve negatif cerrahi sınır (R0) sağlandığında hastalıksız sağkalım aralığını artırabildiği görülmektedir. Sonuç olarak, karmaşık biyolojik yapısı nedeniyle OMMK’de primer tedavi halen sistemik ve hedefe yönelik ajanlar olup, cerrahi girişimler multidisipliner yaklaşımla hastaya özel seçilmelidir.
Oligometastatic breast cancer (OMBC) defines an intermediate stage characterized by limited organ involvement with five or fewer metastatic deposits, exhibiting a better prognosis and higher survival rates than polymetastatic disease. In this patient group, the impact of local treatments, particularly primary tumor surgery and metastasectomy, on progression and survival remains controversial. While retrospective literature suggests that primary tumor resection offers a survival advantage in oligometastatic cases, prospective randomized clinical trials such as ECOG-ACRIN 2108 and ABCSG-28 demonstrated that adding surgery to systemic therapy does not yield a significant difference in overall survival. Conversely, the 10-year long-term follow-up of the multicenter MF07-01 trial conducted in Turkey reported a significantly higher overall survival rate in the surgical arm. Furthermore, metastasectomy performed for isolated liver and lung metastases appears to extend the disease-free survival interval in carefully selected eligible cases, provided that negative surgical margins (R0) are achieved. Consequently, due to its complex biological behavior, the primary treatment for OMBC remains systemic and targeted agents, while surgical interventions should be tailored individually through multidisciplinary consensus.
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