İn Situ Duktal Karsinomda (DCIS) Radyoterapinin Rolü
Özet
Duktal karsinoma in situ (DCIS), tarama programlarının yaygınlaşmasıyla sıklığı artan ve tüm meme kanseri vakalarının yaklaşık %25'ini oluşturan non-invaziv bir hastalıktır. Hastalığın yönetiminde temel amaç invaziv kanser gelişimini önlemektir; çünkü tedavi edilmeyen olgularda 10 yıllık lokal nüks oranları %10-15 civarında olup bu nükslerin yarısı invaziv karakterde gelişebilmektedir. Tedavide total mastektomi yaygın multisentrik tutulum veya negatif cerrahi sınır sağlanamayan durumlarda tercih edilirken, mastektomi sonrası rutin radyoterapi (RT) önerilmemektedir. Uygun hastalarda ise meme koruyucu cerrahi (MKC) ve adjuvan radyoterapi standart yaklaşım olarak öne çıkmaktadır. Yapılan çalışmalar, MKC sonrasına adjuvan RT eklenmesinin tüm hasta alt gruplarında in situ veya invaziv kanser rekürrensini belirgin şekilde azalttığını doğrulamaktadır. Güncel kılavuzlar, konvansiyonel tedaviye benzer onkolojik ve kozmetik sonuçlar sunan, tedavi süresini kısaltarak hasta konforunu artıran hipofraksiyone radyoterapiyi yaygın olarak önermektedir. Ayrıca uygun düşük-orta riskli hastalarda cerrahi kaviteyi hedefleyen akselere parsiyel meme ışınlaması (APBI) da alternatif bir yaklaşım sunmaktadır. Östrojen reseptörü pozitif hastalarda ise ipsilateral ve kontralateral koruma amacıyla 5 yıl süreyle tamoksifen gibi endokrin tedaviler eklenerek lokal kontrol oranları %95'in üzerine çıkarılmaktadır.
Ductal carcinoma in situ (DCIS) is a non-invasive disease that constitutes approximately 25% of all breast cancer cases, with its incidence rising due to widespread screening programs. The primary objective in managing DCIS is to prevent the development of invasive breast cancer, as 10-year local recurrence rates range between 10% and 15%, with nearly half manifesting as invasive disease. While total mastectomy is preferred in cases of extensive multicentric involvement or when negative surgical margins cannot be achieved, routine postoperative radiotherapy (RT) is not recommended after mastectomy. For eligible patients, breast-conserving surgery (BCS) combined with adjuvant radiotherapy represents the standard care approach. Extensive clinical data confirms that adding adjuvant RT after BCS significantly reduces the risk of both in situ and invasive recurrences across all patient subgroups. Modern guidelines increasingly support hypofractionated radiotherapy, which offers similar oncological and cosmetic outcomes to conventional schedules while improving patient comfort and reducing treatment duration. Additionally, accelerated partial breast irradiation (APBI) serves as a suitable localized alternative for select low-to-intermediate-risk patients. For estrogen receptor-positive cases, a 5-year course of endocrine therapy, such as tamoxifen, is recommended to prevent secondary primaries, helping achieve overall local control rates exceeding 95%.
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