Meme Koruyucu Cerrahi Sonrası Radyoterapi Uygulamaları
Özet
Meme koruyucu cerrahi (MKC) sonrası adjuvan radyoterapi (RT), erken evre meme kanserinin lokal ve bölgesel yönetiminde nüks oranlarını azaltarak mastektomiye eşdeğer bir sağkalım avantajı sunmaktadır. Güncel kılavuzlar uyarınca, tüm meme ışınlamasında (TMİ) yaş veya tümör evresine bakılmaksızın hipofraksiyone RT (15-16 fraksiyonda 40-42.5 Gy) standart yaklaşım olarak önerilmekte; bu yöntem konvansiyonel tedaviye göre benzer etkinlik ve toksisite profili sergilemektedir. Yüksek riskli hastalarda lokal kontrolü artırmak adına tümör yatağına elektron, foton veya brakiterapi ile boost dozu (kümülatif 60-66 Gy) uygulanmaktadır. Hastalığın yayılım düzeyine göre supraklavikuler, aksiller veya internal mammarian lenfatikleri kapsayan bölgesel nodal ışınlama tedaviye eklenebilmektedir. Planlama aşamasında forward/inverse YART gibi üç boyutlu teknikler ve derin inspiryumda nefes tutma yöntemi, kalp ve akciğer gibi risk altındaki kritik organların doz maruziyetini minimuma indirmektedir. Akut dönemde en sık dermatolojik reaksiyonlar izlenirken, subakut ve kronik süreçte doku kalınlaşması, ödem ve nadiren kardiyovasküler yan etkiler gelişebilmektedir. Sonuç olarak MKC sonrası RT, modern tekniklerle optimize edilen güvenilir bir lokal tedavi modalitesidir.
Adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) plays a critical role in the local and regional management of early-stage breast cancer by reducing recurrence rates, offering a survival advantage equivalent to mastectomy. According to current guidelines, hypofractionated RT (40-42.5 Gy in 15-16 fractions) is recommended for whole breast irradiation (WBI) regardless of age or tumor stage, demonstrating similar efficacy and toxicity profiles compared to conventional treatment. To enhance local control in high-risk patients, a boost dose (cumulative 60-66 Gy) is delivered to the tumor bed using electrons, photons, or brachytherapy. Depending on the extent of disease, regional nodal irradiation encompassing supraclavicular, axillary, or internal mammary lymphatics may be added. During treatment planning, three-dimensional techniques such as forward/inverse IMRT and the voluntary inspiration breath-hold technique minimize radiation exposure to organs at risk, particularly the heart and lungs. While skin reactions are the most common acute side effects, tissue thickening, edema, and rarely cardiovascular complications may develop in subacute or chronic periods. In conclusion, post-BCS RT is a safe and reliable local treatment modality optimized through modern techniques.
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