Neoadjuvan Kemoterapi Sonrası Radyoterapi Uygulamaları
Özet
Neoadjuvan kemoterapi (NAK), lokal ileri evre meme kanserinde cerrahiyi kolaylaştırmak ve meme koruyucu yaklaşımları artırmak amacıyla yaygınlaşmıştır. NAK ile elde edilen tam patolojik yanıtın (pCR) özellikle triple negatif ve her-2 pozitif alt gruplarda sağkalım üzerinde güçlü bir prognostik öneme sahip olduğu gösterilmiştir. Ancak tedavi sonrasında radyoterapi (RT) planlaması, başlangıç patolojik evresinin net olarak bilinememesi, aksiller lenf nodu cerrahisindeki varyasyonlar ve rekonstrüksiyon durumları nedeniyle oldukça karmaşık bir hal almıştır. Mevcut veriler, neoadjuvan tedavi sonrası mastektomi yapılan ve pCR elde edilen hastalarda bile RT’nin nüksü azaltıp sağkalımı artırdığını ortaya koymaktadır. Meme koruyucu cerrahi uygulanan tüm hastalarda tüm meme ışınlaması standart bir yaklaşımken, nodal ışınlama kararı hastanın yaşı, tümör derecesi, moleküler alt grubu ve rezidü hastalık varlığı gibi risk faktörlerine göre şekillenmektedir. Güncel klinik uygulamalarda RT alanlarının belirlenmesinde merkezler arasında yüksek varyasyonlar görülmekte olup, NSABP B51, Alliance 11202 ve ATNEC gibi devam eden randomize çalışmaların sonuçları NAK sonrası radyoterapi endikasyonlarına yönelik daha güçlü kanıtlar sağlayacaktır.
Neoadjuvant chemotherapy (NAC) has become widely adopted in locally advanced breast cancer to facilitate surgery and increase rates of breast-conserving approaches. Achieving a pathological complete response (pCR) with NAC has been shown to carry strong prognostic significance for survival, particularly in triple-negative and HER-2 positive subtypes. However, planning radiotherapy (RT) after neoadjuvant treatment has become highly complex due to factors such as the lack of knowledge regarding the initial pathological stage, variations in axillary lymph node surgery, and reconstruction status. Current data demonstrate that even in patients who achieve pCR following NAC and mastectomy, post-mastectomy RT significantly reduces recurrence and improves survival rates. While whole-breast irradiation is standard for all patients undergoing breast-conserving surgery, the decision for nodal irradiation depends on risk factors including age, tumor grade, molecular subtype, and the presence of residual disease. Significant practice variations exist among centers regarding RT fields in current clinical management, and the mature results of ongoing randomized trials like NSABP B51, Alliance 11202, and ATNEC are highly anticipated to establish more definitive guidelines for post-NAC radiotherapy.
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