Lokal Bölgesel Rekürrensde Tedavi Seçenekleri Reirradiasyon
Özet
Meme kanserinin standart küratif tedavisi sonrasında az sayıda hastada ipsilateral lokorejyonel rekürrensler (yerel nüksler) görülebilmektedir. İlk tedavisinde radyoterapi (RT) almış olan bu hastaların yönetimi; ileri cerrahi, sistemik tedavi ve reirradiasyonu (yeniden ışınlama) içeren multidisipliner ve karmaşık bir yaklaşım gerektirir. Geçmişte reirradiasyonun potansiyel toksisite riskleri ve kötü kozmetik sonuç endişeleri nedeniyle salvaj mastektomi standart yaklaşım olarak kabul görse de, mastektominin özellikle genç kadınlar üzerinde yarattığı negatif psikolojik etkiler ve beden algısı zorlukları, araştırmacıları ikincil meme koruyucu cerrahi (MKC) seçeneklerine yöneltmiştir. Gelişen teknolojiyle birlikte interstisyel brakiterapi, intraoperatif radyoterapi (İORT) ve eksternal-beam radyoterapi (EBRT) gibi parsiyel meme ışınlama teknikleri ön plana çıkmıştır. Klinik çalışmalar, ikincil lumpektomi sonrası uygulanan bu reirradiasyon tekniklerinin, salvaj mastektomi ile benzer hastalıksız ve genel sağkalım oranları sunduğunu, ayrıca kabul edilebilir yan etki profilleriyle lokal kontrolü başarıyla sağladığını göstermektedir. İnoperabl nükslerde ise hipertermi ile reirradiasyon kombine edilerek tümörün radyosensitivitesi artırılmakta ve etkili palyasyon elde edilmektedir. Sonuç olarak, uygun hasta seçimi ve modern RT teknikleriyle reirradiasyon, lokal rekürrenslerde güvenli ve umut verici bir tedavi seçeneğidir.
Following the standard curative treatment of breast cancer, ipsilateral locoregional recurrences may develop in a small number of patients. The management of these patients, who have previously undergone radiotherapy (RT), requires a complex, multidisciplinary approach incorporating advanced surgery, systemic therapy, and reirradiation. Although salvage mastectomy was historically considered the standard intervention due to concerns over potential toxicities and poor cosmetic outcomes of reirradiation, its negative psychological impacts and body image issues, particularly in young women, have prompted researchers to investigate secondary breast-conserving options. With technological advancements, partial breast irradiation techniques such as interstitial brachytherapy, intraoperative radiotherapy (IORT), and external-beam radiotherapy (EBRT) have emerged. Clinical studies demonstrate that reirradiation following a secondary lumpectomy provides disease-free and overall survival rates comparable to salvage mastectomy, while successfully achieving local control with acceptable toxicity profiles. For inoperable recurrences, combining hyperthermia with reirradiation enhances tumor radiosensitivity, yielding effective palliation. In conclusion, when paired with careful patient selection and modern RT techniques, reirradiation constitutes a safe and promising therapeutic option for managing locoregional breast cancer recurrences.
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