İntraoperatif Radyoterapi Uygulamalarında Cerrahi
Özet
Meme kanserinde lokal nüksü önlemede Meme Koruyucu Cerrahi (MKC) sonrası uygulanan radyoterapi standart bir yaklaşımdır. İntraoperatif Radyoterapi (IORT), ameliyat esnasında doğrudan tümör yatağına tek doz veya ek dozu (Boost) olarak uygulanan, kaynakların doğru kullanımını sağlayan ve tedavi sürelerini kısaltan bir yöntemdir. Cerrahi sınırların güvenliği netleştikten sonra uygun aplikatör boyutları belirlenerek mobil lineer hızlandırıcılarla gerçekleştirilen bu işlemde, cerrahın Onkoplastik Cerrahi (OPC) deneyimi büyük önem taşır. Yaş, tümör boyutu ve meme yoğunluğu gibi kriterler hasta seçiminde belirleyicidir. Geleneksel postoperatif radyoterapiye kıyasla cerrahi esnasında dokunun doğrudan görülerek ışınlanması, coğrafi hedefleme avantajı sağlarken lokal nüks riskini etkin şekilde azaltır ve olumsuz kozmetik sonuçlara yol açmaz. Erken postoperatif dönemde hastalar akut toksisite, iskemi ve hiperemi açısından takip edilmeli, uzun vadede ise radyologlar görüntülemede yağ nekrozu gibi IORT ile ilişkili normal değişimleri tanımalıdır.
In breast cancer treatment, radiotherapy applied after Breast-Conserving Surgery (BCS) is a standard approach to prevent local recurrence. Intraoperative Radiotherapy (IORT) is an advanced method applied directly to the tumor bed during surgery either as a full single dose or as a boost dose, optimizing resource utilization and reducing treatment durations. This procedure is performed with mobile linear accelerators after ensuring clear margins, where the oncoplastic surgery experience of the breast surgeon is crucial. Patient selection relies on parameters such as age, tumor size, and breast density. Compared to standard postoperative boost applications, delivering radiation during surgery allows direct visualization of the tissue, providing geographical accuracy while effectively reducing local recurrence rates without compromising cosmetic outcomes. In the early postoperative period, patients must be carefully monitored for acute toxicity, ischemia, and hyperemia. Long-term follow-ups require close multi-disciplinary communication, as radiologists need to accurately identify specific IORT-related post-surgical tissue changes like fat necrosis to avoid unnecessary interventions.
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