Meme Kanserinde İntraoperatif Radyoterapi
Özet
Meme kanseri tedavisinde adjuvan radyoterapi (RT) sağkalımı artıran standart bir yaklaşımdır. Son yıllarda, erken evre meme kanserinde tüm meme ışınlaması (WBI) yerine tedavi süresini ve toksisiteyi azaltan kısmi meme ışınlaması (PBI) teknikleri öne çıkmaktadır. Bu yöntemlerden biri olan İntraoperatif Radyoterapi (İORT), cerrahi sırasında tek doz olarak uygulanmasıyla diğer hızlandırılmış parsiyel meme ışınlama (APBI) tekniklerinden ayrılır. İORT; tedavi süresini kısaltma, radyasyon merkezine erişim sorunlarını aşma, mastektomi oranlarını azaltma, kalp ile akciğer gibi kritik organları koruma ve operasyon sırasında tümör yatağının daha iyi oksijenlenmesi gibi önemli avantajlar sunar. TARGIT-A ve ELIOT gibi büyük ölçekli randomize çalışmalar, uygun kriterlerdeki düşük riskli hastalarda tek doz İORT'nin etkinliğini ve lokal kontrol oranlarını konvansiyonel eksternal RT (EBRT) ile karşılaştırmalı olarak incelemiştir. Ayrıca İORT, yüksek riskli hastalarda WBI öncesi bir "boost" (ek doz) stratejisi olarak da başarıyla kullanılmaktadır. Toksisite oranları standart tedavilerle benzer olup, maliyet-etkinlik analizi açısından da sağlık sistemlerine büyük ekonomik kazançlar sağlamaktadır. Güncel kılavuzlarda yer bulmaya başlayan İORT, devam eden TARGIT-B ve TARGIT-C gibi çalışmaların uzun dönem sonuçlarıyla tedavi protokollerindeki yerini daha da sağlamlaştıracaktır.
Adjuvant radiotherapy (RT) is a standard paradigm that enhances survival in breast cancer treatment. Recently, partial breast irradiation (PBI) techniques, which reduce treatment duration and toxicities compared to whole breast irradiation (WBI), have gained prominence in early-stage breast cancer. Intraoperative Radiotherapy (IORT) distinguishes itself from other accelerated partial breast irradiation (APBI) methods by being delivered as a single dose during surgery. IORT offers critical advantages, such as shortening the total treatment period, mitigating accessibility issues to radiation centers, reducing mastectomy rates, protecting critical organs like the heart and lungs, and providing better oxygenation of the tumor bed during operations. Large randomized trials, including TARGIT-A and ELIOT, have evaluated the efficacy and local control rates of single-dose IORT compared to conventional external beam RT (EBRT) in well-selected, low-risk patients. Additionally, IORT is effectively utilized as a boost strategy prior to WBI in high-risk patients. Its toxicity profile is comparable to standard treatments, and cost-effectiveness analyses demonstrate significant economic benefits for healthcare systems. While currently incorporated into various international guidelines, the definitive role of IORT in standard treatment protocols will be further consolidated by long-term outcomes from ongoing trials like TARGIT-B and TARGIT-C.
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