Çocukluk Çağı Kanserlerinde Radyoterapi Sonrası Radyoloji Filmlerde Radyasyonun İzleri
Özet
Çocukluk çağı kanserlerinde multidisipliner tedavilerin gelişmesi kür oranlarını artırırken, radyoterapinin (RT) erken ve geç dönem yan etkileri radyolojik görüntülemelerde spesifik bulgularla izlenmektedir. Baş-boyun ışınlamalarında tiroid bezi hasarı, hacim kayıpları ve özellikle papiller tiroid karsinomu riski artmakta; karotis arter tutulumu ise inme riskini doğuran stenoz ve intimal kalınlaşmalara yol açmaktadır. Torasik radyoterapi sonrasında akut dönemde buzlu cam opasiteleri ve konsolidasyonla karakterize radyasyon pnömonisi, kronik dönemde ise akciğer fibrozisi, organize pnömoni ve çeşitli radyasyona bağlı kalp hastalıkları gelişebilmektedir. Abdominal alanda, karaciğerde venooklüzif hasara bağlı hipodens demarkasyon hatları içeren radyasyon hepatiti; böbreklerde fonksiyon kaybı ve atrofi ile karşı böbrekte hipertrofi izlenirken; gastrointestinal sistemde duvar kalınlaşmaları, ülserasyonlar ve fibrotik darlıklar görülmektedir. Kas-iskelet sisteminde ise immatür kemiklerde büyüme bozuklukları, olgun kemiklerde osteoradyonekroz, osteopeni, yapısal deformiteler ve uzun vadede agresif sekonder sarkom riskleri ortaya çıkmaktadır. Bu nedenle, çocukluk çağı kanser sağkalanlarının klinik takibinde onkolog ve radyologların bu radyolojik izleri doğru tanıması hayati önem taşımaktadır.
While advancements in multidisciplinary treatments increase cure rates in childhood cancers, the early and late side effects of radiotherapy (RT) manifest with specific findings in radiological imaging. In head and neck irradiation, thyroid gland damage, volume loss, and particularly the risk of papillary thyroid carcinoma increase, while carotid artery involvement leads to stenosis and intimal thickening, posing a risk of stroke. Following thoracic radiotherapy, radiation pneumonitis characterized by ground-glass opacities and consolidation occurs in the acute phase, whereas lung fibrosis, organizing pneumonia, and various radiation-induced heart diseases may develop in the chronic phase. In the abdominal area, radiation hepatitis presents with hypodense lines of demarcation due to veno-occlusive damage in the liver; the kidneys exhibit atrophy, reduced function, and compensatory hypertrophy of the contralateral kidney, while the gastrointestinal tract shows wall thickening, ulceration, and fibrotic strictures. In the musculoskeletal system, growth disorders occur in immature bones, whereas osteoradionecrosis, osteopenia, structural deformities, and a long-term risk of aggressive secondary sarcomas emerge in mature bones. Therefore, accurate recognition of these radiological findings by oncologists and radiologists is vital during the clinical follow-up of childhood cancer survivors.
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