Radyoterapi Alan Hastalarda Geç Dönem Radyoloji Filmlerinde Radyasyonun İzleri
Özet
Radyoterapi (RT), onkoloji hastalarında sağkalımı artırırken, normal dokularda aylar veya yıllar sonra ortaya çıkabilen, ilerleyici ve büyük oranda geri dönüşümsüz geç dönem hasarlara yol açmaktadır. Bu etkiler; uygulanan doza, tedavi alanına, yaşa ve kemoterapi birlikteliğine göre değişmekte olup, hücre döngüsü yavaş olan deri altı, beyin, karaciğer ve kemik gibi dokularda fibroz, nekroz ve vasküler endotel hasarı ile karakterizedir. Serebral RT sonrasında lökoensefalopati, atrofi, radyonekroz ve moyamoya gibi vasküler patolojiler gelişebilirken; baş-boyun ışınlamalarında kserostomi, osteoradyonekroz ve yumuşak doku nekrozları izlenir. Göğüs ve pelvik radyoterapiler ise sırasıyla traksiyon bronşektazili akciğer fibrozisine, koroner arter hastalıklarına, gastrointestinal darlıklara ve ürogenital organ atrofisi ile fistül oluşumlarına zemin hazırlar. Radyologların, kesitsel görüntüleme yöntemleriyle (BT ve MRG) bu sekel ve komplikasyonları iyi bilmesi, nüks veya kalıntı tümör ayrımını doğru yaparak klinik yönetime katkı sağlaması açısından kritik önem taşımaktadır.
Radiotherapy (RT), while improving survival in oncological patients, causes progressive and largely irreversible late-term tissue damage that manifests months or years post-treatment. Dependent on factors such as radiation dose, field size, patient age, and concomitant chemotherapy, these late effects predominantly involve slower-turnover tissues—including subcutaneous tissue, brain, liver, and bone—leading to fibrosis, necrosis, and vascular endothelial damage. Cerebral RT can result in leukoencephalopathy, parenchymal atrophy, radionecrosis, and vascular conditions like moyamoya; meanwhile, head and neck radiation often induces xerostomia, osteoradionecrosis, and soft-tissue necrosis. Thoracic and pelvic RT are associated with lung fibrosis characterized by traction bronchiectasis, radiation-induced heart disease, gastrointestinal strictures, and urogenital organ atrophy or fistula formations. Thorough knowledge of these imaging manifestations on CT and MRI is vital for radiologists to accurately differentiate expected post-radiation changes from tumor recurrence, ensuring optimal clinical management.
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