Erken ve Lokal İleri Küçük Hücreli Dışı Akciğer Kanseri
Özet
Küçük hücreli dışı akciğer kanserinde (KHDAK) tedavi sonrası takibin amacı tedavi ilişkili yan etkilerin tespiti ve yönetilmesi, hastalık nüksünün erken tespiti ve hastaların gecikmeden ileri basamak tedavilere ve desteğe eriştirilmesidir. Nüksün erken tespit edilmesinin tedavi başarısını ve sağ kalımı arttırabileceği düşünülmektedir. Asemptomatik nükslerin tespitinin daha iyi sağkalım sonuçları ortaya çıkardığı ile ilgili sınırlı bilgiler olsada bu durumun tanı zamanını erkene çekmekle birlikte sağkalım katkısı sağlamadığına dair şüpheler vardır. Bununla beraber lokal yada definitif olarak tedavi edilebilir nükslerin erken tespitinin sağkalıma katkısı olduğu bilinmektedir. European Society for Medical Oncology (ESMO) ve American Society of Clinical Oncology (ASCO) ilk 2 yıl 6 ayda bir sonra yıllık toraks bilgisayarlı tomografi (BT) takibi önerirken, National Comprehensive Cancer Network (NCCN) ise evre 1,2 hastalıkta ilk 2-3 yıl 6 ayda bir, evre 3-4 yada definitif kemoradyoterapi (KRT) ile tedavi edilen hastalarda ilk 3 yıl 3-6 ayda bir sonra 2 yıl 6 ayda bir toraks BT ile takip öneriyor. Nükslerin definitif tedavi edilebilir erken evrelerde tespiti amaçlandığından klinik pratikiğimizde genellikle NCCN’in önerdiği gibi daha sıkı bir takip stratejisi benimsenmektedir.
In non-small cell lung cancer (NSCLC), the goal of post-therapy follow-up is to identify and treat adverse effects of treatment, diagnose disease recurrence early, and promptly connect patients to advanced treatments and support. It is considered that treatment success and survival may be improved by early recurrence detection. Although there is limited information that the detection of asymptomatic recurrences results in better survival outcomes, there are doubts that this situation does not contribute to survival, although it does bring the time of diagnosis earlier. Nonetheless, it is generally accepted that survival is improved by early diagnosis of local and definitively curable recurrences. While the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) recommend thorax computed tomography (CT) follow-up every 6 months for the first 2 years and then annually, the National Comprehensive Cancer Network (NCCN) recommends thorax CT follow-up every 6 months for the first 2-3 years for patients with stage 1 and stage 2 disease, every 3-6 months for the first 3 years, and then every 6 months for the next 2 years for patients in stages 3-4 or those receiving definitive chemoradiotherapy(KRT). Our clinical practice typically follows the NCCN's recommendation for a more intensive follow-up method since the goal is to identify recurrences in their early, definitely curable stages.
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