Yumuşak Doku Sarkomları
Özet
Yumuşak doku sarkomları (YDS), tüm erişkin kanserlerin %1’i oluşturan, mezenkimal dokulardan kaynaklanan, nadir görülen ve heterojen malign tümörlerdendir. Sağkalım sonucu sarkomun histolojik alt tipine, sarkomun primer veya tutulum yaptığı uzak yerleşim yerine, histolojik tümör derecesine, yapılacak olan tedavi tipi ve tedaviye verilen yanıta göre değişiklik göstermektedir. Lokalize hastalıkta cerrahi, birçok YDS’da tedavinin temel taşı olarak kabul edilmektedir. Fonksiyonel organ koruması için veya cerrahi sınır negatif tam rezeksiyon elde etmek için neoadjuvan radyoterapi ve kemoterapinin tedavide önemli bir rolü bulunmaktadır. Adjuvan sistemik tedaviden fayda görecek hastaların belirlenmesi önemlidir. Tüm kanserlerde olduğu gibi bu kanser grubunda da optimal takip, nüksün erken teşhisi ve tedaviye bağlı yan etkilerin izlenmesi için çok önemlidir ve prognozunu etkiler. Literatürde optimal rutin takip ile ilgili çok az veri bulunmaktadır. Bu bölüm, YDS’de optimal takip için bir genel bakış sunmakta ve histolojik alt tip, tümör boyutu ve evresine göre kişiselleştirilmiş tedavinin önemini vurgulamaktadır. Bu bilgilere ek olarak takipte değerlendirilecek görüntüleme yöntemleri, takip sıklığı ve genetik değerlendirmelerin entegrasyonu yer almaktadır. Bu bölümde ayrıca, bu tür hastaları etkin bir şekilde takip etmek olası nüks ya da metastazları erkenden saptayarak potansiyel tedavi şansını kaçırmamak açısından çok önemli olduğu da ele alınmaktadır. YDS tedavi ve takibinin mutlaka multidisipliner ekiple birlikte sarkom merkezlerinde yapılması, bu hastaların uzun vadeli sonuçlarının en üst düzeye ulaşmasına yardımcı olacaktır.
Soft tissue sarcomas (STS) are rare and heterogeneous malignant tumors originating from mesenchymal tissues, accounting for 1% of all adult cancers. Survival outcome depends on the histological subtype of the sarcoma, the primary or distant location of the sarcoma, the histological tumor grade, the type of treatment and the response to treatment. In localized disease, surgery is considered the cornerstone of treatment in many STS. Neoadjuvant radiotherapy and chemotherapy have an important role in treatment for functional organ preservation or to achieve complete resection with negative surgical margins. It is important to identify patients who will benefit from adjuvant systemic therapy. As in all cancers, optimal follow-up in this cancer group is very important for early diagnosis of recurrence and monitoring of treatment-related side effects and affects the prognosis. There is very limited data on optimal routine follow-up in the literature. This chapter provides an overview of optimal follow-up in STS and emphasizes the importance of personalized treatment according to histological subtype, tumor size and stage. In addition to this information, imaging modalities to be considered in follow-up, frequency of follow-up and integration of genetic evaluations are included. This chapter also discusses that effective follow-up of such patients is crucial in order to detect possible recurrence or metastases at an early stage and to avoid missing the chance of potential treatment. Treatment and follow-up of STS in sarcoma centers with a multidisciplinary team will help maximize the long-term outcome of these patients.
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