Üst Üriner Sistem Tümorlerinin Tedavi Yönetimi
Özet
Üst üriner sistem tümörleri (ÜÜST), nadir ancak klinik açıdan önemli malignitelerdir ve tedavi yönetimi büyük ölçüde risk sınıflandırmasına dayanır. Düşük riskli olgularda, böbrek fonksiyonlarını korumak amacıyla endoskopik lazer ablasyon veya üreterorenoskopi gibi böbrek koruyucu yaklaşımlar önceliklidir. Bu yöntemler, uygun hasta seçimi ile radikal cerrahiye benzer sağkalım sağlamaktadır. Yüksek riskli hastalarda altın standart tedavi radikal nefreüreterektomi (RNU) ve mesane cuff eksizyonudur. Lenfadenektomi onkolojik sonuçları iyileştirebilir. Bazı seçilmiş vakalarda segmental üreter rezeksiyonu uygulanabilmektedir. Cisplatin bazlı kemoterapi, hem neoadjuvan hem de adjuvan tedavide sağkalımı artırmada kritik rol oynamaktadır. RNÜ sonrası mesane nüksünü azaltmak için intravezikal tedavi önerilmektedir. Metastatik hastalıkta sisplatin kombinasyonları standarttır. Uygun vakalarda immünoterapiler (avelumab, pembrolizumab, atezolizumab) ek seçenek olarak kullanılabilir. Tedavi sonrası dönemde, rekürrens ve metastazların erken saptanabilmesi için sistoskopi, görüntüleme ve idrar sitolojisi ile risk temelli yakın takip gereklidir. Genel olarak, ÜÜST tedavisi; tümörün risk düzeyi, böbrek fonksiyonları ve hastanın eşlik eden komorbiditeleri dikkate alınarak kişiselleştirilmelidir.
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