Mesane Kanserinde Radyoterapi Endikasyonları ve Uygulama Prensipleri
Özet
Mesane kanseri (MK), üriner sistemin en sık görülen ikinci malignitesidir ve tedavi yaklaşımı hastalığın evresi, hastanın performansı ve eşlik eden hastalıklarına göre değişmektedir. Kasa invaziv olmayan mesane kanserinde (KİOMK) primer RT standart tedavi değildir; ancak BCG’ye dirençli, radikal sistektomiye uygun olmayan veya cerrahiyi tercih etmeyen seçilmiş hastalarda küratif tedavi için iyi bir alternatif olmaktadır. Kasa invaziv mesane kanserinde (KİMK) ise maksimal transüretral mesane tümör rezeksiyonu (TUR-MT) sonrasında eş zamanlı kemoradyoterapi ile uygulanan trimodal tedavi (TMT), beş yıllık genel sağkalım oranlarında %36–74, mesane koruma oranlarında %42–67 gibi sonuçlar sağlayarak radikal sistektomi ile benzer uzun dönem etkinlik göstermektedir. Yapılan meta-analizlerde hem 20 fraksiyonda 55 Gy’lik hipofraksiyone şemalar hem de 32 fraksiyonda 64 Gy’lik konvansiyonel şemalar benzer lokal-bölgesel kontrol ve toksisite profiline sahip oldukları gösterilmiştir. Sistektomi sonrasında ise cerrahi sınır pozitifliği, pT3–T4 hastalık veya tutulu lenf nodu varlığında adjuvan RT önerilmektedir. Ayrıca kanama veya pelvik ağrı gibi semptomları olan MK’lı hastalarda da palyatif RT etkili olmaktadır. Sonuç olarak, modern görüntüleme ve ileri planlama tekniklerinin yanı sıra eş zamanlı kemoterapi kullanımı, RT’yi mesane kanseri yönetiminde cerrahiye alternatif veya tamamlayıcı, organ koruyucu ve yüksek etkinlik sağlayan bir tedavi seçeneği haline getirmiştir.
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