Neoadjuvan Tedavi Uygulanmış Meme Kanserli Hastalarda Aksillaya Onkolojik Yaklaşım
Özet
Bu bölüm, neoadjuvan tedavi (NST) uygulanmış meme kanseri hastalarında aksiller bölgeye yönelik güncel onkolojik yönetim stratejilerini detaylandırmaktadır. NST, tümör boyutunu küçültmek, cerrahi seçenekleri genişletmek ve sistemik tedavinin etkinliğini değerlendirmek amacıyla yaygın olarak kullanılmaktadır. Aksiller lenf nodu (ALN) yönetimi, başlangıç evresine ve tedavi yanıtına bağlı olarak önemli ölçüde değişim göstermiştir.
Sentinel Lenf Nodu Biyopsisinin (SLNB) tanıtılmasıyla erken evre hastalar için cerrahi yaklaşım kökten değişmiş, aksiller lenf nodu diseksiyonuna (ALND) kıyasla daha az morbidite elde edilmiştir. Klinik olarak nod pozitif (cN+) hastalarda, nodal tam patolojik yanıt (pCR) sağlandığında ALND’den kaçınma potansiyeli artmaktadır. Özellikle hedeflenmiş aksiller diseksiyon (TAD), düşük yalancı negatiflik oranları ile dikkat çekmektedir. Bölüm, SLN’de rezidü hastalık veya izole tümör hücreleri (ITC) saptanan hastaların yönetimini ve devam eden klinik çalışmaların (ICARO, NSABP B-51) sonuçlarını ele alarak, nodal pCR elde eden hastalarda bölgesel nodal ışınlamanın (RNI) de-eskalasyon potansiyelini vurgulamaktadır. Multidisipliner yaklaşım, onkolojik sonuçları riske atmadan tedavi yükünü azaltmada kritik bir rol oynamaktadır
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