Metastatik Tiroid Kanserlerinde Tedavi Seçenekleri
Özet
Tiroid kanseri en sık görülen endokrin tümörlerden biridir ve yaygınlığı son yıllarda giderek artmaktadır. 2012 yılında kadınlar arasındaki tahmini insidans oranlarının erkeklerden yaklaşık üç kat daha yüksek olduğunu göstermektedir. Tiroid kanseri ile ilişkili tahmini ölüm oranları ise düşüktür (kadınlar ve erkekler için sırasıyla 100 000 kişi yılda 0,7 ve 0,5 vaka). Tiroid kanserli olguların %90’ından fazlası papiller ve foliküler alt tipleri içerendiferansiye tiroid kanseri olarak ortaya çıkmaktadır. Diferansiye tiroid kanseri hastalarında yaklaşık %10-15’inde uzak metastaz vardır, prognoz kötüdür. Medullar tiroid kanseri Amerika Birleşik Devletlerindeki tiroid kanserlerinin %1-%2’sini oluşturmaktadır. Hastalar için tedavi sonrası prognoz, diferansiye tiroid kanseri olanlara kıyasla daha kötüdür ve mortalite tiroid kanserine bağlı ölümlerin %13’ü dür. Uzak metastazları olan bireyler daha kötü bir prognozludur ve 10 yıllık sağkalım oranı yalnızca %40’tır. Anaplastik tiroid kanseri nadir görülen ancak oldukça agresif bir malignitedir. Tüm tiroid kanseri türlerinin %2’sinden daha azını oluşturmasına rağmen, tiroid kanseri ile ilişkili yıllık ölüm oranının %50’sinden fazlasını oluşturur. Uzak metastazlar genellikle klinik semptomlar veya şüpheli görüntüleme/laboratuvar bulguları nedeniyle teşhis edilir. Metastatik tiroid kanserlerinde cerrahi, sistemik tedavi, radyoaktif iyot, eksternal ışın radyasyon tedavisi, stereotaktik radyoterapi. perkütan etanol enjeksiyonu gibi tedavi seçenekleri uygulanmaktadır. Metastatik hastalık bölgelerine yaklaşımda çok odaklı metastatik hastalıkların oluşturduğu tehdit ile bireysel lezyonların oluşturduğu tehdit kişiselleştirilmeli ve hastanın bakım hedefleri dikkate alınmalıdır.
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