Nüks Tiroid Kanserlerinde Tedavi Algoritmleri
Özet
Diferansiye tiroid karsinomu (DTK), tüm tiroid malignitelerinin %90’ından fazlasını oluşturur ve genellikle iyi prognoza sahiptir. Ancak hastaların %15–30’unda nüks gelişebilir. Nüksün saptanmasında tiroglobulin (Tg) düzeyleri, anti-Tg antikorları, yüksek çözünürlüklü ultrasonografi (US), bilgisayarlı tomografi (BT) ve pozitron emisyon tomografisi (PET-BT) kritik rol oynar. Biyokimyasal nüks, Tg veya anti-Tg antikor artışıyla; yapısal nüks ise boyun lenf düğümleri veya uzak metastazlarla tanımlanır. Tedavide ilk basamak cerrahi rezeksiyon olup, adjuvan radyoaktif iyot (RAI) tedavisi yaygın şekilde uygulanır. Nüks eden olgularda lokal/lokorejyonel hastalık cerrahiyle tedavi edilmeye çalışılır, ancak bazı durumlarda eksternal radyoterapi (RT), radyofrekans ablasyon (RFA) veya perkütan lazer ablasyonu (PLA) gibi girişimsel yöntemler tercih edilir. RAI refrakter hastalıkta prognoz belirgin olarak kötüleşir. Bu durumda sistemik tedaviler,özellikle tirozin kinaz inhibitörleri (TKI) öne çıkar. Lenvatinib ve sorafenib, Faz III çalışmalarda progresyonsuz sağkalımı anlamlı şekilde uzatmıştır. Günümüzde risk sınıflaması, ATA kılavuzları ve TNM evreleme, tedavi yaklaşımını belirlemede yol göstericidir. Nüks tiroid kanserinin yönetiminde multidisipliner yaklaşım ve kişiselleştirilmiş tedavi stratejileri önem taşır.
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