Meme Kanserinde Aksilla Yönetimi
Özet
Aksiller cerrahi, meme kanseri yönetiminde tarihsel olarak tedavi edici bir girişim olarak kabul edilirken, günümüzde evreleme ve prognostik bilgi sağlama amacına evrilmiştir. Radikal mastektomi ile başlayan süreç, modifiye teknikler ve sonrasında sentinel lenf nodu biyopsisinin (SLNB) uygulanmasıyla giderek daha minimal ve morbiditesi düşük yaklaşımlara dönüşmüştür. ACOSOG Z0011, AMAROS ve benzeri çalışmalar, sınırlı aksiller metastaz varlığında aksiller lenf nodu diseksiyonunun (ALND) sağkalım avantajı sağlamadığını ve aksiller radyoterapi ile benzer onkolojik sonuçlar elde edildiğini göstermiştir. Güncel kılavuzlar, klinik olarak nod-negatif hastalarda SLNB’yi standart yöntem olarak önermekte; negatif SLNB durumunda ek aksiller cerrahinin gerekli olmadığını vurgulamaktadır. Mikrometastatik nodal hastalıkta ALND’nin sağkalım üzerine etkisi olmadığı, makrometastatik sınırlı tutulumda ise SLNB’nin radyoterapi ile kombine edilmesinin güvenli olduğu gösterilmiştir. Neoadjuvan kemoterapi ve endokrin tedavi sonrası aksiller yönetim, yanıtın değerlendirilmesiyle şekillenmekte olup, hedeflenmiş aksiller diseksiyon (TAD) gibi yöntemler cerrahinin kapsamını azaltmaktadır. Böylece aksiller cerrahinin rolü, düşük morbidite ile doğru evreleme sağlamaya yönelmiş; multidisipliner tedavi stratejileri ile kişiselleştirilmiş yaklaşım ön plana çıkmıştır.
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