Pankreas Tümörlerinde Neoadjuvan ve Adjuvan Onkolojik Tedaviler
Özet
Pankreas kanserinde neoadjuvan ve adjuvan onkolojik tedavilerin güncel durumunu inceleyen bu çalışma, dünya genelinde insidansı artan ve prognozu oldukça kötü olan bu hastalıkta sağkalımı artırmaya yönelik yaklaşımları ele almaktadır. Uzun süreli sağkalım için negatif sınırlarla yapılan cerrahi rezeksiyonun kritik önemine değinilerek, cerrahi sonrası uygulanan adjuvan tedavilerin nüks oranlarını azalttığı ve mFOLFIRINOX rejiminin standart haline geldiği belirtilmektedir. Cerrahi öncesi uygulanan neoadjuvan tedavilerin (NAT) ise tümör boyutunu küçülterek rezektabilite şansını artırdığı, cerrahi komplikasyonları azalttığı ve mikrometastatik hastalığı erken aşamada hedeflediği vurgulanmaktadır. Özellikle FOLFIRINOX ve Gemsitabin+nab-paklitaksel gibi rejimlerin sağkalım üzerindeki olumlu etkileri çeşitli klinik çalışmalarla desteklenmektedir. Sonuç olarak, pankreas kanserinde tedavi sonuçlarını optimize etmek için net evreleme kılavuzlarına dayanan multidisipliner bir yaklaşım ve faz III çalışmalarla desteklenen kanıtlara ihtiyaç duyulmaktadır.
This study, which examines current neoadjuvant and adjuvant oncological treatments in pancreatic cancer, addresses approaches to increasing survival in this disease, whose incidence is increasing globally and whose prognosis is quite poor. Emphasizing the critical importance of surgical resection with negative margins for long-term survival, it is stated that adjuvant treatments applied after surgery reduce recurrence rates and the mFOLFIRINOX regimen has become the standard. It is highlighted that neoadjuvant treatments (NAT) applied before surgery increase the chance of resectability by reducing tumor size, decrease surgical complications, and target micrometastatic disease at an early stage. The positive effects of regimens such as FOLFIRINOX and Gemcitabine+nab-paclitaxel on survival are supported by various clinical studies. Consequently, a multidisciplinary approach based on clear staging guidelines and evidence supported by phase III trials is required to optimize treatment outcomes in pancreatic cancer.
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