Baş Boyun Radyoterapisi Sonrası Tükürük Bezi Disfonksiyonu, Kserostomi Alınması Gereken Önlemler
Özet
Baş boyun kanserlerinin tedavisinde önemli bir rol oynayan radyoterapi (RT), hedef tümörün yanı sıra tükürük bezleri gibi sağlıklı ikincil dokularda da fonksiyon kayıplarına yol açabilmektedir. Bu istenmeyen etkilerin en başında, hastaların yaklaşık %70'inde görülen ve objektif olarak tükürük miktarının azalarak içeriğinin değişmesi şeklinde tanımlanan kserostomi (ağız kuruluğu) gelmektedir. Tükürük bezlerinin toplam 50 Gy doza maruz kalmasından bir hafta sonra tükürük akışı yarı yarıya azalmakta ve kalıcı hasar oluşmaktadır. Kserostomi; konuşma, çiğneme, yutma ve uyku gibi temel günlük aktiviteleri olumsuz etkileyerek hastaların yaşam kalitesini ciddi ölçüde düşürür. Erken evrelerde hidrasyon ve şekersiz sakız gibi basit önlemler tercih edilirken, ileri düzeylerde kolinerjik ilaçlar (pilokarpin, cevimeline), akupunktur, elektrostimülasyon ve cerrahi bez transferi gibi yöntemlere başvurulmaktadır. Günümüzde Yoğunluk Ayarlı Radyoterapi (IMRT/VMAT) ve proton tedavileri tükürük bezlerini korumada en etkili teknolojik yöntemler olarak öne çıkarken, gelecekte kserostomi tedavisinde gen ve mezenkimal kök hücre tedavilerinin umut vadettiği görülmektedir.
Radiotherapy (RT) plays a crucial role in managing head and neck cancers, yet it frequently induces adverse effects on adjacent healthy tissues, particularly the salivary glands. The most significant manifestation is xerostomia (dry mouth), characterized by a reduction in saliva volume and alterations in its composition, affecting approximately 70% of patients. Exposure of salivary glands to a cumulative dose of 50 Gy diminishes salivary flow by half within a week, leading to permanent damage, which escalates further during standard treatments reaching 65–75 Gy. This dysfunction severely impairs vital daily activities such as speaking, swallowing, chewing, and sleeping, thereby degrading the patient's quality of life. Management strategies range from non-pharmacological interventions like hydration and sugar-free gum for mild cases, to sialagogues (pilocarpine, cevimeline) and advanced therapies including acupuncture, electrostimulation, and hyperbaric oxygen. Modern techniques like Intensity-Modulated Radiation Therapy (IMRT/VMAT) and proton therapy are highly effective in preserving gland function, while emerging fields like gene transfer and mesenchymal stem cell therapies offer promising future alternatives for restoration.
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