Baş Boyun Bölgesinde Radyoterapi Sonrası Değişiklikler ve Karotis Değerlendirilmesi
Özet
Baş ve boyun kanserlerinin tedavisinde radyoterapi (RT) temel dayanak olmakla birlikte, yumuşak doku ödemi, mukozit, fibrozis ve atrofi gibi erken veya geç dönem yapısal değişikliklere yol açarak nüks tümörlerin klinik ve radyolojik tespitini zorlaştırmaktadır. Bu süreçteki en kritik geç komplikasyonlardan biri, radyasyonun damar duvarında inflamasyon, intima-media kalınlığında (İMK) artış ve heterojen plak oluşumu tetiklemesiyle gelişen karotis arter aterosklerozudur. Literatür, RT sonrasında iskemik inme ve geçici iskemik atak riskinin en az iki kat arttığını ve radyasyona bağlı stenozun diğer aterosklerotik süreçlere kıyasla çok daha hızlı ilerlediğini göstermektedir. Tanıda B-Mod, renkli Doppler, Duplex ve kontrastlı ultrasonografi (USG) gibi modaliteler kullanılmakta olup, özellikle Duplex USG yüksek riskli hastaların tespiti ve stenoz takibinde öne çıkmaktadır. Her ne kadar rutin karotis taramasına yönelik evrensel bir kılavuz bulunmasa da, artan yaşam süreleri ve eşlik eden risk faktörleri göz önüne alındığında, serebrovasküler olayları engellemek amacıyla RT almış hastalarda düzenli ultrason taramalarının yapılması klinik takibin optimize edilmesi açısından büyük önem taşımaktadır.
Although radiotherapy (RT) remains a cornerstone in treating head and neck malignancies, it induces structural alterations such as interstitial edema, mucositis, fibrosis, and tissue atrophy, which can obscure or mimic tumor recurrence during clinical and radiological examinations. Among these alterations, radiation-induced carotid artery atherosclerosis represents a clinically significant late complication driven by vessel wall inflammation, increased intima-media thickness (IMT), and accelerated heterogeneous plaque formation. Studies indicate that head and neck RT at least doubles the relative risk of ischemic stroke and transient ischemic attack, with radiation-induced stenosis progressing substantially faster than conventional atherosclerotic disease. Diagnostic modalities including B-Mode, color Doppler, Duplex, and contrast-enhanced ultrasonography (USG) are utilized to detect these vascular shifts, with Duplex USG demonstrating robust utility in stratifying high-risk cohorts and tracking stenotic progression. Despite the current lack of a consensus guidelines for routine surveillance in this patient population, the expanded long-term survival rates coupled with traditional cardiovascular comorbidities underscore the necessity of integrating routine ultrasound screening into post-RT follow-up protocols to effectively mitigate neurovascular morbidities.
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