Tedaviye Sekonder İskelet Sistemi Bozuklukları, Tedavisi ve Alınacak Önlemler
Özet
Günümüzde kanser vakalarının ve sağ kalım oranlarının artmasıyla birlikte, önemli bir tedavi yöntemi olan radyoterapinin (RT) iskelet sistemi üzerindeki olumsuz etkileri daha görünür hale gelmiştir. RT, sağlıklı hücrelerde iyonize radyasyon nedeniyle doğrudan DNA hasarı veya dolaylı serbest oksijen radikalleri oluşumu yoluyla hücresel yaşlanma, apopitoz, damar tıkanıklığı ve atrofiye yol açmaktadır. Bu durumun sonucunda iskelet sisteminde radyasyon osteiti, osteoradyonekroz, avasküler nekroz, osteoporoz, yüksek kaynamama oranlarına sahip yetmezlik kırıkları ve sekonder olarak iyi huylu bir tümör olan osteokondroma gelişebilmektedir. Bu hasarların boyutu emilen doza, fraksiyona, yaşa, kemik yapısına ve ilaç kullanımına bağlıdır. Özellikle 16 yaş altı çocuklarda epifizin ışınlanması; asimetrik büyümeye, ekstremite kısalıklarına ve skolyoz gibi kalıcı postural deformitelere neden olan kritik bir doz sınırlayıcı faktördür. Bu olumsuz etkileri azaltmak amacıyla amifostin gibi radyoprotektörler ve radyomitigatörler geliştirilmekte, ayrıca yoğunluk modülasyonlu radyoterapi (IMRT) gibi modern tekniklerle doz azaltımı yapılarak sağlıklı dokunun korunması hedeflenmektedir.
With the increase in cancer cases and survival rates today, the negative effects of radiotherapy (RT), a crucial treatment modality, on the skeletal system have become more prominent. RT induces cellular senescence, apoptosis, vascular occlusion, and atrophy in healthy cells through direct DNA damage or indirect formation of free oxygen radicals caused by ionizing radiation. Consequently, skeletal conditions such as radiation osteitis, osteoradionecrosis, avascular necrosis, osteoporosis, insufficiency fractures with high nonunion rates, and secondary osteochondroma, a benign tumor, can develop. The extent of this damage depends on the absorbed dose, fractionation, age, bone structures, and medication use. Particularly in children under 16, irradiation of the epiphysis is a critical dose-limiting factor that causes asymmetric growth, limb shortening, and permanent postural deformities like scoliosis. To mitigate these adverse effects, radioprotectors such as amifostine and radiomitigators are being developed, and technical advancements like intensity-modulated radiotherapy (IMRT) are utilized to minimize doses and protect healthy tissues.
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