Radyoterapinin Vasküler Komplikasyonları ve Alınacak Önlemler
Özet
Radyoterapi, kanser tedavisinde yaygın olarak kullanılan bir yöntem olmasına rağmen, özellikle kan damarlarının iyonize radyasyona son derece duyarlı olan intima tabakasındaki endotel hücrelerine zarar vererek ciddi vasküler komplikasyonlara yol açabilmektedir. Tedavinin akut döneminde DNA hasarı, inflamasyon, tromboz oluşumu ve kapiller rüptürler gözlenirken; kronik dönemde hücresel yaşlanma, ilerleyici fibrozis ve erken dönem ateroskleroz gelişimi tetiklenmektedir. Vasküler etkilenmeler damar boyutlarına göre değişiklik gösterir; küçük ve orta boy damarlarda luminal tıkanmalar ve intimal fibrozis sıklıkla izlenirken, büyük boy arterlerde atipik yerleşimli frajil aterosklerotik plaklar, darlıklar, anevrizmalar ve rüptür riski yüksek frajil yapılar oluşmaktadır. Klinik pratikte en sık radyasyona bağlı karotis arter darlığı ile karşılaşılmakta, bunu subklavyen, aksiller, iliak ve femoral arter hastalıkları takip etmektedir. Venöz sistemde ise tümör fibrozisine komşuluk veya doğrudan endotel hasarı nedeniyle Vena Kava Süperior sendromu ile iliak ve femoral ven stenozları gelişebilmekte ve tromboz riski belirgin şekilde artmaktadır. Bu komplikasyonların yönetiminde statinler ve antiagreganları içeren agresif medikal tedavilerin yanı sıra perkütan endovasküler girişimler (balon, stent) ve açık cerrahi baypas seçenekleri uygulanmakta, ancak radyasyonun yol açtığı yoğun doku fibrozisi cerrahi prosedürleri oldukça zorlaştırmaktadır.
Radiation therapy is a widely used method in cancer treatment, yet it can cause severe vascular complications by damaging endothelial cells in the tunica intima layer of blood vessels, which is highly sensitive to ionizing radiation. During the acute phase of treatment, DNA damage, inflammation, thrombosis, and capillary ruptures are observed, whereas cellular senescence, progressive fibrosis, and accelerated atherosclerosis are triggered in the chronic phase. Vascular involvement varies by vessel size; small and medium-sized vessels frequently display luminal occlusions and intimal fibrosis, while large arteries develop atypical, fragile atherosclerotic plaques, stenoses, aneurysms, and fatal rupture risks. In clinical practice, radiation-induced carotid artery stenosis is the most common manifestation, followed by subclavian, axillary, iliac, and femoral artery diseases. In the venous system, direct endothelial damage or fibrosis adjacent to tumors leads to Superior Vena Cava syndrome and iliac-femoral vein stenoses, significantly increasing thrombosis risk. Management of these complications involves aggressive medical therapies including statins and antiplatelets, alongside percutaneous endovascular interventions (ballooning, stenting) and open surgical bypass options; however, severe radiation-induced tissue fibrosis significantly complicates surgical procedures.
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