Pediatrik Hastaların Radyoterapisinde Radyasyon Maruziyetinin Gelecekteki Sorunları
Özet
Kanser tedavisindeki multimodal yaklaşımlar ve radyoterapi (RT) teknolojisindeki ilerlemeler, pediatrik kanser hastalarında 5 yıllık sağkalım oranlarını %85 civarına yükselterek mortaliteyi önemli ölçüde azaltmıştır. Ancak bu başarı, erişkinlere kıyasla önlerinde çok daha uzun bir yaşam süresi bulunan çocuklarda, tedaviye bağlı geç yan etkileri ve mortalite riskini en önemli sorun olarak ön plana çıkarmıştır. Pediatrik hastaların hassas doku ve organ toleranslarını belirlemek amacıyla PENTEC gibi doz-hacim-risk rehberleri geliştirilmiştir. RT uygulamaları; kranial alanda nörokognitif bozukluklara, IQ düşüşüne ve nöroendokrin düzensizliklere yol açabilirken; kardiyovasküler sistemde mikrovasküler hasara bağlı mortal riskler oluşturmaktadır. Ayrıca büyüme geriliği, işitme ve görme kayıpları ile normal popülasyona göre 6 kat artmış ikincil kanser gelişimi gibi ciddi anatomik ve fonksiyonel sorunlar tetiklenebilmektedir. Bu dinamikler karşısında radyasyon onkologlarının, çocukların yetişkinlerden farklı olan anatomik küçüklüğünü, uzun yaşam beklentisini ve sosyopsikolojik adaptasyon yeteneğini gözeterek, sadece 5 yıllık sağkalımı değil, 70-80 yıllık sağlıklı bir ömrü hedefleyen, vicdani ve yüksek titizlikte bir tedavi vizyonu benimsemeleri gerekmektedir.
Advances in multimodal treatments and radiotherapy (RT) technology have significantly reduced mortality by raising 5-year survival rates to around 85% in pediatric cancer patients. However, this success has brought treatment-related late effects and mortality risks to the forefront as the most critical issues in children, who have a much longer life expectancy compared to adults. To determine the delicate tissue and organ tolerances of pediatric patients, dose-volume-risk guidelines such as PENTEC have been developed. While cranial RT applications can lead to neurocognitive impairments, a decrease in IQ, and neuroendocrine disorders, they also pose mortal risks in the cardiovascular system due to microvascular damage. Furthermore, severe anatomical and functional problems such as growth retardation, hearing and visual loss, and a 6-fold increased risk of secondary cancers compared to the normal population can be triggered. In the face of these dynamics, radiation oncologists must consider children's anatomical smallness, long life expectancy, and sociopsychological adaptation skills, which differ from adults, and adopt a conscientious, highly meticulous treatment vision prioritizing a 70-80 year healthy survival rather than just a 5-year survival.
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