Adrenal Bez Tümörlerinde Radyoterapi
Özet
Adrenal bez tümörlerinde radyoterapi (RT) uygulamalarını ele alan bu çalışma, iyonizan radyasyonun kanser hücrelerinin DNA'sına hasar vererek mitotik hücre ölümüne yol açma mekanizmasını ve tedavinin maksimum etkinliğe ulaştığı dönemin RT bitiminden üç ay sonrası olduğunu belirterek başlar. Temel amacın çevre dokuları koruyarak hedef hacme (GTV, CTV, PTV) odaklanmak olduğu vurgulanırken, nadir görülen primer adrenal tümörlerden adrenokortikal karsinomda (AKK) cerrahi ana tedavi yöntemi olsa da lokal nüksü azaltmak adına özellikle pozitif cerrahi sınır varlığında adjuvan RT'nin rolü tartışılmaktadır. Çocukluk çağında sık rastlanan nöroblastomada RT, International Neuroblastoma Risk Group (INRG) sınıflandırmasına göre yüksek riskli gruplarda standart olarak, düşük ve orta riskli gruplarda ise klinik semptomların varlığında tercih edilir. Son dönemde popülerleşen Stereotaktik Beden Radyoterapisi (SBRT), adrenal beze en sık yönelen metastatik ve oligometastatik olgularda, hipofraksiyonasyon yöntemiyle az sayıda seansta yüksek doz radyasyon vererek çevre kritik organları koruyan ve yüksek lokal kontrol sağlayan etkin bir birinci basamak tedavi seçeneği olarak öne çıkmaktadır.
This study, which addresses radiotherapy (RT) applications in adrenal gland tumors, begins by stating that ionizing radiation causes mitotic cell death by damaging the DNA of cancer cells and that the period when the treatment reaches maximum efficacy is three months after the end of RT. While it is emphasized that the primary goal is to focus on the target volume (GTV, CTV, PTV) while protecting surrounding tissues, the role of adjuvant RT, especially in the presence of positive surgical margins, is controversial in reducing local recurrence in adrenocortical carcinoma (ACC), where surgery is the primary treatment method despite being a rare primary adrenal tumor. In neuroblastoma, which is frequently encountered in childhood, RT is preferred as a standard in high-risk groups according to the International Neuroblastoma Risk Group (INRG) classification, and in the presence of clinical symptoms in low and medium-risk groups. Stereotactic Body Radiotherapy (SBRT), which has become popular recently, stands out as an effective first-line treatment option that provides high local control while protecting surrounding critical organs by delivering high biological effective doses in a small number of fractions using the hypofractionation method in metastatic and oligometastatic cases that most frequently target the adrenal gland.
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