[et_pb_section fb_built=”1″ fullwidth=”on” _builder_version=”4.4.8″ background_color=”rgba(0,0,0,0)” background_image=”https:\/\/www.intheranostics.com\/wp-content\/uploads\/2020\/06\/metastatik_prostat_kanseri.jpg” custom_padding=”100px||100px||false|false” locked=”off”][et_pb_fullwidth_header title=”Lutetium-177 PSMA Treatment” text_orientation=”center” content_max_width_last_edited=”off|desktop” _builder_version=”4.4.8″ title_font_size=”50px” content_font_size=”41px” subhead_font=”|700|||||||” subhead_font_size=”38px” subhead_line_height=”1.1em” background_enable_color=”off” background_enable_image=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” animation_style=”slide” animation_direction=”bottom”][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.4.8″ custom_margin=”0px||0px||false|false” custom_padding=”0px|0px|0px|0px|false|false”][et_pb_row _builder_version=”4.4.8″ custom_margin=”0px||||false|false” custom_padding=”0px|0px|0px|0px|false|false”][et_pb_column type=”4_4″ admin_label=”Column” _builder_version=”4.4.8″][et_pb_divider divider_weight=”0px” _builder_version=”4.4.8″ use_background_color_gradient=”on” background_color_gradient_start=”#8dd2e1″ background_color_gradient_end=”#23afca” background_color_gradient_direction=”90deg” width=”50%” module_alignment=”center” height=”10px”][\/et_pb_divider][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ admin_label=”section” _builder_version=”4.4.8″][et_pb_row admin_label=”row” _builder_version=”4.4.8″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” custom_margin=”||||false|false” custom_padding=”0px|0px|0px|0px|false|false”][et_pb_column type=”4_4″ admin_label=”Column” _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.4.8″ hover_enabled=”0″]<\/p>\n
Cancer is caused by uncontrollably growing and proliferating cells. When cancer begins in the prostate gland tissue, it is called prostate cancer<\/strong>. The condition in which prostate cancer cells spread to other parts of the body forming multiple focuses is called metastatic prostate cancer<\/strong>.<\/p>\n Theranostic is an emerging field in the medical world. It is an approach in which tumor and metastases detected by imaging with a tumor-specific drug and they can be treated with a same specific drug, which is previously known, how far it will go, and how its power will affect the diseased tissue. \u00a0In prostate cancer, on the one hand, GA-68 PSMA PET\/CT can visualize the tumoral tissues of prostate cancer with high sensitivity and specificity, on the other hand, specific and targeted treatment of these tumoral tissues can be performed with Lu-177 PSMA. This is a very successful and new method for theranostic applications.<\/p>\n Lu-177 PSMA therapy <\/strong>is an innovative and effective treatment that is increasingly used to treat metastatic castration-resistant prostate cancer. Generally, it is used with the recommendation of the referring physician when other approved methods are insufficient, shown to be ineffective or patients cannot tolerate them. This treatment; It helps to reduce tumor size and prevent tumor proliferation, as well as reduce signs and symptoms caused by the tumor.<\/p>\n Lu-177 PSMA therapy has passed phase I and phase II trials and is being tested in phase III randomized clinical trials. Therefore, it is not yet a part of routine clinical therapy. Nevertheless, it has been shown that long-term improvement can be achieved with Lu-177 PSMA treatment in many prostate cancer patients. Currently, there are a limited number of clinics in our country and in the world that offer this treatment service for patients with advanced and metastatic prostate cancer.<\/p>\n Most types of prostate cancer have high levels of tumor-like PSMA sought for treatment. However, it is also known that 5 to 10 percent of all prostate cancer patients do not produce PSMA. Therefore, before starting Lu-177 PSMA therapy, imaging with GA-68 PSMA PET\/CT is performed to determine if the treatment is targeting the tumor tissue.<\/p>\n PSMA is a type of protein found in healthy prostate cell membranes with multiple cellular functions. Although healthy prostate cells naturally produce very low levels of PSMA, cancerous prostate tumors produce extremely high levels of PSMA (usually 1000 times higher than normal prostate cells). This is also valid for prostate cancer metastases in other parts of the body. The 177Lu atom is a radioactive element emitting radioactive beta particles that can be attached to a carrier molecule called PSMA. When Lu-177 PSMA is administered intravenously, it goes to all tumor tissues where PSMA is present and destroys these cancer cells by emitting radiation. Since Lu-177 PSMA therapy targets cancer tissue, the radiation dose received in other parts of the body is very low. The part of Lu-177 PSMA that is not retained by tumor cells passes into saliva, urine and feces and is excreted from the body.<\/p>\n Lu-177 PSMA therapy is performed after the evaluations of a multidisciplinary team.<\/p>\n Who is Lutetium-177 PSMA Treatment Applied?<\/p>\n In patients with metastatic castration-resistant prostate cancer (mCRPC) and approved (alternative) no treatment methods are left \/ suitable, it can be applied with the recommendation of the responsible physician.<\/p>\n Before therapy, the patient must have gone through the following procedures :<\/p>\n – Total white cell count to be less than <2.5×109<\/sup>\/L<\/p>\n – Platelet count to be less than <75×109<\/sup>\/L<\/p>\n ECOG Performance Scale<\/em><\/strong><\/p>\n The radiation used in Lu-177 PSMA treatment is designed only to destroy cancer cells. Treatment with theranostics is more individual, so that cancer and metastases are effectively detected first. Then, the whole body dose is kept to a minimum and the cancer cells are destroyed by irradiation. Blood tests to ensure that the radiation does not damage healthy tissues; Imaging is also performed to ensure that the radioactive material in the tumor sites is properly placed.<\/p>\n Your Specialist Nuclear Medicine Physician will guide you about the possible side effects of the treatment and provide necessary advice. As the treatment is directed towards the tumor, serious side effects do usually not seen in most of the patients treated with Lu-177 PSMA. However, in some patients; Nausea, dry mouth, fatigue, decreased kidney function, and especially in patients with bone lesions, temporary decrease in blood cell production can be seen. The most common side effect is mild nausea. To prevent this, your physician will recommend anti-nausea medication if needed.<\/p>\n It is important that you bring the information and documents listed below with you on your first application to the clinic. The digital preparation of your patient information (DICOM, JPEG, PNG, PDF, Microsoft Word (.doc, .docx) etc.) will allow it to be shared quickly and easily by e-mail and will greatly facilitate the evaluation of your disease.<\/p>\n In addition, your Nuclear Medicine doctor will order the following blood tests. Since these tests are expected to show your condition during treatment, they should be done at least 2 weeks before treatment.<\/p>\n Your physician may also order additional blood tests as needed.<\/p>\n You need to make sure that at least 4 weeks have passed since your last chemotherapy administration. Before treatment, it is important that you have used the medication prescribed by your Nuclear Medicine Physician as recommended.<\/p>\n Since you will wear your own clothes during the treatment, we recommend that you bring comfortable and wide clothes with you. You can use the old clothes that you can throw away after wearing it during the treatment. Since the vascular access placed on your arm or the back of your hand will be used both for your treatment and to taking of blood for the tests, it will be useful to choose short-sleeved or wide-sleeved clothes.<\/p>\n Before treatment, if you do not have any special restrictions, you will be asked to drink plenty of water. Lu-177 PSMA will be administered through a vein placed on your arm or back of the hand in less than 1 minute, then saline will be given slowly through the vein for about half an hour. During and after the injection, you must remain in the clinic for the period specified by your Nuclear Medicine Physician. Urinary catheters are used with the recommendation of the Nuclear Medicine Physician in our patients who have urinary retention problems.<\/p>\n Your total treatment consists of 2 to 6 cycles to be applied at 6-8 week intervals. You should avoid close and prolonged contact with people until 24 hours after the injection (it is recommended that you do not participate in flight \/ travel \/ public events).<\/p>\n If needed, anti-nausea medication can be given during or after your treatment.<\/p>\n Lu-177 PSMA to be used for treatment is produced in the radiopharmacy department of the institution to be treated and applied in treatment rooms specially prepared for radionuclide treatments. Unless otherwise stated due to radiation in your body, you will need to stay in the hospital in this special lead-covered room, in the form of a daily or overnight stay, where a specialist team will coordinate the treatment. During the first 12 hours after treatment, a large amount of radioactivity will be excreted through your urine.<\/p>\n Your physician will perform a whole body scan in the Nuclear Medicine Department between 1 and 48 hours after the medication is given.<\/p>\n As a precaution, no visitors are allowed during your stay in the hospital. However, if you want, you can make a phone call.<\/p>\n Blood tests will be done approximately 2 weeks to 6 weeks after treatment.<\/p>\n How Many Cure Treatments Are Applied?<\/strong><\/p>\n Usually, 2 to 6 cures of treatment are given every 6-8 weeks. Your Nuclear Medicine physician will see you after each cycle in order to re-evaluate your health and response to treatment. Subsequent treatments is planned according to PSA level and based on its effect on your blood cells, kidney, and liver. This clinical evaluation will be done 2 weeks before the next course of therapy. In this evaluation, blood tests, bone scintigraphy, Ga-68 PSMA and 18F-FDG PET\/CT are performed.<\/p>\n You are usually discharged 24 hours after treatment. In such treatments, the radiation stays inside the body and emits very little outside the body. As we mentioned before, as a precaution, no visitors are allowed during the treatment. After your discharge, your family and friends are no longer at risk. However, we recommend that you take some reasonable precautions, as listed below:<\/p>\n <\/p>\n [\/et_pb_text][et_pb_accordion disabled_on=”on|on|on” _builder_version=”%224.4.8%22″ disabled=”on”][et_pb_accordion_item title=”%22TANI” open=”on” open_toggle_text_color=”%22#0ca7c5%22″ _builder_version=”%224.4.8%22″ toggle_font=”%22|700|||||||%22″ toggle_font_size=”%2218px%22″]<\/p>\n Flor-18 NaF PET\/BT Nedir, T\u00fcm\u00f6r Oda\u011f\u0131n\u0131 Nas\u0131l G\u00f6sterir?<\/b><\/span><\/p>\n Teranostik t\u0131p d\u00fcnyas\u0131nda yeni geli\u015fmekte olan bir aland\u0131r. T\u00fcm\u00f6re \u00f6zg\u00fcl bir ila\u00e7 ile g\u00f6r\u00fcnt\u00fcleme yaparak saptanan t\u00fcm\u00f6r ve metastazlar\u0131n\u0131n, nereye gidece\u011fi, ne kadar gidece\u011fi ve hastal\u0131kl\u0131 dokuyu etkileme g\u00fcc\u00fc \u00f6nceden bilinen yine \u00f6zg\u00fcl bir ila\u00e7 ile tedavi edilebildi\u011fi bir yakla\u015f\u0131md\u0131r. Bu yakla\u015f\u0131m, geleneksel t\u0131ptan ki\u015fiye \u00f6zg\u00fc \u00e7a\u011fda\u015f t\u0131p uygulamalar\u0131na ge\u00e7i\u015f yap\u0131lmas\u0131n\u0131 sa\u011flamaktad\u0131r.<\/span><\/b><\/span><\/p>\n Prostat kanserinden \u00f6l\u00fcmler genellikle kemik metastaz\u0131 ve komplikasyonlar\u0131ndan kaynaklanmaktad\u0131r. Prostat kanseri kemik metastazlar\u0131\u00a0Flor-18 NaF (<\/span>18<\/sup><\/span>F-NaF) PET\/BT ile y\u00fcksek duyarl\u0131l\u0131kla g\u00f6r\u00fcnt\u00fclenebilmekte ve Radyum-223 ile bu t\u00fcm\u00f6ral dokular\u0131n \u00f6zg\u00fcl ve hedefe y\u00f6nelik tedavisi yap\u0131labilmektedir. Bu, teranostik uygulamalar i\u00e7in olduk\u00e7a ba\u015far\u0131l\u0131 bir \u00f6rnektir.<\/span><\/p>\n Hastal\u0131\u011f\u0131n\u0131z\u0131 takip eden hekiminiz, kemik metastazlar\u0131n\u0131n tan\u0131s\u0131 amac\u0131yla size bu tetkiki \u00f6nerebilir.\u00a0F-18 NaF PET\/BT; kemik metastazlar\u0131n\u0131n yeri ve yayg\u0131nl\u0131\u011f\u0131n\u0131 do\u011fru bir \u015fekilde g\u00f6sterirken a\u011fr\u0131l\u0131 kemik metastazlar\u0131nda hedefe y\u00f6nelik ba\u015far\u0131l\u0131 bir tedavi se\u00e7ene\u011fi olan Radyum-223 tedavisinin kullan\u0131m\u0131n\u0131 da m\u00fcmk\u00fcn k\u0131lar.<\/span><\/p>\n Flor-18 NaF PET\/BT\u2019nin \u00dcst\u00fcn Yanlar\u0131 Nelerdir?<\/b><\/span><\/p>\n F-18 NaF PET\/BT, kemik g\u00f6r\u00fcnt\u00fcleme maddesi olarak ideal \u00f6zelliklere sahiptir ve 45-60 dakika gibi k\u0131sa bir s\u00fcre i\u00e7inde \u00fcst\u00fcn kalitede g\u00f6r\u00fcnt\u00fcler \u00fcretir.\u00a0Ba\u015fta kemik metastaz\u0131 ara\u015ft\u0131r\u0131lan hastalar olmak \u00fczere bir\u00e7ok hasta i\u00e7in,\u00a0F-18 NaF PET\/BT, geleneksel kemik sintigrafisine g\u00f6re \u00e7ok daha ba\u015far\u0131l\u0131 sonu\u00e7lar\u0131 ile ideal bir alternatiftir.<\/span><\/p>\n Flor-18 NaF PET\/BT Kimlere Uygulan\u0131r?<\/b><\/span><\/p>\n Hastal\u0131\u011f\u0131n\u0131z\u0131 takip eden hekiminiz sizden\u00a0F-18 NaF PET\/BT taramas\u0131n\u0131 \u015fu ama\u00e7lar i\u00e7in isteyebilir:<\/span><\/p>\n Flor-18 NaF PET\/BT G\u00fcvenli midir?<\/b><\/span><\/p>\n F-18 NaF bilinen yan etkisi olmayan g\u00fcvenli bir radyoaktif maddedir. Bu i\u015flemde al\u0131nan radyasyon dozu azd\u0131r ve g\u00fcn sonunda v\u00fccudunuzdan temizlenir. N\u00fckleer T\u0131p klini\u011finden ayr\u0131lman\u0131z birka\u00e7 saat s\u00fcrmektedir. PET\/BT taramas\u0131n\u0131 izleyen 6 saat boyunca ba\u015fkalar\u0131yla (\u00f6zellikle \u00e7ocuklar ve hamile kad\u0131nlar) temas\u0131n\u0131z\u0131 en aza indirmenizi \u00f6nermekteyiz.<\/span><\/p>\n Flor-18 NaF PET\/BT \u00d6ncesi Haz\u0131rl\u0131k<\/b><\/span><\/p>\n F-18 NaF PET\/BT g\u00f6r\u00fcnt\u00fclemesi \u00f6ncesinde N\u00fckleer T\u0131p b\u00f6l\u00fcm\u00fcne iletmek \u00fczere, hastal\u0131\u011f\u0131n\u0131za y\u00f6nelik baz\u0131 tetkik ve bilgileri yan\u0131n\u0131zda bulundurman\u0131z istenecektir:<\/span><\/p>\n F-18 NaF PET\/BT i\u015flemi i\u00e7in a\u00e7 olman\u0131za gerek yoktur. \u0130la\u00e7lar\u0131n\u0131z\u0131 her zamanki gibi alabilirsiniz. <\/span>B\u00f6brekten at\u0131l\u0131m\u0131 art\u0131rmak, al\u0131nan radyasyon dozunu azaltmak ve en iyi g\u00f6r\u00fcnt\u00fc kalitesine ula\u015fmak i\u00e7in,\u00a0F-18 NaF enjeksiyonu \u00f6ncesinde ve sonras\u0131nda en az iki\u015fer bardak su i\u00e7melisiniz. Tetkik sonras\u0131nda g\u00fcn\u00fcn geri kalan\u0131nda da su i\u00e7meye devam etmeniz faydal\u0131 olacakt\u0131r.\u00a0\u0130\u015flem s\u0131ras\u0131nda g\u00f6r\u00fcnt\u00fc bozulmalar\u0131n\u0131 \u00f6nlemek i\u00e7in t\u00fcm metal e\u015fyalar\/tak\u0131lar\/protezler \u00e7\u0131kar\u0131lmal\u0131d\u0131r.<\/span><\/p>\n Flor-18 NaF PET\/BT Nas\u0131l Uygulan\u0131r?<\/b><\/span><\/p>\n Az miktarda (1.5-3.7 Mbq\/Kg (0.04-0.1 mCi\/Kg) dozunda) F-18-NaF, g\u00f6r\u00fcnt\u00fcleme i\u015fleminden yakla\u015f\u0131k 30-60 dakika \u00f6nce, kol ya da el s\u0131rt\u0131n\u0131za yerle\u015ftirdi\u011fimiz damar yolundan uygulanacakt\u0131r.\u00a0<\/span>F-18 NaF PET\/BT g\u00f6r\u00fcnt\u00fclemesinden hemen \u00f6nce mesanenizi bo\u015faltman\u0131z gerekmektedir.<\/span><\/p>\n PET\/BT g\u00f6r\u00fcnt\u00fclemesi boyunca (yakla\u015f\u0131k 20-25 dk.), v\u00fccut g\u00f6r\u00fcnt\u00fclerinin s\u00fcrekli kaydedildi\u011fi, her iki ucu a\u00e7\u0131k, geni\u015f halka \u015feklindeki bir cihazda, \u00f6zel \u00e7ekim yata\u011f\u0131 \u00fczerinde uzanman\u0131z istenecektir. \u0130\u015flemin tek zahmetli yan\u0131; bu s\u00fcre zarf\u0131nda hareketsiz kalman\u0131zd\u0131r. \u0130htiyac\u0131n\u0131z halinde, g\u00f6r\u00fcnt\u00fcleme \u00f6ncesi, beraberinizde getirdi\u011finiz a\u011fr\u0131 kesicinizi kullanabilirsiniz.<\/span><\/p>\n \u0130htiya\u00e7 duyulursa uzmanlar\u0131m\u0131z ek g\u00f6r\u00fcnt\u00fc alabilir. Ek g\u00f6r\u00fcnt\u00fcleme i\u015flemi yakla\u015f\u0131k 10-15 dakika s\u00fcrmektedir. <\/span>N\u00fckleer T\u0131p klini\u011findeki i\u015flemlerin tamamlanmas\u0131 birka\u00e7 saati bulabilir. <\/span>Kolunuzdaki damar yolu, g\u00f6r\u00fcnt\u00fclemeniz tamamland\u0131ktan ve t\u00fcm g\u00f6r\u00fcnt\u00fcleriniz kontrol edildikten sonra \u00e7\u0131kart\u0131lacakt\u0131r. Sa\u011fl\u0131k personelimizin onay vermesiyle, N\u00fckleer T\u0131p b\u00f6l\u00fcm\u00fcnden art\u0131k g\u00fcvenle ayr\u0131labilirsiniz.<\/span><\/p>\n \u0130la\u00e7 verildikten sonra ilk 6 saat k\u00fc\u00e7\u00fck \u00e7ocuklarla ve hamile kad\u0131nlarla temastan ka\u00e7\u0131nman\u0131z gerekti\u011fini l\u00fctfen unutmay\u0131n\u0131z. G\u00f6r\u00fcnt\u00fcleriniz N\u00fckleer T\u0131p Uzmanlar\u0131m\u0131z taraf\u0131ndan belirtilen s\u00fcrede de\u011ferlendirilerek rapor edilecektir.<\/span><\/p>\n [\/et_pb_accordion_item][et_pb_accordion_item title=”TEDAV\u0130 H\u0130ZMETLER\u0130 – RADYUM-223 TEDAV\u0130S\u0130” open_toggle_text_color=”#0ca7c5″ _builder_version=”4.4.8″ toggle_font=”|700|||||||” toggle_font_size=”18px” open=”off”]<\/p>\n Radyum-223 Tedavisi Nedir?<\/b><\/span><\/p>\n Teranostik t\u0131p d\u00fcnyas\u0131nda yeni geli\u015fmekte olan bir aland\u0131r. T\u00fcm\u00f6re \u00f6zg\u00fcl bir ila\u00e7 ile g\u00f6r\u00fcnt\u00fcleme yaparak saptanan t\u00fcm\u00f6r ve metastazlar\u0131n\u0131n, nereye gidece\u011fi-ne kadar gidece\u011fi ve hastal\u0131kl\u0131 dokuyu etkileme g\u00fcc\u00fc \u00f6nceden bilinen yine \u00f6zg\u00fcl bir ila\u00e7 ile tedavi edilebildi\u011fi bir yakla\u015f\u0131md\u0131r. Bu yakla\u015f\u0131m, geleneksel t\u0131ptan ki\u015fiye \u00f6zg\u00fc \u00e7a\u011fda\u015f t\u0131p uygulamalar\u0131na ge\u00e7i\u015f yap\u0131lmas\u0131n\u0131 sa\u011flamaktad\u0131r.<\/span><\/p>\n Prostat kanseri\u00a0<\/strong>v\u00fccudun di\u011fer b\u00f6lgelerine yay\u0131ld\u0131\u011f\u0131nda, s\u0131kl\u0131kla kemiklerde yerle\u015fmektedir. Kemik metastaz\u0131 a\u011fr\u0131 d\u0131\u015f\u0131nda, k\u0131r\u0131k, omurilik s\u0131k\u0131\u015fmas\u0131 veya hayat\u0131 tehdit edebilen y\u00fcksek kan kalsiyum seviyeleri gibi ba\u015fka sorunlara da neden olabilir. Kanser kemiklere ula\u015ft\u0131\u011f\u0131nda, a\u011fr\u0131y\u0131 ve di\u011fer komplikasyonlar\u0131 kontrol etmek veya hafifletmek tedavinin \u00e7ok \u00f6nemli bir par\u00e7as\u0131d\u0131r. Hormon tedavisi, kemoterapi ve a\u015f\u0131lar gibi tedaviler buna yard\u0131mc\u0131 olabilir. Ancak uygun hastalarda, \u00f6zellikle kemik metastaz\u0131n\u0131 hedef alan ve alfa \u0131\u015f\u0131mas\u0131 yapan Radyum-223 tedavisi ile bir yandan semptomlar kontrol alt\u0131na al\u0131n\u0131rken bir yandan da sa\u011f kal\u0131m\u0131 art\u0131r\u0131c\u0131 etki sa\u011flanabilmektedir.<\/p>\n Radyum-223 Nas\u0131l Tedavi Eder?<\/b><\/span><\/p>\n Radyum-223, kemik metastazlar\u0131na se\u00e7ici olarak ba\u011flanan ve \u00e7ok k\u0131sa menzilli y\u00fcksek enerjili par\u00e7ac\u0131klar\u0131 (<100 \u03bcm) yayan, radyoaktif bir elementtir. Radyum-223 diklor\u00fcr molek\u00fcl\u00fc, kalsiyumu taklit ederek kemik metastazlar\u0131na ba\u011flan\u0131r ve ard\u0131ndan y\u00fcksek enerjili alfa par\u00e7ac\u0131\u011f\u0131na ait radyasyon, DNA k\u0131r\u0131klar\u0131na neden olarak t\u00fcm\u00f6r h\u00fccrelerini \u00f6ld\u00fcr\u00fcr. Alfa par\u00e7ac\u0131klar\u0131n\u0131n k\u0131sa olan menzili, kom\u015fu sa\u011fl\u0131kl\u0131 doku ve \u00f6zellikle kemik ili\u011fi \u00fczerindeki zararl\u0131 etkinin de en az d\u00fczeyde kalmas\u0131 anlam\u0131na gelmektedir.<\/span><\/p>\n Sa\u011f kal\u0131m\u0131 uzatt\u0131\u011f\u0131 bilinen kemi\u011fe \u00f6zg\u00fc tek ila\u00e7, radyoaktif alfa par\u00e7ac\u0131\u011f\u0131 yayarak tedavi edici etkisini g\u00f6steren Radyum-223’t\u00fcr. Bilimsel \u00e7al\u0131\u015fmalar ile Radyum-223 tedavisinin ortalama ya\u015fam s\u00fcresini uzatt\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. Buna ek olarak a\u011fr\u0131da ve ya\u015fam kalitesinde iyile\u015fmeyi sa\u011flamaktad\u0131r. T\u00fcm bu faydalar\u0131n\u0131n yan\u0131nda kan de\u011ferlerinde ge\u00e7ici d\u00fc\u015fme ve ishal d\u0131\u015f\u0131nda Radyum-223 tedavisi ile ili\u015fkili yan etkiler olduk\u00e7a hafif d\u00fczeylerde izlenmi\u015ftir.<\/span><\/p>\n Radyum-223 Tedavisi Kimlere Uygulan\u0131r?<\/b><\/span><\/p>\n Radyum-223 tedavisi \u00e7ok spesifik bir tedavi t\u00fcr\u00fcd\u00fcr, bu nedenle sadece kemiklere yay\u0131lm\u0131\u015f ve a\u011fr\u0131 \u015fikayeti olan prostat kanserli hastalarda, takip eden hekimleri taraf\u0131ndan uygun g\u00f6r\u00fclmesi durumunda uygulanabilir.<\/span><\/p>\n Radyum-223 tedavisi, kemi\u011fe yay\u0131lm\u0131\u015f kanserin s\u0131kl\u0131kla neden oldu\u011fu a\u011fr\u0131y\u0131 hafifletebilir. Bu tedavinin uygulanmas\u0131na karar verildi\u011finde, tedavi \u00f6ncesinde, t\u00fcm v\u00fccut kemik taramas\u0131 (\u00f6rn. F-NaF PET\/BT, kemik sintigrafisi) yap\u0131lmaktad\u0131r. Bu, Radyum-223’\u00fcn tedavi s\u0131ras\u0131nda do\u011fru alanlar\u0131 hedefledi\u011finden emin olunmas\u0131n\u0131 sa\u011flayacakt\u0131r.<\/span><\/p>\n Radyum-223 Tedavisi G\u00fcvenli midir?<\/b><\/span><\/p>\n Radyum-223 tedavisinde kullan\u0131lan alfa radyasyonu \u00e7ok y\u00fcksek bir enerji seviyesine sahiptir. Bununla birlikte alfa radyasyon, do\u011fas\u0131 gere\u011fi sadece \u00e7ok k\u0131sa mesafelere (iki ila on h\u00fccre mesafesinde) seyahat eder ve bu da radyasyonun yok edici etkisinin sa\u011fl\u0131kl\u0131 h\u00fccrelerde de\u011fil, kemikteki kanser h\u00fccrelerinde olu\u015fmas\u0131n\u0131 sa\u011flamaktad\u0131r. Sa\u011fl\u0131kl\u0131 h\u00fccrelerce al\u0131nan minimal radyasyon dozu, Radium-223 tedavisi ile ili\u015fkili yan etkilerin de ihmal edilebilir d\u00fczeyde oldu\u011fu anlam\u0131na gelir ve \u00fcretilen kan h\u00fccrelerinin say\u0131s\u0131nda ge\u00e7ici bir azalma ve nadiren bulant\u0131, kusma ve ishal, tedavi olan hastalar\u0131m\u0131zda g\u00f6r\u00fclebilmektedir.<\/span><\/p>\n Radyum-223 Tedavisi \u00d6ncesi Haz\u0131rl\u0131k \u00a0<\/b><\/span><\/p>\n Klini\u011fe ilk ba\u015fvurunuzda, a\u015fa\u011f\u0131da listelenen bilgi ve belgeleri beraberinizde getirmeniz \u00f6nemlidir. Hasta bilgilerinizin dijital ortamda haz\u0131rlanmas\u0131 (DICOM, JPEG, PNG, PDF, Microsoft Word (.doc, .docx, vb.)), e-posta ile h\u0131zl\u0131 ve kolayca payla\u015f\u0131lmas\u0131na imkan tan\u0131yacak ve hastal\u0131\u011f\u0131n\u0131z\u0131n de\u011ferlendirilmesini b\u00fcy\u00fck oranda kolayla\u015ft\u0131racakt\u0131r:<\/span><\/p>\n N\u00fckleer T\u0131p Hekiminiz, bu tedavi \u00f6ncesinde ihtiya\u00e7 duyulmas\u0131 halinde, tedaviye uygunlu\u011funuzu de\u011ferlendirmek amac\u0131yla 18F-NaF PET\/BT veya t\u00fcm v\u00fccut kemik sintigrafisi g\u00f6r\u00fcnt\u00fclemeleri ile kemik erimesi varl\u0131\u011f\u0131n\u0131n ara\u015ft\u0131r\u0131lmas\u0131 i\u00e7in kemik mineral yo\u011funlu\u011fu \u00f6l\u00e7\u00fcm\u00fc isteyebilir.<\/span><\/p>\n Ayr\u0131ca a\u015fa\u011f\u0131daki kan testlerini yapt\u0131rman\u0131z istenecektir. Bu testlerin, tedavi s\u0131ras\u0131ndaki durumunuzu g\u00f6stermesi beklendi\u011finden, tedaviden en ge\u00e7 2 hafta \u00f6nce yap\u0131lm\u0131\u015f olmas\u0131 gerekmektedir. Bu testler tedaviye ba\u015flarken ve her tedavi k\u00fcr\u00fcnden \u00f6nce yap\u0131lacakt\u0131r.<\/span><\/p>\n Hekiminiz, gerekti\u011finde ek kan testleri de isteyebilir. <\/span>Karaci\u011fer ve b\u00f6brek yetmezli\u011fi olan hastalar\u0131m\u0131zda, Radyum-223 tedavisi herhangi bir doz ayarlamas\u0131na gitmeden uygulanabilir.<\/span>Kemik k\u0131r\u0131\u011f\u0131 ya da omurilik bas\u0131s\u0131 olan hastalar\u0131m\u0131zda ise \u00f6ncelikle bu sorunlar\u0131n d\u00fczeltilmesi istenecektir.<\/span><\/p>\n Kemoterapi tedavisi ald\u0131ysan\u0131z en son k\u00fcr\u00fcn \u00fczerinden en az 4 hafta ge\u00e7ti\u011finden emin olman\u0131z gerekmektedir.<\/span>Tedavi s\u0131ras\u0131nda evden getirdi\u011finiz kendi giysilerinizi giyece\u011finiz i\u00e7in rahat ve geni\u015f k\u0131yafetler tercih etmenizi \u00f6neririz. Tedaviniz ve birlikte yap\u0131lan testler i\u00e7in kolunuza veya elinizin s\u0131rt\u0131na yerle\u015ftirilen damar yolu kullan\u0131laca\u011f\u0131ndan, k\u0131sa kollu ya da geni\u015f kollu giysileri bulundurman\u0131z yararl\u0131 olacakt\u0131r.<\/span><\/p>\n Radyum-223 ba\u011f\u0131rsaktan at\u0131ld\u0131\u011f\u0131 i\u00e7in \u201c\u00fclseratif kolit\u201d ve \u201cCrohn hastal\u0131\u011f\u0131\u201d gibi enflamatuar ba\u011f\u0131rsak hastal\u0131\u011f\u0131 olan ya da ba\u011f\u0131rsak t\u0131kan\u0131kl\u0131\u011f\u0131 hikayesi bulunan hastalar\u0131m\u0131zda ek destekleyici \u00f6nlemler almam\u0131z gerekebilir.<\/span><\/p>\n Radyum-223 Tedavisi Nas\u0131l Uygulan\u0131r?<\/b><\/span><\/p>\n Standard Radyum-223 tedavisi; d\u00f6rt haftal\u0131k aral\u0131klarla, toplam alt\u0131 tedavi k\u00fcr\u00fcnden (6 adet, birer dakikal\u0131k enjeksiyon) olu\u015fmaktad\u0131r. <\/span>Sizin i\u00e7in \u00fcretilmi\u015f, kullan\u0131ma haz\u0131r Radyum-223 diklor\u00fcr \u00e7\u00f6zeltisi, N\u00fckleer T\u0131p Klini\u011finde, yerle\u015ftirdi\u011fimiz periferik damar yoluyla enjekte edilecektir.<\/span><\/p>\n Radyum-223 uygulamadan \u00f6nce, damar yolunuzun a\u00e7\u0131kl\u0131\u011f\u0131, en az 10 ml serum fizyolojik ile y\u0131kanarak kontrol edilecek ve Radyum-223 yakla\u015f\u0131k 1 dakika boyunca yava\u015f enjeksiyon \u015feklinde uygulanacak, sonras\u0131nda damar yolunuz yine en az 10 ml serum fizyolojik ile y\u0131kanacakt\u0131r. Bu i\u015flem s\u0131ras\u0131nda a\u011fr\u0131 hissedilmemektedir.<\/span><\/p>\n Enjeksiyondan sonra Radyum-223 diklor\u00fcr h\u0131zla kandan temizlenecek ve \u00f6ncelikle kemik ve kemik metastazlar\u0131nda tutulacak veya ba\u011f\u0131rsa\u011fa at\u0131lacakt\u0131r.<\/span><\/p>\n Olas\u0131 Yan Etkiler ve Talimatlar<\/b><\/span><\/p>\n Radyum-223 tedavisi uygulanan hastalar\u0131m\u0131zda g\u00f6r\u00fclebilecek en yayg\u0131n yan etkiler (\u2265% 10) bulant\u0131, kusma ve ishaldir. Ayr\u0131ca kan h\u00fccre say\u0131s\u0131nda ge\u00e7ici d\u00fc\u015fmeler g\u00f6r\u00fclebilmektedir.<\/span><\/p>\n Tedavi alan hastalar\u0131m\u0131z\u0131n a\u015fa\u011f\u0131daki talimatlara uymalar\u0131 \u00f6nemlidir:\u00a0\u00a0<\/span><\/p>\n Daha fazla bilgi i\u00e7in l\u00fctfen bizimle irtibata ge\u00e7iniz.<\/i><\/span><\/p>\n [\/et_pb_accordion_item][\/et_pb_accordion][et_pb_code _builder_version=”4.4.8″][\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":" [et_pb_section fb_built=”1″ fullwidth=”on” _builder_version=”4.4.8″ background_color=”rgba(0,0,0,0)” background_image=”https:\/\/www.intheranostics.com\/wp-content\/uploads\/2020\/06\/metastatik_prostat_kanseri.jpg” custom_padding=”100px||100px||false|false” locked=”off”][et_pb_fullwidth_header title=”Lutetium-177 PSMA Treatment” text_orientation=”center” content_max_width_last_edited=”off|desktop” _builder_version=”4.4.8″ title_font_size=”50px” content_font_size=”41px” subhead_font=”|700|||||||” subhead_font_size=”38px” subhead_line_height=”1.1em” background_enable_color=”off” background_enable_image=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” animation_style=”slide” animation_direction=”bottom”][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.4.8″ custom_margin=”0px||0px||false|false” custom_padding=”0px|0px|0px|0px|false|false”][et_pb_row _builder_version=”4.4.8″ custom_margin=”0px||||false|false” custom_padding=”0px|0px|0px|0px|false|false”][et_pb_column type=”4_4″ admin_label=”Column” _builder_version=”4.4.8″][et_pb_divider divider_weight=”0px” _builder_version=”4.4.8″ use_background_color_gradient=”on” background_color_gradient_start=”#8dd2e1″ background_color_gradient_end=”#23afca” background_color_gradient_direction=”90deg” width=”50%” module_alignment=”center” height=”10px”][\/et_pb_divider][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ admin_label=”section” _builder_version=”4.4.8″][et_pb_row admin_label=”row” _builder_version=”4.4.8″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” custom_margin=”||||false|false” custom_padding=”0px|0px|0px|0px|false|false”][et_pb_column type=”4_4″ […]<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"[et_pb_section fb_built=\"1\" fullwidth=\"on\" _builder_version=\"4.4.8\" background_color=\"rgba(0,0,0,0)\" background_image=\"https:\/\/www.intheranostics.com\/wp-content\/uploads\/2020\/06\/metastatik_prostat_kanseri.jpg\" custom_padding=\"100px||100px||false|false\" locked=\"off\"][et_pb_fullwidth_header title=\"Lutesyum-177 PSMA Tedavisi \" text_orientation=\"center\" content_max_width_last_edited=\"off|desktop\" _builder_version=\"4.4.8\" title_font_size=\"50px\" content_font_size=\"41px\" subhead_font=\"|700|||||||\" subhead_font_size=\"38px\" subhead_line_height=\"1.1em\" background_enable_color=\"off\" background_enable_image=\"off\" custom_margin=\"||||false|false\" custom_padding=\"||||false|false\" animation_style=\"slide\" animation_direction=\"bottom\"][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=\"1\" _builder_version=\"4.4.8\" custom_margin=\"0px||0px||false|false\" custom_padding=\"0px|0px|0px|0px|false|false\"][et_pb_row _builder_version=\"4.4.8\" custom_margin=\"0px||||false|false\" custom_padding=\"0px|0px|0px|0px|false|false\"][et_pb_column type=\"4_4\" _builder_version=\"4.4.8\"][et_pb_divider divider_weight=\"0px\" _builder_version=\"4.4.8\" use_background_color_gradient=\"on\" background_color_gradient_start=\"#8dd2e1\" background_color_gradient_end=\"#23afca\" background_color_gradient_direction=\"90deg\" width=\"50%\" module_alignment=\"center\" height=\"10px\"][\/et_pb_divider][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\"1\" admin_label=\"section\" _builder_version=\"4.4.8\"][et_pb_row admin_label=\"row\" _builder_version=\"4.4.8\" background_size=\"initial\" background_position=\"top_left\" background_repeat=\"repeat\" custom_margin=\"||||false|false\" custom_padding=\"0px|0px|0px|0px|false|false\"][et_pb_column type=\"4_4\" _builder_version=\"3.25\" custom_padding=\"|||\" custom_padding__hover=\"|||\"][et_pb_text _builder_version=\"4.4.8\" hover_enabled=\"0\"] Kansere, kontrols\u00fcz olarak b\u00fcy\u00fcyen ve \u00e7o\u011falan kanserli (malign) h\u00fccreler neden olur. Prostat bezi dokusunda kanser ba\u015flad\u0131\u011f\u0131nda, buna prostat kanseri denir. Prostat kanseri h\u00fccrelerinin, v\u00fccudun di\u011fer b\u00f6lgelerine yay\u0131larak t\u00fcm\u00f6rler olu\u015fturdu\u011fu duruma ise metastatik prostat kanseri denmektedir.<\/p>\r\n Teranostik t\u0131p d\u00fcnyas\u0131nda yeni geli\u015fmekte olan bir aland\u0131r. T\u00fcm\u00f6re \u00f6zg\u00fcl bir ila\u00e7 ile g\u00f6r\u00fcnt\u00fcleme yaparak saptanan t\u00fcm\u00f6r ve metastazlar\u0131n\u0131n, nereye gidece\u011fi, ne kadar gidece\u011fi ve hastal\u0131kl\u0131 dokuyu etkileme g\u00fcc\u00fc \u00f6nceden bilinen yine \u00f6zg\u00fcl bir ila\u00e7 ile tedavi edilebildi\u011fi bir yakla\u015f\u0131md\u0131r. Bu yakla\u015f\u0131m, geleneksel t\u0131ptan ki\u015fiye \u00f6zg\u00fc \u00e7a\u011fda\u015f t\u0131p uygulamalar\u0131na ge\u00e7i\u015f yap\u0131lmas\u0131n\u0131 sa\u011flamaktad\u0131r. Prostat kanserinde, bir yandan GA-68 PSMA PET\/BT ile prostat kanserine ait t\u00fcm\u00f6ral dokular y\u00fcksek duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fckte g\u00f6r\u00fcnt\u00fclenebilmekte, di\u011fer yandan Lu-177 PSMA ile bu t\u00fcm\u00f6ral dokular\u0131n \u00f6zg\u00fcl ve hedefe y\u00f6nelik tedavisi yap\u0131labilmektedir. Bu, teranostik uygulamalar i\u00e7in olduk\u00e7a ba\u015far\u0131l\u0131 ve yeni bir y\u00f6ntemdir.<\/p>\r\n Lu-177 PSMA tedavisi, metastatik kastrasyona diren\u00e7li prostat kanserini tedavi etmek i\u00e7in, giderek daha fazla kullan\u0131lan yenilik\u00e7i ve etkili bir tedavidir. Genellikle, di\u011fer onaylanm\u0131\u015f y\u00f6ntemlerle tedavi se\u00e7eneklerinin t\u00fckendi\u011fi, etkisiz oldu\u011funun g\u00f6sterildi\u011fi veya hastalar\u0131n bunlar\u0131 tolere edemedi\u011fi durumlarda, takip eden hekimin \u00f6nerisiyle kullan\u0131l\u0131r. Bu tedavi; t\u00fcm\u00f6r boyutunu k\u00fc\u00e7\u00fcltmeye ve t\u00fcm\u00f6r\u00fcn \u00e7o\u011falmas\u0131n\u0131 \u00f6nlemeye, ayr\u0131ca t\u00fcm\u00f6r\u00fcn neden oldu\u011fu bulgu ve \u015fikayetleri (semptomlar\u0131) azaltmaya yard\u0131mc\u0131 olur.<\/p>\r\n Lu-177 PSMA tedavisi, faz I ve faz II ara\u015ft\u0131rma safhalar\u0131n\u0131 ge\u00e7mi\u015f, faz III randomize klinik \u00e7al\u0131\u015fmalarda test edilme a\u015famas\u0131ndad\u0131r. Bu nedenle hen\u00fcz rutin klinik tedavinin bir par\u00e7as\u0131 de\u011fildir. Yine de bir\u00e7ok prostat kanseri hastas\u0131nda, Lu-177 PSMA tedavisi ile uzun s\u00fcreli d\u00fczelme elde edilebildi\u011fi g\u00f6sterilmi\u015ftir. \u015eu anda \u00fclkemizde ve d\u00fcnyada, ilerlemi\u015f ve metastatik prostat kanserli olgular i\u00e7in bu tedavi hizmetini sunan s\u0131n\u0131rl\u0131 say\u0131da klinik bulunmaktad\u0131r.<\/p>\r\n \u00c7o\u011fu prostat kanseri t\u00fcr\u00fcnde, tedavi i\u00e7in aranan t\u00fcm\u00f6ral y\u00fcksek PSMA d\u00fczeyi mevcuttur. Bununla birlikte, t\u00fcm prostat kanseri hastalar\u0131n\u0131n y\u00fczde 5 ila 10\u2019unun PSMA olu\u015fturmad\u0131\u011f\u0131 da bilinen bir durumdur. Bu nedenle, Lu-177 PSMA tedavisine ba\u015flamadan \u00f6nce, tedavinin t\u00fcm\u00f6r dokusunu hedef ald\u0131\u011f\u0131n\u0131 belirlemek i\u00e7in GA-68 PSMA PET\/BT ile g\u00f6r\u00fcnt\u00fcleme yap\u0131lmaktad\u0131r.<\/p>\r\n PSMA, \u00e7ok say\u0131da h\u00fccresel fonksiyona sahip, sa\u011fl\u0131kl\u0131 prostat h\u00fccre zar\u0131nda bulunan bir protein t\u00fcr\u00fcd\u00fcr. Her ne kadar sa\u011fl\u0131kl\u0131 prostat h\u00fccreleri do\u011fal olarak \u00e7ok d\u00fc\u015f\u00fck seviyelerde PSMA olu\u015ftursa da kanserli prostat t\u00fcm\u00f6rleri son derece y\u00fcksek seviyelerde (genellikle normal prostat h\u00fccresinden 1000 kat daha y\u00fcksek) PSMA olu\u015fturmaktad\u0131r. Prostat kanseri v\u00fccudun di\u011fer b\u00f6lgelerine metastaz yapm\u0131\u015fsa, PSMA bu b\u00f6lgelerde g\u00f6r\u00fclebilir. Lu-177 atomu, PSMA ad\u0131n\u0131 verdi\u011fimiz ta\u015f\u0131y\u0131c\u0131 molek\u00fcle ekleyebildi\u011fimiz, radyoaktif beta par\u00e7ac\u0131klar\u0131 g\u00f6nderen radyoaktif bir elementtir.<\/p>\r\n Lu-177 PSMA damar yoluyla uyguland\u0131\u011f\u0131nda, PSMA\u2019n\u0131n bulundu\u011fu t\u00fcm\u00f6r dokular\u0131na gider ve hastal\u0131kl\u0131 t\u00fcm\u00f6r dokusundaki PSMA resept\u00f6rlerine tutunduktan sonra, radyasyon yayarak bu kanser h\u00fccrelerini yok eder. Lu-177 PSMA tedavisi kanser dokusunu hedef ald\u0131\u011f\u0131ndan, v\u00fccudun di\u011fer b\u00f6lgelerinde al\u0131nan \u0131\u015f\u0131n dozu \u00e7ok az d\u00fczeylerde olur. Lu-177 PSMA\u2019n\u0131n t\u00fcm\u00f6r h\u00fccreleri taraf\u0131ndan tutulmayan k\u0131sm\u0131 ise t\u00fck\u00fcr\u00fck, idrar ve d\u0131\u015fk\u0131ya ge\u00e7erek v\u00fccuttan at\u0131l\u0131r. Lu-177 PSMA tedavisi, konusunda uzman multidisipliner ekip taraf\u0131ndan de\u011ferlendirildikten sonra uygulanmaktad\u0131r.<\/p>\r\n Metastatik kastrasyona diren\u00e7li prostat kanseri (mCRPC) olan ve onaylanm\u0131\u015f (alternatif) tedavi y\u00f6ntemleri t\u00fckenmi\u015f\/uygun olmayan hastalarda, sorumlu hekimin \u00f6nerisiyle uygulanabilir.<\/p>\r\n Hastan\u0131n daha \u00f6nce a\u015fa\u011f\u0131daki i\u015flemlerden ge\u00e7mi\u015f olmas\u0131 gerekmektedir:<\/strong><\/p>\r\n Lutesyum-177 PSMA tedavisi, a\u015fa\u011f\u0131da belirtilen durumlarda uygulanamamaktad\u0131r:<\/strong><\/p>\r\n Kemik ili\u011fi fonksiyonunun bask\u0131lanmas\u0131:<\/strong><\/p>\r\n 0- Tam aktif, hastal\u0131k \u00f6ncesi t\u00fcm aktivitelerini k\u0131s\u0131tlama olmaks\u0131z\u0131n yerine getirebilir.<\/p>\r\n 1- Zorlu fizik aktivitede k\u0131s\u0131tlama var, ancak ayakta ve hafif i\u015fleri yapabiliyor. \u00d6rne\u011fin; hafif ev ve ofis i\u015fleri.<\/p>\r\n 2- Ayakta ve kendi i\u015flerini yapabiliyor, ancak herhangi bir i\u015fte \u00e7al\u0131\u015fam\u0131yor ve g\u00fcnd\u00fcz saatlerinin yar\u0131s\u0131ndan fazlas\u0131n\u0131 ayakta ge\u00e7irebiliyor.<\/p>\r\n 3- Kendi bak\u0131m\u0131n\u0131 yapmakta zorlan\u0131yor, g\u00fcnd\u00fcz saatlerinin yar\u0131s\u0131ndan fazlas\u0131nda yat\u0131yor veya sandalyede oturuyor.<\/p>\r\n 4- Kendi bak\u0131m\u0131n\u0131 yapam\u0131yor, tam olarak sandalye veya yata\u011fa ba\u011f\u0131ml\u0131.<\/p>\r\n Lu-177 PSMA tedavisinde kullan\u0131lan radyasyon, sadece kanser h\u00fccrelerini yok etmek i\u00e7in tasarlanm\u0131\u015ft\u0131r. Teranostikler ile tedavi daha ki\u015fiselle\u015fir, \u00f6nce kanser ve metastaz\u0131 etkili bir \u015fekilde saptan\u0131r. Ard\u0131ndan t\u00fcm v\u00fccut doz al\u0131m\u0131 minimum seviyede tutularak kanser h\u00fccrelerinin \u0131\u015f\u0131nlanarak yok edilmesi hedeflenir. Radyasyonun sa\u011fl\u0131kl\u0131 dokulara zarar vermemesini sa\u011flamak i\u00e7in kan testleri; t\u00fcm\u00f6r b\u00f6lgelerindeki radyoaktif maddenin do\u011fru \u015fekilde emildi\u011finden emin olmak i\u00e7in de g\u00f6r\u00fcnt\u00fclemeler yap\u0131lmaktad\u0131r.<\/p>\r\n Uzman N\u00fckleer T\u0131p Hekiminiz, size tedavinin olas\u0131 yan etkileri konusunda rehberlik edecek ve gerekli tavsiyelerde bulunacakt\u0131r. Tedavi do\u011frudan t\u00fcm\u00f6re y\u00f6nelik oldu\u011fu i\u00e7in Lu-177 PSMA ile tedavi edilen hastalar\u0131n \u00e7o\u011funda genellikle ciddi yan etki g\u00f6r\u00fclmemektedir. Bununla birlikte baz\u0131 hastalarda; bulant\u0131, a\u011f\u0131z kurulu\u011fu, yorgunluk, b\u00f6brek fonksiyonlar\u0131nda azalma ve \u00f6zellikle kemik lezyonlar\u0131 olan hastalarda kan h\u00fccresi \u00fcretiminde ge\u00e7ici azalma g\u00f6r\u00fclebilmektedir. En s\u0131k g\u00f6r\u00fclen yan etki hafif bulant\u0131d\u0131r. Bunu \u00f6nlemek i\u00e7in hekiminiz, ihtiya\u00e7 halinde size bulant\u0131 \u00f6nleyici ila\u00e7 \u00f6nerecektir.<\/p>\r\n \u0130lk G\u00f6r\u00fc\u015fme S\u0131ras\u0131nda \u0130stenen Bilgiler<\/p>\r\n Klini\u011fe ilk ba\u015fvurunuzda, a\u015fa\u011f\u0131da listelenen bilgi ve belgeleri beraberinizde getirmeniz \u00f6nemlidir. Hasta bilgilerinizin dijital ortamda haz\u0131rlanmas\u0131 (DICOM, JPEG, PNG, PDF, Microsoft Word (.doc, .docx) vb.), e-posta ile h\u0131zl\u0131 ve kolayca payla\u015f\u0131lmas\u0131na imkan tan\u0131yacak ve hastal\u0131\u011f\u0131n\u0131z\u0131n de\u011ferlendirilmesini b\u00fcy\u00fck oranda kolayla\u015ft\u0131racakt\u0131r.<\/p>\r\n Ayr\u0131ca tedaviyi yapacak hekiminiz, a\u015fa\u011f\u0131daki kan testlerini isteyecektir. Bu testlerin tedavi s\u0131ras\u0131ndaki durumunuzu g\u00f6stermesi beklendi\u011finden, tedaviden en ge\u00e7 2 hafta \u00f6nce yap\u0131lm\u0131\u015f olmas\u0131 gerekmektedir.<\/p>\r\n Hekiminiz, gerekti\u011finde ek kan testleri de isteyebilir.<\/p>\r\n En son kemoterapi uygulaman\u0131z\u0131n \u00fczerinden en az 4 hafta ge\u00e7ti\u011finden emin olman\u0131z gerekmektedir. Tedavi \u00f6ncesinde, N\u00fckleer T\u0131p Hekiminiz taraf\u0131ndan re\u00e7ete edilmi\u015f ilac\u0131n\u0131z varsa \u00f6nerilen \u015fekilde kullanman\u0131z \u00f6nemlidir.<\/p>\r\n Tedavi s\u00fcresince kendi giysilerinizi giyece\u011finiz i\u00e7in yan\u0131n\u0131zda rahat ve geni\u015f k\u0131yafetler getirmenizi \u00f6nermekteyiz. Tedavi boyunca giydikten sonra atabilece\u011finiz eski k\u0131yafetleri bu ama\u00e7la kullanabilirsiniz. Tedavinizde ve birlikte yap\u0131lan testler i\u00e7in kolunuza veya elinizin s\u0131rt\u0131na yerle\u015ftirilen damar yolu kullan\u0131laca\u011f\u0131ndan, k\u0131sa kollu ya da geni\u015f kollu giysileri tercih etmeniz yararl\u0131 olacakt\u0131r.<\/p>\r\n Tedaviden \u00f6nce, \u00f6zel bir k\u0131s\u0131tlaman\u0131z yoksa bol su i\u00e7meniz istenecektir. Lu-177 PSMA kolunuz ya da el s\u0131rt\u0131n\u0131za yerle\u015ftirilen damar yoluyla 1 dakikadan k\u0131sa bir s\u00fcrede uygulanacak, ard\u0131ndan da serum fizyolojik yakla\u015f\u0131k yar\u0131m saat s\u00fcreyle yine damar yolundan yava\u015f olarak verilecektir. Enjeksiyon s\u0131ras\u0131nda ve sonras\u0131nda, N\u00fckleer T\u0131p Hekiminiz taraf\u0131ndan belirtilen s\u00fcre boyunca, klinikte kalman\u0131z gereklidir. \u0130drar tutma sorunu ya\u015fayan hastalar\u0131m\u0131zda, N\u00fckleer T\u0131p Hekiminin \u00f6nerisiyle idrar sondas\u0131 kullan\u0131lmaktad\u0131r.<\/p>\r\n Toplam tedaviniz, 6-8 hafta aral\u0131klarla uygulanacak 2 ila 6 k\u00fcrden olu\u015fmaktad\u0131r. Enjeksiyondan 24 saat sonraya kadar insanlarla yak\u0131n ve uzun s\u00fcreli temastan ka\u00e7\u0131nmal\u0131s\u0131n\u0131z (u\u00e7u\u015f\/seyahat\/toplu etkinliklere kat\u0131lmaman\u0131z \u00f6nerilir).<\/p>\r\n \u0130htiya\u00e7 halinde, tedaviniz s\u0131ras\u0131nda veya sonras\u0131nda bulant\u0131 \u00f6nleyici ila\u00e7 verilebilmektedir. Tedavi i\u00e7in kullan\u0131lacak Lu-177 PSMA, tedavi verilecek kurumda bulunan radyofarmasi b\u00f6l\u00fcm\u00fcnde \u00fcretilmekte ve radyon\u00fcklid tedaviler i\u00e7in \u00f6zel olarak haz\u0131rlanm\u0131\u015f tedavi odalar\u0131nda uygulanmaktad\u0131r. V\u00fccudunuzdaki radyasyon nedeniyle, aksi belirtilmedik\u00e7e, uzman bir ekibin tedaviyi koordine edece\u011fi, g\u00fcn\u00fcbirlik ya da tek gecelik konaklama \u015feklinde, kur\u015fun kapl\u0131 bu \u00f6zel odada, hastanede kalman\u0131z gerekecektir. Tedaviden sonraki ilk 12 saat boyunca b\u00fcy\u00fck miktarda radyoaktivite, idrar\u0131n\u0131z yoluyla v\u00fccuttan d\u0131\u015far\u0131 at\u0131lacakt\u0131r.<\/p>\r\n Hekiminiz, ila\u00e7 verilmesini takiben 1. ila 48. saatler aras\u0131nda, N\u00fckleer T\u0131p B\u00f6l\u00fcm\u00fcnde t\u00fcm v\u00fccut taramas\u0131 yapacakt\u0131r. \u00d6nlem olarak, hastanede kald\u0131\u011f\u0131n\u0131z s\u00fcre boyunca hi\u00e7bir ziyaret\u00e7iye izin verilmemektedir. Bununla birlikte isterseniz telefon g\u00f6r\u00fc\u015fmesi yapabilirsiniz.Tedaviden yakla\u015f\u0131k 2 hafta ila 6 hafta sonra kan testleri yap\u0131lacakt\u0131r.<\/p>\r\n Genellikle 6-8 haftada bir, 2 ile 6 k\u00fcr tedavi verilmektedir. Tedaviyi uygulayan hekiminiz sa\u011fl\u0131\u011f\u0131n\u0131z\u0131 ve tedaviye yan\u0131t\u0131 yeniden de\u011ferlendirmek amac\u0131yla, her k\u00fcrden sonra sizi g\u00f6recektir. Sonraki tedaviler; PSA, kan h\u00fccreleriniz, b\u00f6brek ve karaci\u011feriniz \u00fczerindeki etkisine g\u00f6re planlanmaktad\u0131r. Bu klinik de\u011ferlendirme, bir sonraki tedavi k\u00fcr\u00fcnden 2 hafta \u00f6nce yap\u0131lacakt\u0131r. Bu de\u011ferlendirmede kan testleri, kemik sintigrafisi, GA-68 PSMA ve ihtiyaca g\u00f6re 18F-FDG PET\/BT taramalar\u0131 yap\u0131lmaktad\u0131r.<\/p>\r\n Tedaviden genellikle 24 saat sonra taburcu olunmaktad\u0131r. Bu t\u00fcr tedavilerde radyasyon v\u00fccudun i\u00e7inde kalmakta ve v\u00fccut d\u0131\u015f\u0131na \u00e7ok az miktarda \u00e7\u0131kmaktad\u0131r. Daha \u00f6nce de belirtti\u011fimiz gibi \u00f6nlem olarak, tedavi s\u0131ras\u0131nda hi\u00e7bir ziyaret\u00e7iye izin verilmemektedir. Taburcu olduktan sonra aileniz ve arkada\u015flar\u0131n\u0131z art\u0131k risk alt\u0131nda de\u011fildir. Ancak a\u015fa\u011f\u0131da s\u0131ralad\u0131\u011f\u0131m\u0131z baz\u0131 makul \u00f6nlemleri alman\u0131z\u0131 \u00f6nermekteyiz:<\/p>\r\n Tedavi g\u00fcn\u00fcnde ve sonras\u0131nda hekiminizin, ki\u015fisel ko\u015fullar\u0131n\u0131za g\u00f6re size \u00f6zel verece\u011fi tavsiyelere uyunuz.<\/p>[\/et_pb_text][et_pb_accordion disabled_on=\"on|on|on\" _builder_version=\"%224.4.8%22\" disabled=\"on\"][et_pb_accordion_item title=\"%22TANI\" open=\"on\" open_toggle_text_color=\"%22#0ca7c5%22\" _builder_version=\"%224.4.8%22\" toggle_font=\"%22|700|||||||%22\" toggle_font_size=\"%2218px%22\"] Flor-18 NaF PET\/BT Nedir, T\u00fcm\u00f6r Oda\u011f\u0131n\u0131 Nas\u0131l G\u00f6sterir?<\/b><\/span><\/p>\r\n Teranostik t\u0131p d\u00fcnyas\u0131nda yeni geli\u015fmekte olan bir aland\u0131r. T\u00fcm\u00f6re \u00f6zg\u00fcl bir ila\u00e7 ile g\u00f6r\u00fcnt\u00fcleme yaparak saptanan t\u00fcm\u00f6r ve metastazlar\u0131n\u0131n, nereye gidece\u011fi, ne kadar gidece\u011fi ve hastal\u0131kl\u0131 dokuyu etkileme g\u00fcc\u00fc \u00f6nceden bilinen yine \u00f6zg\u00fcl bir ila\u00e7 ile tedavi edilebildi\u011fi bir yakla\u015f\u0131md\u0131r. Bu yakla\u015f\u0131m, geleneksel t\u0131ptan ki\u015fiye \u00f6zg\u00fc \u00e7a\u011fda\u015f t\u0131p uygulamalar\u0131na ge\u00e7i\u015f yap\u0131lmas\u0131n\u0131 sa\u011flamaktad\u0131r.<\/span><\/b><\/span><\/p>\r\n Prostat kanserinden \u00f6l\u00fcmler genellikle kemik metastaz\u0131 ve komplikasyonlar\u0131ndan kaynaklanmaktad\u0131r. Prostat kanseri kemik metastazlar\u0131\u00a0Flor-18 NaF (<\/span>18<\/sup><\/span>F-NaF) PET\/BT ile y\u00fcksek duyarl\u0131l\u0131kla g\u00f6r\u00fcnt\u00fclenebilmekte ve Radyum-223 ile bu t\u00fcm\u00f6ral dokular\u0131n \u00f6zg\u00fcl ve hedefe y\u00f6nelik tedavisi yap\u0131labilmektedir. Bu, teranostik uygulamalar i\u00e7in olduk\u00e7a ba\u015far\u0131l\u0131 bir \u00f6rnektir.<\/span><\/p>\r\n Hastal\u0131\u011f\u0131n\u0131z\u0131 takip eden hekiminiz, kemik metastazlar\u0131n\u0131n tan\u0131s\u0131 amac\u0131yla size bu tetkiki \u00f6nerebilir.\u00a0F-18 NaF PET\/BT; kemik metastazlar\u0131n\u0131n yeri ve yayg\u0131nl\u0131\u011f\u0131n\u0131 do\u011fru bir \u015fekilde g\u00f6sterirken a\u011fr\u0131l\u0131 kemik metastazlar\u0131nda hedefe y\u00f6nelik ba\u015far\u0131l\u0131 bir tedavi se\u00e7ene\u011fi olan Radyum-223 tedavisinin kullan\u0131m\u0131n\u0131 da m\u00fcmk\u00fcn k\u0131lar.<\/span><\/p>\r\n Flor-18 NaF PET\/BT\u2019nin \u00dcst\u00fcn Yanlar\u0131 Nelerdir?<\/b><\/span><\/p>\r\n F-18 NaF PET\/BT, kemik g\u00f6r\u00fcnt\u00fcleme maddesi olarak ideal \u00f6zelliklere sahiptir ve 45-60 dakika gibi k\u0131sa bir s\u00fcre i\u00e7inde \u00fcst\u00fcn kalitede g\u00f6r\u00fcnt\u00fcler \u00fcretir.\u00a0Ba\u015fta kemik metastaz\u0131 ara\u015ft\u0131r\u0131lan hastalar olmak \u00fczere bir\u00e7ok hasta i\u00e7in,\u00a0F-18 NaF PET\/BT, geleneksel kemik sintigrafisine g\u00f6re \u00e7ok daha ba\u015far\u0131l\u0131 sonu\u00e7lar\u0131 ile ideal bir alternatiftir.<\/span><\/p>\r\n Flor-18 NaF PET\/BT Kimlere Uygulan\u0131r?<\/b><\/span><\/p>\r\n Hastal\u0131\u011f\u0131n\u0131z\u0131 takip eden hekiminiz sizden\u00a0F-18 NaF PET\/BT taramas\u0131n\u0131 \u015fu ama\u00e7lar i\u00e7in isteyebilir:<\/span><\/p>\r\n Flor-18 NaF PET\/BT G\u00fcvenli midir?<\/b><\/span><\/p>\r\n F-18 NaF bilinen yan etkisi olmayan g\u00fcvenli bir radyoaktif maddedir. Bu i\u015flemde al\u0131nan radyasyon dozu azd\u0131r ve g\u00fcn sonunda v\u00fccudunuzdan temizlenir. N\u00fckleer T\u0131p klini\u011finden ayr\u0131lman\u0131z birka\u00e7 saat s\u00fcrmektedir. PET\/BT taramas\u0131n\u0131 izleyen 6 saat boyunca ba\u015fkalar\u0131yla (\u00f6zellikle \u00e7ocuklar ve hamile kad\u0131nlar) temas\u0131n\u0131z\u0131 en aza indirmenizi \u00f6nermekteyiz.<\/span><\/p>\r\n Flor-18 NaF PET\/BT \u00d6ncesi Haz\u0131rl\u0131k<\/b><\/span><\/p>\r\n F-18 NaF PET\/BT g\u00f6r\u00fcnt\u00fclemesi \u00f6ncesinde N\u00fckleer T\u0131p b\u00f6l\u00fcm\u00fcne iletmek \u00fczere, hastal\u0131\u011f\u0131n\u0131za y\u00f6nelik baz\u0131 tetkik ve bilgileri yan\u0131n\u0131zda bulundurman\u0131z istenecektir:<\/span><\/p>\r\nHow Does Lutetium-177 PSMA Treat?<\/h3>\n
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Lutetium-177 PSMA therapy cannot be applied in the following situations :<\/h3>\n
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\n \n0<\/td>\n Fully active, able to perform all pre-illness activities without restrictions.<\/td>\n<\/tr>\n<\/thead>\n \n 1<\/td>\n There is a limitation in vigorous physical activity, but he can stand and do soft work. For example; mild home and office work<\/td>\n<\/tr>\n \n 2<\/td>\n Standing and doing his own work, but unable to work and able to spend more than half of the daylight hours on his feet.<\/td>\n<\/tr>\n \n 3<\/td>\n Difficulty self-care, sleeping for more than half of the daylight hours or sitting in a chair.<\/td>\n<\/tr>\n \n 4<\/td>\n Cannot self-care, fully dependent on chair or bed.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n Is Lutetium-177 PSMA Therapy Safe ?<\/h3>\n
Preperation Before Lutetium-177 PSMA Therapy<\/h3>\n
Information Required During the First Visit<\/h3>\n
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Preperation Before Lutetium-177 PSMA Therapy<\/h3>\n
How is Lutetium-177 PSMA Treatment Applied?<\/h3>\n
What Should You Do After Lutetium-177 PSMA Treatment?<\/h3>\n
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<\/span>– Klozeti oturarak kullan\u0131n\u0131z ve her kullan\u0131mdan sonra sifonu en az 2 kez \u00e7ekiniz.
<\/span>– \u0130drar ve d\u0131\u015fk\u0131 ile kirlenmi\u015f giysilerinizi derhal ve di\u011fer k\u0131yafetlerden ayr\u0131 olarak y\u0131kay\u0131n\u0131z.<\/span><\/li>\nLutesyum-177 PSMA Tedavisi Nedir?<\/h2>\r\n
Lutesyum-177 PSMA Nas\u0131l Tedavi Eder?<\/h3>\r\n
Lutesyum-177 PSMA Tedavisi Kimlere Uygulan\u0131r?<\/h3>\r\n
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Lutesyum-177 PSMA Tedavisi G\u00fcvenli midir?<\/h3>\r\n
Lutesyum-177 PSMA Tedavisi \u00d6ncesi Haz\u0131rl\u0131k<\/h3>\r\n
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Tedavi \u00d6ncesi Haz\u0131rl\u0131k<\/h3>\r\n
Lutesyum-177 PSMA Tedavisi Nas\u0131l Uygulan\u0131r?<\/h3>\r\n
Ka\u00e7 K\u00fcr Tedavi Uygulan\u0131r?<\/h3>\r\n
Lutesyum-177 PSMA Tedavisi Sonras\u0131nda Neler Yapman\u0131z Gerekir?<\/h3>\r\n
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