{"id":2827,"date":"2020-10-28T18:30:46","date_gmt":"2020-10-28T15:30:46","guid":{"rendered":"https:\/\/www.intheranostics.com\/prof\/?page_id=2827"},"modified":"2020-11-05T00:01:44","modified_gmt":"2020-11-04T21:01:44","slug":"karaciger-tumorleri-sp-bg","status":"publish","type":"page","link":"https:\/\/www.intheranostics.com\/prof\/bg\/karaciger-tumorleri-sp-bg\/","title":{"rendered":"\u0427\u0435\u0440\u043d\u043e\u0434\u0440\u043e\u0431\u043d\u0438\u0442\u0435 \u0442\u0443\u043c\u043e\u0440\u0438"},"content":{"rendered":"

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[\/et_pb_text][et_pb_accordion disabled_on=“on|on|on“ _builder_version=“4.4.8″ disabled=“on“][et_pb_accordion_item title=“TEDAV\u0130 PLANLAMASI – 99MTC-MAA KARACI\u011eER PERF\u00dcZYON S\u0130NT\u0130GRAF\u0130S\u0130“ open=“on“ open_toggle_text_color=“#0ca7c5″ _builder_version=“4.4.8″ toggle_font=“|700|||||||“ toggle_font_size=“18px“]<\/p>\n

Endikasyon <\/b><\/span><\/p>\n

Tc-99m MAA karaci\u011fer perf\u00fczyon sintigrafisi, tan\u0131sal anjiyografi i\u015flemi ile e\u015f zamanl\u0131 yap\u0131l\u0131r ve Y-90 mikrok\u00fcre tedavisine aday hastalar\u0131n tedavi planlamas\u0131nda endikedir. <\/span><\/p>\n

Tc-99m MAA Karaci\u011fer Perf\u00fczyon Sintigrafisi Nedir, T\u00fcm\u00f6r Oda\u011f\u0131n\u0131 Nas\u0131l G\u00f6sterir?<\/b><\/span><\/p>\n

Teranostik<\/b>; t\u0131p d\u00fcnyas\u0131nda yeni ve geli\u015fmekte olan bir aland\u0131r. G\u00f6r\u00fcnt\u00fcleme ve tedavinin tek bir sistem \u00fczerinden ger\u00e7ekle\u015ftirilmesini esas al\u0131r, spesifik tedaviye ve tedavinin takibine e\u015f zamanl\u0131 olarak izin verir. <\/span><\/p>\n

Karaci\u011fer kanserlerinde, tedavi \u00f6ncesi prova amac\u0131yla yap\u0131lan Tc-99m MAA karaci\u011fer perf\u00fczyon sintigrafisi ile pulmoner ve gastrointestinal \u015fantlar y\u00fcksek duyarl\u0131l\u0131kta saptanabilmekte ve optimum tedavi dozu planlanabilmektedir. Di\u011fer yandan \u0130trium-90 (Y-90) mikrok\u00fcre tedavisi ile bu t\u00fcm\u00f6ral dokular\u0131n hedefe y\u00f6nelik tedavisi yap\u0131labilmektedir. <\/span>Bu, teranostik uygulamalar i\u00e7in olduk\u00e7a ba\u015far\u0131l\u0131 ve yeni bir y\u00f6ntemdir. <\/span><\/p>\n

Hepatik arter yoluyla tedavilerde, karaci\u011ferin dual kanlanma \u00f6zelli\u011finin bulunmas\u0131 ve \u00e7ap\u0131 3 mm’den b\u00fcy\u00fck t\u00fcm\u00f6rlerin %80-90 oran\u0131nda hepatik arterden kanlanmas\u0131 avantajlar\u0131ndan faydalan\u0131lmaktad\u0131r. Di\u011fer yandan normal karaci\u011fer parankimi b\u00fcy\u00fck oranda portal venden kanlanmaktad\u0131r. 30 y\u0131l\u0131 a\u015fk\u0131n s\u00fcredir bu fark, kemoterapi ajanlar\u0131n\u0131n intraarteriyel pompalar yoluyla uygulanmas\u0131nda ve t\u00fcm\u00f6rlerin embolizasyonunda kullan\u0131lmaktad\u0131r. Transarteriyel radyoembolizasyon (TARE) olarak da isimlendirilen Y-90 mikrok\u00fcre tedavisi, karaci\u011ferin hem primer hem de metastatik maligniteleri i\u00e7in etkili bir tedavidir ve ameliyat veya di\u011fer b\u00f6lgesel tedavilerin kontrendike oldu\u011fu hastalarda daha iyi sa\u011f kal\u0131m ve azalm\u0131\u015f hastal\u0131k y\u00fck\u00fc i\u00e7in \u00f6nemli bir tedavi se\u00e7ene\u011fidir.<\/span><\/p>\n

Bir hasta Y-90 mikrok\u00fcre tedavisi i\u00e7in aday olarak se\u00e7ildikten sonra, ilk olarak anjiyografik de\u011ferlendirme yap\u0131l\u0131r. Bu i\u015flem ile viseral anatomi ve anatomik varyasyonlar tan\u0131mlan\u0131r ve hepatik dola\u015f\u0131m de\u011ferlendirilerek ekstrahepatik damarlar\u0131n t\u0131kanmas\u0131\/embolizasyonu ger\u00e7ekle\u015ftirilir. Anjiyografi i\u015flemi ile vask\u00fcler haritalaman\u0131n tamamlanmas\u0131ndan hemen sonra da, Y-90 mikrok\u00fcre tedavisinin sim\u00fclasyonu olan ve akci\u011fer\/gastrointestinal ka\u00e7aklar\u0131n ara\u015ft\u0131r\u0131ld\u0131\u011f\u0131 ve optimum tedavi dozunun planlanmas\u0131na imkan sa\u011flayan Tc-99m MAA karaci\u011fer perf\u00fczyon sintigrafisi \u00e7al\u0131\u015fmas\u0131 yap\u0131l\u0131r.<\/span><\/p>\n

99mTc ile i\u015faretli makro agrege albumin (MAA) partik\u00fclleri 15-100 \u03bcm boyutlar\u0131nda olup, Y-90 mikrok\u00fcreler gibi hepatik kapillerler ve prekapiller arteriyollere mikroemboliler yaparak yerle\u015firler. B\u00f6ylece hepatik arter yoluyla uygulanan MAA par\u00e7ac\u0131klar\u0131 ile normal karaci\u011fer dokusu ve t\u00fcm\u00f6r odaklar\u0131n\u0131n arteriyel perf\u00fczyonu do\u011fru bir \u015fekilde haritalan\u0131r<\/span><\/p>\n

Tc-99m MAA Karaci\u011fer Perf\u00fczyon Sintigrafisi Kimlere Uygulan\u0131r?<\/b><\/span><\/p>\n

Tc-99m MAA karaci\u011fer perf\u00fczyon sintigrafisi, Y-90 mikrok\u00fcre tedavisine aday olgularda uygulan\u0131r. Tedavi \u00f6ncesi ki\u015fiye \u00f6zel planlamay\u0131 m\u00fcmk\u00fcn k\u0131lan, tan\u0131sal anjiyografi i\u015flemi s\u0131ras\u0131nda yap\u0131lan bir g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemidir. <\/span><\/p>\n

Tc-99m MAA Karaci\u011fer Perf\u00fczyon Sintigrafisi G\u00fcvenli midir?<\/b><\/span><\/p>\n

Tc-99m MAA karaci\u011fer perf\u00fczyon sintigrafisi ile vask\u00fcler haritalama i\u015flemi, d\u00fc\u015f\u00fck dozlarda radyasyonun kullan\u0131ld\u0131\u011f\u0131, g\u00fcvenli bir g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemidir. Birlikte yap\u0131lacak anjiyografi i\u015flemine ait \u00f6neri ve bilgilendirmeler ise giri\u015fimsel radyoloji uzman\u0131 taraf\u0131ndan verilmektedir. Her iki i\u015flem, kullan\u0131lan radyasyon nedeniyle\u00a0 <\/span>hamilelerde kontrendikedirler.<\/span><\/p>\n

Tc-99m MAA Karaci\u011fer Perf\u00fczyon Sintigrafisi \u00d6ncesi Haz\u0131rl\u0131k <\/b><\/span><\/p>\n

Tc-99m MAA karaci\u011fer perf\u00fczyon sintigrafisi i\u00e7in \u00f6zel bir hasta haz\u0131rl\u0131\u011f\u0131na gerek yoktur. Bununla birlikte yap\u0131lacak anjiyografi i\u015flemine ait \u00f6neri ve bilgilendirmeler giri\u015fimsel radyoloji uzman\u0131 taraf\u0131ndan sa\u011flanmaktad\u0131r.<\/span><\/p>\n

Tc-99m MAA Karaci\u011fer Perf\u00fczyon Sintigrafisi \u0130\u015flemi<\/b><\/span><\/p>\n

Y-90 mikrok\u00fcre tedavisi \u00f6ncesi temel a\u015famalardan ilki; giri\u015fimsel radyoloji \u00fcnitesinde, t\u00fcm\u00f6r\u00fc besleyen damarlar\u0131 haritalamak, kollateral damarlar\u0131 embolize etmek ve portal ven a\u00e7\u0131kl\u0131\u011f\u0131n\u0131 de\u011ferlendirmek i\u00e7in yap\u0131lan anjiyografi i\u015flemidir. Bu i\u015flem tamamland\u0131ktan sonra mevcut mikrokateterden yakla\u015f\u0131k 150-185 MBq (4-5 mCi) Tc-99m MAA’n\u0131n intraarteriyel enjeksiyonu yap\u0131l\u0131r. \u0130n vivo ayr\u0131\u015fmaya ba\u011fl\u0131 g\u00f6r\u00fcnt\u00fc artefaktlar\u0131n\u0131 \u00f6nlemek amac\u0131yla, hasta N\u00fckleer T\u0131p Klini\u011fine transfer edilerek, enjeksiyon sonras\u0131 ilk 1 saat i\u00e7erisinde, akci\u011fer ve karaci\u011ferin dahil edildi\u011fi \u00f6n, arka ve sa\u011f yan statik g\u00f6r\u00fcnt\u00fcleri ve m\u00fcmk\u00fcn oldu\u011fu durumlarda SPECT\/BT g\u00f6r\u00fcnt\u00fclemeleri elde edilir. Bu g\u00f6r\u00fcnt\u00fcler ile bir yandan akci\u011fer ve gastrointestinal sisteme olan \u015fantlar de\u011ferlendirilirken di\u011fer yandan da Y-90 mikrok\u00fcre tedavisi i\u00e7in optimum tedavi edici aktivitenin belirlendi\u011fi dozimetrik \u00e7al\u0131\u015fma yap\u0131l\u0131r. <\/span><\/p>\n

Tc-99m MAA Enjeksiyon Yeri Se\u00e7enekleri<\/b><\/span><\/p>\n

\u25cfY-90 mikrok\u00fcre inf\u00fczyonunun planland\u0131\u011f\u0131 b\u00f6lgeye,<\/span><\/p>\n

\u25cfY\u00fcksek akci\u011fer \u015fant oran\u0131 i\u00e7in en y\u00fcksek risk ta\u015f\u0131yan hepatik loba ait lober artere (\u00f6rn. vask\u00fcler invazyon veya daha fazla t\u00fcm\u00f6r y\u00fck\u00fc olan),<\/span><\/p>\n

\u25cfAna hepatik arter veya proper hepatik artere Tc-99m MAA enjeksiyonu yap\u0131labilir.<\/span><\/p>\n

Hepatik arterin anatomik varyasyonlar\u0131 ile kar\u015f\u0131la\u015f\u0131ld\u0131\u011f\u0131nda, tek bir anjiyografi i\u015flemi s\u0131ras\u0131nda t\u00fcm karaci\u011ferin perf\u00fczyonunun de\u011ferlendirilebilmesi i\u00e7in MAA dozlar\u0131 k\u00fc\u00e7\u00fck dozlara b\u00f6l\u00fcn\u00fcr (\u00f6rn. 1-5 mCi) ve sa\u011f ve sol hepatik arterlere enjeksiyonu yap\u0131l\u0131r. <\/span><\/p>\n

Tc-99m MAA karaci\u011fer perf\u00fczyon sintigrafisinde supraumbilikal deri alt\u0131 yumu\u015fak dokuya ka\u00e7ak g\u00f6zlenebilmektedir. Kar\u0131n \u00f6n duvar\u0131na ka\u00e7ak saptanmas\u0131 durumunda Y-90 mikrok\u00fcre tedavisi sonras\u0131 deri alt\u0131 enflamasyon ve radyasyon hasar\u0131 geli\u015fme riskine kar\u015f\u0131, tedavi s\u0131ras\u0131nda kar\u0131n \u00f6n duvar\u0131na so\u011fuk kompres uygulamas\u0131 ile vazospazm yap\u0131lmas\u0131 \u00f6nerilir. <\/span><\/p>\n

Tc-99m MAA Karaci\u011fer Perf\u00fczyon Sintigrafisi – Kantitatif Hesaplamalar<\/b><\/span><\/p>\n

T\u00fcm\u00f6r \/ Karaci\u011fer tutulum oran\u0131<\/b>\u00a0 <\/span>= [T\u00fcm\u00f6rsay\u0131m (say\u0131m\/piksel)] \/[Karaci\u011fersay\u0131m (say\u0131m\/piksel)], e\u015fik de\u011fer >2 olmal\u0131d\u0131r.<\/span><\/p>\n

Hepatopulmoner \u015fant oran\u0131<\/b> = \u221a[(anteriorAkci\u011fersay\u0131m) x (posteriorAkci\u011fersay\u0131m)]\u00a0 <\/span>\/ \u221a[(anteriorAkci\u011fersay\u0131m + anteriorKaraci\u011fersay\u0131m) x (posteriorAkci\u011fersay\u0131m + posteriorKaraci\u011fersay\u0131m) ] x100<\/span><\/p>\n

[\/et_pb_accordion_item][et_pb_accordion_item title=“TEDAV\u0130 H\u0130ZMETLER\u0130 – \u0130TRIYUM-90 MIKROK\u00dcRE TEDAV\u0130S\u0130“ open_toggle_text_color=“#0ca7c5″ _builder_version=“4.4.8″ toggle_font=“|700|||||||“ toggle_font_size=“18px“ open=“off“]<\/p>\n

Endikasyon<\/b><\/span><\/p>\n

Y-90 mikrok\u00fcre tedavisi, di\u011fer ad\u0131yla transarteriyel radyoembolizasyon (TARE), rezeke edilemeyen primer ve metastatik karaci\u011fer kanserlerinin tedavisinde endikedir.<\/span><\/p>\n

\u0130triyum-90 Mikrok\u00fcre 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

Karaci\u011fer kanserlerinde, tedavi \u00f6ncesi prova amac\u0131yla yap\u0131lan 99mTc-MAA karaci\u011fer perf\u00fczyon sintigrafisi<\/b> ile pulmoner ve gastrointestinal \u015fantlar y\u00fcksek duyarl\u0131l\u0131kla saptanabilmekte ve optimum tedavi dozu planlanabilmektedir. Di\u011fer yandan \u0130trium-90 (Y-90) mikrok\u00fcre tedavisi<\/b> ile bu t\u00fcm\u00f6ral dokular\u0131n hedefe y\u00f6nelik tedavisi yap\u0131labilmektedir. <\/span>Bu, teranostik uygulamalar i\u00e7in olduk\u00e7a ba\u015far\u0131l\u0131 ve yeni bir y\u00f6ntemdir. <\/span><\/p>\n

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\u0130triyum-90 Mikrok\u00fcre Nas\u0131l Tedavi Eder?<\/b><\/span><\/p>\n

Hepatik arter yoluyla tedavilerde, karaci\u011ferin dual kanlanma \u00f6zelli\u011finin bulunmas\u0131 ve \u00e7ap\u0131 3 mm’den b\u00fcy\u00fck t\u00fcm\u00f6rlerin %80-90 oran\u0131nda hepatik arterden kanlanmas\u0131 avantajlar\u0131ndan faydalan\u0131lmaktad\u0131r. Di\u011fer yandan normal karaci\u011fer parankimi b\u00fcy\u00fck oranda portal venden kanlanmaktad\u0131r. 30 y\u0131l\u0131 a\u015fk\u0131n s\u00fcredir bu fark, kemoterapi ajanlar\u0131n\u0131n intraarteriyel pompalar yoluyla uygulanmas\u0131nda ve t\u00fcm\u00f6rlerin embolizasyonunda kullan\u0131lmaktad\u0131r. Transarteriyel radyoembolizasyon (TARE) olarak da isimlendirilen Y-90 mikrok\u00fcre tedavisi, karaci\u011ferin hem primer hem de metastatik maligniteleri i\u00e7in etkili bir tedavidir ve ameliyat veya di\u011fer b\u00f6lgesel tedavilerin kontrendike oldu\u011fu hastalarda daha iyi sa\u011f kal\u0131m ve azalm\u0131\u015f hastal\u0131k y\u00fck\u00fc i\u00e7in \u00f6nemli bir tedavi se\u00e7ene\u011fidir. <\/span><\/p>\n

Karaci\u011fer t\u00fcm\u00f6rlerindeki bu \u00f6zel kanlanma paterni, radyoaktif par\u00e7ac\u0131klar\u0131n hepatik artere verilmesi ile olduk\u00e7a se\u00e7ici t\u00fcm\u00f6r tutulumuna imkan sa\u011flamaktad\u0131r. Buna kar\u015f\u0131l\u0131k karaci\u011fer metastazlar\u0131, avask\u00fcler hepatik kistlerden, hipovask\u00fclarer metastatik lezyonlara (kolon, pankreas, meme ca vb.) ve hipervask\u00fcler metastazlara (renal, n\u00f6roendokrin, tiroid ca vb.) kadar de\u011fi\u015fken vask\u00fclariteye sahip olabilirler. Selektif olarak uyguland\u0131\u011f\u0131nda, par\u00e7ac\u0131klar\u0131n k\u00fc\u00e7\u00fck boyutu metastatik t\u00fcm\u00f6rlerin g\u00f6receli \u201chipovask\u00fclaritesini\u201d dengeler ve sonu\u00e7ta metastatik lezyonlar y\u00fcksek radyasyon dozu al\u0131rken, normal parankimdeki absorbe edilen doz nispeten d\u00fc\u015f\u00fck d\u00fczeylerde kal\u0131r. <\/span><\/p>\n

Y-90, ortalama 0.94 MeV enerjiye sahip bir beta-radyasyonu yayar ve t\u00fcm\u00f6r b\u00f6lgesinde, h\u00fccre \u00f6l\u00fcm\u00fc ve t\u00fcm\u00f6r nekrozuna neden olur. Yar\u0131 \u00f6mr\u00fc yakla\u015f\u0131k 64 saat olan Y-90 izotopunun doku penetrasyonu yakla\u015f\u0131k 1 cm’dir ve bu k\u0131sa menzili ile \u00e7evre parankime olan radyasyon dozu da hasta lehine s\u0131n\u0131rlanmaktad\u0131r. Y-90 i\u00e7eren radyoaktif partik\u00fcllerin intraarteriyel enjeksiyonunun avantaj\u0131, eksternal radyoterapiye k\u0131yasla normal karaci\u011fer parankiminde \u00e7ok daha d\u00fc\u015f\u00fck radyasyon dozu imkan\u0131 sunarak, y\u00f6nlendirildi\u011fi t\u00fcm\u00f6re m\u00fcmk\u00fcn olan en y\u00fcksek radyasyon dozunu vermesidir. Buna ek olarak, s\u0131n\u0131rl\u0131 doku penetrasyonu, hastan\u0131n bak\u0131m\u0131n\u0131 yapan t\u0131bbi personel ve aile \u00fcyeleri i\u00e7in de hastay\u0131 daha g\u00fcvenli k\u0131lmaktad\u0131r.<\/span><\/p>\n

Y-90 Mikrok\u00fcreler<\/b><\/span><\/p>\n

Re\u00e7ine mikrok\u00fcreler <\/b>(SIR-Spheres\u00ae), \u00e7ap\u0131 20 ila 60 \u03bcm aras\u0131nda olan akrilik polimer mikrok\u00fcreleridir ve Y-90, mikrok\u00fcrelerin haz\u0131rlanmas\u0131ndan sonra, polimerin karboksilik grubuna ba\u011flan\u0131r.<\/span><\/p>\n

Cam mikrok\u00fcreler<\/b> (TheraSphere\u00ae), ortalama 20-30 \u03bcm b\u00fcy\u00fckl\u00fckteki cam mikrok\u00fcrelerdir, burada cam matris i\u00e7ine g\u00f6m\u00fclm\u00fc\u015f 89Y, bir n\u00fckleer reakt\u00f6rde Y-90’ye aktive edilir. <\/span><\/p>\n

Cam k\u00fcreler ile re\u00e7ine k\u00fcreleri aras\u0131ndaki temel fark her bir k\u00fcredeki radyoaktivitenin farkl\u0131 olmas\u0131d\u0131r. Bir cam k\u00fcrede yakla\u015f\u0131k 2.500 Bq radyoaktivite bulunurken, bir re\u00e7ine k\u00fcresinde bu de\u011fer yakla\u015f\u0131k 50 Bq’dir. Ticari olarak sat\u0131lan her bir viyal i\u00e7in toplam radyoaktivite dozu ise cam mikrok\u00fcreler i\u00e7in 3-20 GBq (6 farkl\u0131 doz se\u00e7ene\u011fi),\u00a0 <\/span>re\u00e7ine mikrok\u00fcreler i\u00e7in 3 GBq’dir. Sa\u011flanmak istenen ayn\u0131 aktivite i\u00e7in, daha az say\u0131da cam mikrok\u00fcre enjekte edilirken muhtemelen mikrodamarlar \u00fczerinde daha az embolik etki olu\u015fmaktad\u0131r. Bununla birlikte potansiyel olarak, se\u00e7ilen ayn\u0131 aktivite i\u00e7in, daha fazla say\u0131da re\u00e7ine k\u00fcresi ile daha homojen doz da\u011f\u0131l\u0131m\u0131 ve daha y\u00fcksek bir biyolojik etki (toksisite ve etkinlik) sa\u011flanabilir.<\/span><\/p>\n

166Ho Mikrok\u00fcreler<\/b><\/span><\/p>\n

Holmiyum-166 (166Ho) mikrok\u00fcreler (QuiremSpheres\u00ae), 25-35 \u03bcm b\u00fcy\u00fckl\u00fckteki poli-L-laktik asit esasl\u0131 mikrok\u00fcrelerdir. Y-90 esasl\u0131 mikrok\u00fcreler ile benzer etki mekanizmas\u0131na sahiptir ve 166Ho taraf\u0131ndan yay\u0131lan beta radyasyonu ile t\u00fcm\u00f6r dokusuna zarar verir. Bununla birlikte 166Ho yayd\u0131\u011f\u0131 gama radyasyonu ile sintigrafik g\u00f6r\u00fcnt\u00fclemeye izin verirken, olduk\u00e7a paramanyetik bir element olu\u015fuyla da MR ile g\u00f6r\u00fcnt\u00fclenebilmektedir. \u015eu an i\u00e7in, 166Ho mikrok\u00fcreler Y-90 esasl\u0131 mikrok\u00fcreler kadar yayg\u0131n kullan\u0131lmamaktad\u0131r.<\/span><\/p>\n

\u0130triyum-90 Mikrok\u00fcre Tedavisi Kimlere Uygulan\u0131r?<\/b><\/span><\/p>\n

Y-90 mikrok\u00fcre tedavisi klasik olarak rezeke edilemeyen primer ve metastatik karaci\u011fer kanserlerinde uygulanmaktad\u0131r.<\/span><\/p>\n

Hepatosell\u00fcler Karsinom (HCC)<\/b><\/span><\/p>\n

HCC, sistemik kemoterapi ve eksternal radyoterapinin d\u00fc\u015f\u00fck yan\u0131t oranlar\u0131, y\u00fcksek yan etkileri ve radyosensitif karaci\u011fer parankiminde tedavi dozlar\u0131nda dahi kolayca hasar\u0131n\u0131n geli\u015fmesi, bu se\u00e7eneklerin tedavide kullan\u0131mlar\u0131n\u0131 k\u0131s\u0131tland\u0131rmaktad\u0131r.<\/span><\/p>\n

Lokalize HCC’nin geleneksel tedavisi cerrahidir. Bununla birlikte, baz\u0131 hastalar cerrahiye uygun birer aday de\u011filken, baz\u0131 hastalar da ba\u015fvuru an\u0131nda zaten multifokal\/bilobar hastal\u0131\u011fa sahiptirler. HCC radyosensitif oldu\u011fundan, bu olgularda arter i\u00e7i Y-90 mikrok\u00fcre tedavisi ba\u015far\u0131yla kullan\u0131lmaktad\u0131r. <\/span><\/p>\n

Rezeksiyona uygun olmayan HCC olgular\u0131ndan elde edilmi\u015f ilk sonu\u00e7lar t\u00fcm\u00f6r vask\u00fclaritesinde ve sa\u011f kal\u0131mda iyile\u015fmeyi g\u00f6stermi\u015ftir. Lokalize hastal\u0131kta Y-90 mikrok\u00fcre tedavisinin, transarteriyel kemoembolizasyon veya ablasyon gibi di\u011fer lokal tedaviler ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131 sonraki \u00e7al\u0131\u015fmalarda ise benzer tedavi ba\u015far\u0131lar\u0131na sahip olduklar\u0131 g\u00f6sterilmi\u015ftir. <\/span><\/p>\n

\u0130ntrahepatik Kolanjiyokarsinom<\/b><\/span><\/p>\n

\u0130ntrahepatik kolanjiyokarsinom (ICC) karaci\u011ferin ikinci en s\u0131k g\u00f6r\u00fclen primer malignitesidir. Rezeke edilemedi\u011finde, prognozu k\u00f6t\u00fcd\u00fcr. Kombine kemoterapiyle (gemsitabin ve sisplatin) genellikle sistemik toksisitenin e\u015flik etti\u011fi, artm\u0131\u015f genel sa\u011f kal\u0131m sa\u011flanabilmektedir. Kolanjiyokarsinom ayn\u0131 zamanda radyosensitif bir t\u00fcm\u00f6rd\u00fcr ve palyatif Y-90 mikrok\u00fcre tedavisi ile s\u0131n\u0131rl\u0131 yan etkinin e\u015flik etti\u011fi, uzam\u0131\u015f medyan sa\u011f kal\u0131ma ula\u015f\u0131labilmekedir.<\/span><\/p>\n

Kolorektal Kanserler <\/b><\/span><\/p>\n

Kolorektal kanser d\u00fcnya \u00e7ap\u0131nda en s\u0131k g\u00f6r\u00fclen malignitelerden biridir ve portal ven\u00f6z drenaj nedeniyle ana metastaz b\u00f6lgesi karaci\u011ferdir. Metastatik kolorektal kanser i\u00e7in standart tedavi \u015fu anda florourasil, l\u00f6kovorin ve oksaliplatinden (FOLFOX) olu\u015fan bir kemoterapi rejimidir; bununla birlikte, \u00f6zellikle kemoterapiye diren\u00e7li olan hastalarda Y-90 mikrok\u00fcre tedavisi ile kombinasyon yararl\u0131 olabilir. <\/span><\/p>\n

N\u00f6roendokrin T\u00fcm\u00f6rler (NET)<\/b><\/span><\/p>\n

N\u00f6roendokrin t\u00fcm\u00f6rler, \u00e7o\u011funlukla sindirim sisteminden kaynaklanan, geni\u015f yelpazeli bir malignite grubudur. Kolorektal kanserlere benzer \u015fekilde, portal ven\u00f6z drenaj nedeniyle s\u0131kl\u0131kla karaci\u011fere metastaz yaparlar. Cerrahi rezeksiyon i\u00e7in uygun olmayan \u00e7ok yayg\u0131n metastazlar\u0131 olan hastalarda karaci\u011fer metastazlar\u0131n\u0131n radyasyonsuz intraarteriyel embolizasyon ile palyatif tedavisi m\u00fcmk\u00fcnd\u00fcr.\u00a0 <\/span>Bununla birlikte n\u00f6roendokrin t\u00fcm\u00f6rler radyosensitif olduklar\u0131ndan, Y-90 mikrok\u00fcre tedavisi bu hastalarda da ba\u015far\u0131yla kullan\u0131labilmektedir. <\/span><\/p>\n

Rezeksiyon veya Karaci\u011fer Nakli \u00d6ncesi Down-Staging <\/b><\/span><\/p>\n

Y-90 mikrok\u00fcre tedavisi; HCC, metastatik kolorektal kanser ve kolanjiyokarsinom hastalar\u0131n\u0131 cerrahi rezeksiyona uygun hale getirmek amac\u0131yla,\u00a0 <\/span>neoadjuvan tedavi olarak kullan\u0131labilir. Ayr\u0131ca Y-90 mikrok\u00fcre ile radyoembolizasyondan, t\u00fcm\u00f6r y\u00fck\u00fcn\u00fc ve hastal\u0131\u011f\u0131n ilerleme h\u0131z\u0131n\u0131 yava\u015flatarak, hastalar\u0131 karaci\u011fer nakline k\u00f6pr\u00fcleme i\u00e7in de faydalan\u0131labilir. <\/span><\/p>\n

Radyasyon Segmentektomi<\/b><\/span><\/p>\n

Bir segmente s\u0131n\u0131rl\u0131 karaci\u011fer hastal\u0131\u011f\u0131nda ve di\u011fer k\u00fcratif ama\u00e7l\u0131 tedavilerin uygun olmad\u0131\u011f\u0131 olgularda, t\u00fcm\u00f6re k\u00fcratif ama\u00e7la \u00e7ok daha y\u00fcksek dozda radyasyon verilmesine ve o segmentte radyasyon nekrozu geli\u015fmesi prensibine dayan\u0131r. Radyasyon segmentektomi sadece bir segmenti veya segmentin bir b\u00f6l\u00fcm\u00fcn\u00fc kaplayan malign hastal\u0131kta ve sadece o b\u00f6lgeyi besleyen arter yoluyla Y-90 mikrok\u00fcrelerin verilebildi\u011fi durumlarda uygulanabilmektedir.<\/span><\/p>\n

\u0130triyum-90 Mikrok\u00fcre Tedavisi G\u00fcvenli midir?<\/b><\/span><\/p>\n

Y-90 mikrok\u00fcre tedavisi tipik olarak iyi tolere edilen g\u00fcvenli bir tedavidir. Y-90, saf beta par\u00e7ac\u0131\u011f\u0131 yayd\u0131g\u0306\u0131 ve gama radyasyonu bulunmad\u0131g\u0306\u0131 i\u00e7in tedavi sonras\u0131 hasta izolasyonu gerekmemektedir.<\/span><\/p>\n

Y-90 mikrok\u00fcre tedavisinin en s\u0131k yan etkisi; yorgunluk, bulant\u0131, kusma ve\/veya kar\u0131n a\u011fr\u0131s\u0131 ile karakterize olan post-radyoembolizasyon sendromudur. \u015eikayetler, analjezik ve antiemetik ila\u00e7lar ile tedavi edilebilir. <\/span><\/p>\n

Di\u011fer t\u00fcm minimal invazif karaci\u011fer uygulamalar\u0131nda da g\u00f6r\u00fclebilen, t\u00fcm\u00f6r nekrozuna ba\u011fl\u0131 perihepatik s\u0131v\u0131, hepatik apse geli\u015fimi bu tedavi sonras\u0131nda da g\u00f6r\u00fclebilir<\/span><\/p>\n

Ayr\u0131ca, a\u015fa\u011f\u0131da s\u0131ralanan ve tecr\u00fcbeli eller ile g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 daha da azalabilen, \u00e7ok daha nadir yan etkilere de rastlanabilmektedir.<\/span><\/p>\n

Her anjiyografik i\u015flemde olabilecek, kontrast kullan\u0131m\u0131na ba\u011fl\u0131 alerji ve nefrotoksisite geli\u015fimi ile damar yaralanmalar\u0131 ortaya \u00e7\u0131kabilir. <\/span><\/p>\n

Doz planlamas\u0131nda normal karaci\u011fer dokusunun minimum dozu almas\u0131 i\u00e7in bir\u00e7ok \u00f6nlemin al\u0131nmas\u0131na kar\u015f\u0131n, bazen hasta fizyolojisindeki varyasyonlar, karaci\u011fer parankiminde \u201cradyoembolizasyona ba\u011fl\u0131 karaci\u011fer hastal\u0131\u011f\u0131\u201d, karaci\u011fer fibrozisi ve portal hipertansiyon gibi komplikasyonlara neden olabilir. Bu risk, birden fazla mikrok\u00fcre tedavisi alan veya eksternal radyoterapi uygulanan olgularda artmaktad\u0131r. <\/span><\/p>\n

Yak\u0131n kom\u015fuluk nedeniyle biliyer sistem de Y-90 mikrok\u00fcre tedavisinde potansiyel komplikasyon b\u00f6lgelerindendir. <\/span><\/p>\n

Kolesistit, duodenal \u00fclser, pankreatit, radyasyon pn\u00f6monisi ve kar\u0131n duvar\u0131nda radyasyon dermatiti gibi komplikasyonlar ise hedef d\u0131\u015f\u0131 radyoembolizasyona ba\u011fl\u0131 geli\u015febilir. \u00d6n planlama anjiografisinde ilgili damarlar\u0131n profilaktik embolizasyonu veya uygun kateterizasyon teknikleri ile bu komplikasyonlar\u0131n \u00f6n\u00fcne ge\u00e7ilebilir. <\/span><\/p>\n

<\/b><\/span><\/p>\n

\u0130triyum-90 Mikrok\u00fcre Tedavisi \u00d6ncesi Haz\u0131rl\u0131k <\/b><\/span><\/p>\n

Y-90 mikrok\u00fcre tedavisine hasta se\u00e7imi; genel cerrah, medikal onkolog, gastroenterolog, giri\u015fimsel radyolog ve N\u00fckleer T\u0131p Uzman\u0131ndan olu\u015fan multidisipliner t\u00fcm\u00f6r kurulunda yap\u0131l\u0131r. <\/span><\/p>\n

Hasta Se\u00e7imi <\/b><\/span><\/p>\n

Y-90 Mikrok\u00fcre \u0130\u00e7in Uygun Hastalar<\/i><\/b><\/span><\/p>\n