{"id":2504,"date":"2020-10-10T00:24:28","date_gmt":"2020-10-09T21:24:28","guid":{"rendered":"https:\/\/www.intheranostics.com\/prof\/?page_id=2504"},"modified":"2020-11-06T15:58:51","modified_gmt":"2020-11-06T12:58:51","slug":"%d1%80%d0%b0%d0%ba-%d0%bf%d1%80%d0%b5%d0%b4%d1%81%d1%82%d0%b0%d1%82%d0%b5%d0%bb%d1%8c%d0%bd%d0%be%d0%b9-%d0%b6%d0%b5%d0%bb%d0%b5%d0%b7%d1%8b-%d1%81-%d0%bc%d0%b5%d1%82%d0%b0%d1%81%d1%82%d0%b0%d0%b7","status":"publish","type":"page","link":"https:\/\/www.intheranostics.com\/prof\/ru\/%d1%80%d0%b0%d0%ba-%d0%bf%d1%80%d0%b5%d0%b4%d1%81%d1%82%d0%b0%d1%82%d0%b5%d0%bb%d1%8c%d0%bd%d0%be%d0%b9-%d0%b6%d0%b5%d0%bb%d0%b5%d0%b7%d1%8b-%d1%81-%d0%bc%d0%b5%d1%82%d0%b0%d1%81%d1%82%d0%b0%d0%b7\/","title":{"rendered":"\u0420\u0430\u043a \u043f\u0440\u0435\u0434\u0441\u0442\u0430\u0442\u0435\u043b\u044c\u043d\u043e\u0439 \u0436\u0435\u043b\u0435\u0437\u044b \u0441 \u043c\u0435\u0442\u0430\u0441\u0442\u0430\u0437\u0430\u043c\u0438 \u0432 \u043a\u043e\u0441\u0442\u0438"},"content":{"rendered":"<p>[et_pb_section fb_built=&#187;1&#8243; 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_builder_version=&#187;4.4.8&#8243; disabled=&#187;on&#187;][et_pb_accordion_item title=&#187;TANI H\u0130ZMETLER\u0130 &#8212; F-18 NAF PET\/BT&#187; open=&#187;on&#187; open_toggle_text_color=&#187;#0ca7c5&#8243; _builder_version=&#187;4.4.8&#8243; toggle_font=&#187;|700|||||||&#187; toggle_font_size=&#187;18px&#187;]<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Endikasyon<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">F-18 NaF PET\/BT g\u00f6r\u00fcnt\u00fclemesi; <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">1) Kemik metastazlar\u0131n\u0131n tan\u0131mlanmas\u0131 ve yayg\u0131nl\u0131\u011f\u0131n\u0131n belirlenmesi, <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">2) Malign kemik lezyonlar\u0131n\u0131n lokalizasyonu, <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">3) A\u011fr\u0131l\u0131 kemik metastazlar\u0131n\u0131n Radyum-223 diklor\u00fcr tedavisi \u00f6ncesi de\u011ferlendirilmesi<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">4) Tedaviye yan\u0131t\u0131n de\u011ferlendirilmesinde endikedir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Flor-18 NaF PET\/BT Nedir, T\u00fcm\u00f6r Oda\u011f\u0131n\u0131 Nas\u0131l G\u00f6sterir?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">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<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Prostat kanserinde bir yandan Flor-18 NaF (F-18 NaF) PET\/BT ile kemik metastazlar\u0131 y\u00fcksek duyarl\u0131l\u0131kta g\u00f6r\u00fcnt\u00fclenebilmekte, di\u011fer yandan Radyum-223 ile bu t\u00fcm\u00f6ral dokular\u0131n \u00f6zg\u00fcl ve hedefe y\u00f6nelik tedavisi yap\u0131labilmektedir. <\/span><span class=\"s2\">Bu, teranostik uygulamalar i\u00e7in olduk\u00e7a ba\u015far\u0131l\u0131 bir \u00f6rnektir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p5\"><span class=\"s1\">Metastatik kastrasyona diren\u00e7li prostat kanseri olan hastalar\u0131n %90&#8217;\u0131ndan fazlas\u0131nda \u00f6l\u00fcm, sakatl\u0131k ve azalm\u0131\u015f hayat kalitesinin ba\u015fl\u0131ca sebebi olan, kemik metastaz\u0131na ait bulgular mevcuttur. Di\u011fer bir\u00e7ok kanser t\u00fcr\u00fcndeki \u00f6l\u00fcmlerin aksine, prostat kanserinden \u00f6l\u00fcmler genellikle kemik metastaz\u0131 ve komplikasyonlar\u0131ndan kaynaklanmaktad\u0131r. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p6\"><span class=\"s1\"><b>Flor-18 NaF PET\/BT\u2019nin \u00dcst\u00fcn Yanlar\u0131 Nelerdir?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">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. F-18 NaF PET&#8217;in kemik matrisindeki de\u011fi\u015fiklikleri g\u00f6sterebilme yetene\u011fi ve PET\/BT taray\u0131c\u0131n\u0131n y\u00fcksek \u00e7\u00f6z\u00fcn\u00fcrl\u00fc\u011fe sahip tomografik iskelet g\u00f6r\u00fcnt\u00fcleri, geleneksel N\u00fckleer T\u0131p SPECT veya planar kemik sintigrafisine k\u0131yasla duyarl\u0131l\u0131k seviyesi \u00e7ok daha y\u00fcksektir. Ek olarak, t\u00fcm iskeleti tomografik olarak g\u00f6r\u00fcnt\u00fcleyebilmesi, F-18 NaF PET\/BT&#8217;yi \u00e7ok \u00e7e\u015fitli kemik hastal\u0131klar\u0131n\u0131n te\u015fhisinde de faydal\u0131 hale getirmektedir. Ba\u015fta kemik metastaz\u0131 ara\u015ft\u0131r\u0131lan hastalar olmak \u00fczere bir\u00e7ok hasta i\u00e7in, F-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<p>&nbsp;<\/p>\n<p class=\"p5\"><span class=\"s1\">100 dakika gibi k\u0131sa yar\u0131 \u00f6m\u00fcrl\u00fc kemik g\u00f6r\u00fcnt\u00fcleme maddesi olan F-18 NaF ile yap\u0131lan PET\/BT g\u00f6r\u00fcnt\u00fclemesi,<span class=\"Apple-converted-space\">\u00a0 <\/span>b\u00f6lgesel kemik metabolizmas\u0131n\u0131n e\u015fsiz bir \u015fekilde de\u011ferlendirmesine imkan verir. F-18 NaF, yeni kemik olu\u015fumu b\u00f6lgelerine ba\u011flan\u0131r ve kemik kan ak\u0131\u015f\u0131n\u0131n ve osteoblastik aktivitenin bir belirteci olarak i\u015flev g\u00f6r\u00fcr. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p5\"><span class=\"s1\">Kemi\u011fin 2\/3&#8217;\u00fc minerallerden, 1\/3&#8217;\u00fc de kollajen, ekstrasell\u00fcler matris ve \u00e7e\u015fitli kemik astar h\u00fccrelerinden olu\u015fur. Mineral matris kalsiyum hidroksiapatitten olu\u015fur. Flor\u00fcr iyonlar\u0131n\u0131n hidroksiapatit y\u00fczeyine kemisorpsiyonunun ard\u0131ndan,<span class=\"Apple-converted-space\">\u00a0 <\/span>kristal i\u00e7indeki hidroksil (OH\u2212) iyonlar\u0131 ile yer de\u011fi\u015ferek floroapatit olu\u015ftururlar.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p5\"><span class=\"s1\">F-18 NaF&#8217;\u0131n %100&#8217;e yak\u0131n ilk ge\u00e7i\u015f klirensi nedeniyle, plazmadan temizlenmesi \u00e7ok h\u0131zl\u0131d\u0131r ve bu da konvansiyonel kemik sintigrafisine g\u00f6re \u00e7ok daha erken g\u00f6r\u00fcnt\u00fcleme yap\u0131labilmesine olanak sa\u011flamaktad\u0131r. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p5\"><span class=\"s1\">Yap\u0131lan bir\u00e7ok \u00e7al\u0131\u015fmada, F-18 NaF PET\/BT&#8217;nin, malign kemik hastal\u0131klar\u0131n\u0131n de\u011ferlendirilmesinde, geleneksel kemik sintigrafisinden veya kemik SPECT&#8217;ten daha do\u011fru oldu\u011funu g\u00f6sterilmi\u015ftir. Daha y\u00fcksek kalitede g\u00f6r\u00fcnt\u00fcleme, artan klinik do\u011fruluk, hasta ve sevk eden hekime daha fazla kolayl\u0131k sa\u011flamas\u0131 ve N\u00fckleer T\u0131p kaynaklar\u0131n\u0131n daha verimli kullan\u0131m\u0131 gibi sonu\u00e7lar, F-18 NaF PET\/BT&#8217;nin malign iskelet hastal\u0131klar\u0131n\u0131n g\u00f6r\u00fcnt\u00fclenmesinde kullan\u0131m\u0131n\u0131n \u00f6n\u00fcn\u00fc a\u00e7maktad\u0131r.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\"><b>Flor-18 NaF PET\/BT Kimlere Uygulan\u0131r?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">F-18 NaF PET\/BT&#8217;nin ana klinik endikasyonlar\u0131 \u015fu \u015fekilde s\u0131ralanabilir:<\/span><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li class=\"p2\"><span class=\"s1\">Kemik metastazlar\u0131n\u0131n tan\u0131mlanmas\u0131<\/span><\/li>\n<li class=\"p2\"><span class=\"s1\">Hastal\u0131\u011f\u0131n yayg\u0131nl\u0131\u011f\u0131n\u0131n do\u011fru belirlenmesi<\/span><\/li>\n<li class=\"p2\"><span class=\"s1\">Malign kemik lezyonlar\u0131n\u0131n lokalizasyonu<\/span><\/li>\n<li class=\"p2\"><span class=\"s1\">Kemik a\u011fr\u0131s\u0131n\u0131n tedavisi amac\u0131yla Radyum-223 uygulanmas\u0131 \u00f6ncesinde osteoblastik aktivitenin da\u011f\u0131l\u0131m\u0131n\u0131n de\u011ferlendirilmesi<span class=\"Apple-converted-space\">\u00a0<span class=\"Apple-tab-span\"> <\/span><\/span><\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Tedavi yan\u0131t\u0131n\u0131n de\u011ferlendirilmesi<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p class=\"p10\"><span class=\"s1\"><b>Flor-18 NaF PET\/BT G\u00fcvenli midir?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p9\"><span class=\"s1\">F-18 NaF PET\/BT taramas\u0131 g\u00fcvenli ve rutin bir i\u015flemdir. Milyonlarca PET\/BT taramas\u0131 t\u00fcm d\u00fcnyada sorunsuz olarak ger\u00e7ekle\u015ftirilmektedir. Uygulanan radyoaktif madde olan F-18 NaF g\u00fcvenlidir ve bilinen bir yan etkisi yoktur. PET\/BT taramas\u0131 i\u00e7in uygulanan radyoaktivite miktar\u0131 azd\u0131r ve g\u00fcn sonunda hastan\u0131n v\u00fccudundan temizlenir. Hastalar\u0131n N\u00fckleer T\u0131p Klini\u011finden ayr\u0131lmas\u0131 birka\u00e7 saat s\u00fcrmektedir ve PET\/BT taramas\u0131n\u0131 izleyen 6 saat boyunca ba\u015fkalar\u0131yla (\u00f6zellikle \u00e7ocuklar ve hamile kad\u0131nlar) temas\u0131n en aza indirilmesi \u00f6nerilmektedir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p11\"><span class=\"s1\"><b>Flor-18 NaF PET\/BT \u00d6ncesi Haz\u0131rl\u0131k <\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p12\"><span class=\"s1\"><b><i>F-18 NaF PET\/BT \u0130stemi S\u0131ras\u0131nda Gereken Bilgiler<\/i><\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li class=\"p2\"><span class=\"s1\">Endikasyon<\/span><\/li>\n<li class=\"p2\"><span class=\"s1\">Malignite hikayesi<\/span><\/li>\n<li class=\"p2\"><span class=\"s1\">\u00d6nceki onkolojik tedavilerin tipi ve tarihi (\u00f6rn., kemoterapi ve\/veya radyoterapi)<\/span><\/li>\n<li class=\"p2\"><span class=\"s1\">\u00d6nceki k\u0131r\u0131klar veya yak\u0131n tarihli travma (yeri ve tarihi)<\/span><\/li>\n<li class=\"p2\"><span class=\"s1\">\u00d6nceki ortopedik cerrahi giri\u015fimler (m\u00fcdahale tarihi, tipi ve yeri)<\/span><\/li>\n<li class=\"p2\"><span class=\"s1\">\u00d6nceki enfeksiyon ve yeri<\/span><\/li>\n<li class=\"p2\"><span class=\"s1\">\u00dcriner diversiyon prosed\u00fcrleri<\/span><\/li>\n<li class=\"p2\"><span class=\"s1\">Her bir kemik a\u011fr\u0131s\u0131n\u0131n yeri<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Di\u011fer g\u00f6r\u00fcnt\u00fclemeler ve raporlar\u0131 (\u00f6zellikle kemik sintigrafisi, BT veya MRI)<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p class=\"p12\"><span class=\"s1\"><b><i>Hasta Haz\u0131rl\u0131\u011f\u0131 <\/i><\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Hastalar\u0131n F-18 NaF PET\/BT i\u015flemi i\u00e7in a\u00e7 olmalar\u0131na gerek yoktur. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">\u0130la\u00e7lar\u0131n\u0131 her zamanki gibi alabilirler.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Hastalar, b\u00f6brekten at\u0131l\u0131m\u0131 art\u0131rmak, al\u0131nan radyasyon dozunu azaltmak ve optimal g\u00f6r\u00fcnt\u00fc kalitesine ula\u015fmak i\u00e7in, F-18 NaF enjeksiyonu \u00f6ncesinde ve sonras\u0131nda en az iki\u015fer bardak su i\u00e7melidirler. Tetkik sonras\u0131nda g\u00fcn\u00fcn geri kalan\u0131nda da su i\u00e7meye devam etmeleri ald\u0131klar\u0131 radyasyon dozunu azaltmada faydal\u0131 olacakt\u0131r. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">F-18 NaF PET\/BT g\u00f6r\u00fcnt\u00fclemesinden hemen \u00f6nce hastalar mesanelerini bo\u015faltmal\u0131d\u0131rlar.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p9\"><span class=\"s1\">G\u00f6r\u00fcnt\u00fc artefaktlar\u0131n\u0131 \u00f6nlemek i\u00e7in t\u00fcm metal e\u015fyalar\/tak\u0131lar\/protezler \u00e7\u0131kar\u0131lmal\u0131d\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p10\"><span class=\"s1\"><b>Flor-18 NaF PET\/BT \u0130\u015flemi Nas\u0131l Uygulan\u0131r?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">F-18 NaF PET\/BT g\u00f6r\u00fcnt\u00fclemesi, F-18 NaF&#8217;\u0131n 1.5-3.7 Mbq\/Kg (0.04-0.1 mCi\/Kg) dozunda i.v. bolus enjeksiyonu sonras\u0131 yakla\u015f\u0131k 30-60. dakikada yap\u0131l\u0131r. Obez hastalar i\u00e7in \u00f6nerilen maksimum toplam doz 370 MBq&#8217;dir (10 mCi).<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Hastalar\u0131n N\u00fckleer T\u0131p Klini\u011finden ayr\u0131lmas\u0131 birka\u00e7 saat s\u00fcrmektedir ve PET\/BT taramas\u0131n\u0131 izleyen 6 saat boyunca ba\u015fkalar\u0131yla (\u00f6zellikle \u00e7ocuklar ve hamile kad\u0131nlar) temas\u0131n en aza indirilmesi \u00f6nerilmektedir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p14\"><span class=\"s1\"><i>Normal Biyoda\u011f\u0131l\u0131m ve G\u00f6r\u00fcnt\u00fc Yorumlama<\/i><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Genel olarak, normal F-18 NaF PET\/BT&#8217;de, F-18 NaF&#8217;\u0131n t\u00fcm iskelette simetrik ve homojen da\u011f\u0131l\u0131m\u0131 g\u00f6zlenir. Ayr\u0131ca F-18 NaF idrar yoluyla at\u0131ld\u0131\u011f\u0131ndan, b\u00f6brek fonksiyonu normal olgularda, b\u00f6brek, \u00fcreter ve idrar kesesi de g\u00f6r\u00fcnt\u00fclenir.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Genellikle b\u00f6lgesel kan ak\u0131\u015f\u0131 ve\/veya yeni kemik olu\u015fumu gibi nedenlere ba\u011fl\u0131 olarak de\u011fi\u015fmi\u015f kemik metabolizmas\u0131na neden olabilecek herhangi bir neden, artm\u0131\u015f F-18 NaF al\u0131m\u0131na da neden olabilmektedir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Minimal osteoblastik kemik de\u011fi\u015fikli\u011fe sahip lezyonlar veya temel olarak osteolitik karakterli lezyonlar ise aktivite art\u0131\u015f\u0131 g\u00f6stermeyen bir lezyondan sadece lezyonu \u00e7evreleyen aktiviteye ya da belirgin olarak artm\u0131\u015f F-18 NaF tutulumuna kadar \u00e7ok farkl\u0131 paternler g\u00f6sterebilir. F-18 NaF tutulumu iyi huylu kemik lezyonlar\u0131nda da olduk\u00e7a belirgin olabilir. Bu nedenle, F-18 NaF tutulumunun derecesi (SUVmaksimum vb.) iyi huylu lezyonlar\u0131 malign lezyonlardan ay\u0131rt edemez. Bununla birlikte, tutulumun paterni spesifik tan\u0131 i\u00e7in olduk\u00e7a karakteristik olabilir. PET\/BT&#8217;nin BT bile\u015feni de lezyon lokalizasyonu i\u00e7in kullan\u0131l\u0131rken, potansiyel olarak yorumu da geli\u015ftirir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p15\"><span class=\"s1\"><b><i>Daha fazla bilgi i\u00e7in l\u00fctfen bizimle irtibata ge\u00e7iniz.<\/i><\/b><\/span><\/p>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#187;TEDAV\u0130 H\u0130ZMETLER\u0130 &#8212; RADYUM-223 TEDAV\u0130S\u0130&#187; open_toggle_text_color=&#187;#0ca7c5&#8243; _builder_version=&#187;4.4.8&#8243; toggle_font=&#187;|700|||||||&#187; toggle_font_size=&#187;18px&#187; open=&#187;off&#187;]<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Endikasyon<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Radyum-223 diklor\u00fcr tedavisi, medikal ve cerrahi kastrasyonun i\u015fe yaramad\u0131\u011f\u0131, kanserin kemiklere yay\u0131larak semptoma neden oldu\u011fu ve bilinen organ metastaz\u0131n\u0131n bulunmad\u0131\u011f\u0131 prostat kanserli hastalarda endikedir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Radyum-223 Tedavisi Nedir?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">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<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Prostat kanserinde, bir yandan F-18 NAF PET\/BT ile kemik metastazlar\u0131 y\u00fcksek duyarl\u0131l\u0131kta g\u00f6r\u00fcnt\u00fclenebilmekte, di\u011fer yandan 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<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Metastatik kastrasyona diren\u00e7li prostat kanseri olan hastalar\u0131n %90&#8217;\u0131ndan fazlas\u0131nda, bu hastal\u0131kta \u00f6l\u00fcm, sakatl\u0131k ve azalm\u0131\u015f hayat kalitesinin ba\u015fl\u0131ca sebebi olan, kemik metastaz\u0131na ait bulgular mevcuttur. Di\u011fer bir\u00e7ok kanser t\u00fcr\u00fcndeki \u00f6l\u00fcmlerin aksine, prostat kanserinden \u00f6l\u00fcmler genellikle kemik metastaz\u0131 ve komplikasyonlar\u0131ndan kaynaklanmaktad\u0131r. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Radyum-223 Nas\u0131l Tedavi Eder?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p6\"><span class=\"s1\">Radyum-223, kemik metastazlar\u0131nda artm\u0131\u015f kemik d\u00f6ng\u00fcs\u00fc alanlar\u0131na se\u00e7ici olarak ba\u011flanan ve \u00e7ok k\u0131sa menzilli y\u00fcksek enerjili alfa par\u00e7ac\u0131klar\u0131 (&lt;100 \u03bcm) yayan, radyoaktif bir elementtir. Radyum-223 diklor\u00fcr (<\/span><span class=\"s2\"><sup>223<\/sup><\/span><span class=\"s1\">RaCl<\/span><span class=\"s2\"><sub>2<\/sub><\/span><span class=\"s1\">) molek\u00fcl\u00fc, kalsiyumu taklit ederek, osteoblastik veya sklerotik metastazlar gibi yeni olu\u015fmu\u015f kemik stromas\u0131na ba\u011flan\u0131r ve ard\u0131ndan y\u00fcksek enerjili alfa par\u00e7ac\u0131\u011f\u0131na ait radyasyon, \u00e7ift sarmall\u0131 DNA k\u0131r\u0131klar\u0131na neden olarak metastazlarda g\u00fc\u00e7l\u00fc ve olduk\u00e7a lokalize bir sitotoksik etki meydana getirir. Alfa par\u00e7ac\u0131klar\u0131n\u0131n k\u0131sa menzili, kom\u015fu sa\u011fl\u0131kl\u0131 doku ve \u00f6zellikle kemik ili\u011fi \u00fczerindeki toksik etkinin de en az d\u00fczeyde kalmas\u0131 anlam\u0131na gelmektedir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p3\"><span class=\"s1\">Sa\u011f kal\u0131ma yararl\u0131 etkisi oldu\u011fu bilinen kemi\u011fe \u00f6zg\u00fc tek ila\u00e7, radyoaktif alfa par\u00e7ac\u0131\u011f\u0131 yayarak tedavi edici etkisini g\u00f6steren Radyum-223&#8217;t\u00fcr. 921 semptomatik mKDPK hastas\u0131n\u0131n dahil edildi\u011fi ALSYMPCA \u00e7al\u0131\u015fmas\u0131 ile Radyum-223 tedavisinin medyan genel sa\u011fl\u0131m\u0131 3.6 ay uzatt\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. Buna ek olarak; ilk iskelet kaynakl\u0131 hadisenin ortaya \u00e7\u0131k\u0131\u015f\u0131n\u0131 geciktirme, a\u011fr\u0131 skorlar\u0131nda d\u00fczelme ve ya\u015fam kalitesinde iyile\u015fme de Radyum-223 tedavisi ile ili\u015fkili bulunmu\u015ftur. T\u00fcm bu olumlu sonu\u00e7lar\u0131na ek olarak, hematolojik toksisite ve ishal d\u0131\u015f\u0131nda Radyum-223 ile ili\u015fkili<span class=\"Apple-converted-space\">\u00a0 <\/span>toksisite olduk\u00e7a hafif d\u00fczeylerde izlenmi\u015ftir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Radyum-223 tedavisine May\u0131s 2013&#8217;te FDA, Kas\u0131m 2013&#8217;te de EMA taraf\u0131ndan; medikal ve cerrahi kastrasyonun i\u015fe yaramad\u0131\u011f\u0131, kanserin kemiklere yay\u0131larak semptoma neden oldu\u011fu ve bilinen organ metastaz\u0131n\u0131n bulunmad\u0131\u011f\u0131 prostat kanserli hastalarda kullan\u0131lmak \u00fczere onay verilmi\u015f ve ard\u0131ndan bu endikasyon ile maj\u00f6r k\u0131lavuzlarda (NCCN, Avrupa \u00dcroloji Derne\u011fi vb.) yerini alm\u0131\u015ft\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p7\"><span class=\"s1\"><b>Radyum-223 Tedavisi Kimlere Uygulan\u0131r?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Radyum-223 diklor\u00fcr; semptomatik kemik metastazlar\u0131 olan ve bilinen organ metastaz\u0131 bulunmayan, \u00f6ncesinde en az iki basamak sistemik tedavi uygulanmas\u0131na kar\u015f\u0131n progresyon g\u00f6zlenmi\u015f ya da mKDPK i\u00e7in mevcut sistemik tedavilere uygun olmayan yetis\u0327kin kastrasyona diren\u00e7li prostat kanseri hastalar\u0131n\u0131n tedavisinde endikedir. Radyum-223 tedavisi, abirateron asetat ve prednizon\/prednizolon ile kombinasyonu kontrendikedir. Bununla birlikte, monoterapi veya LHRH analoglar\u0131 ile kombinasyon \u015feklide, sa\u011fkal\u0131m\u0131 art\u0131rmak ve a\u011fr\u0131 palyasyonu ile ya\u015fam kalitesini y\u00fckseltmek i\u00e7in uygulanabilir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p7\"><span class=\"s1\"><b>Radyum-223 Tedavisi G\u00fcvenli midir?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Radyum-223 tedavisinde kullan\u0131lan, \u00e7ok k\u0131sa menzilli (&lt;100 \u03bcm) alfa par\u00e7ac\u0131klar\u0131 miyelos\u00fcpresyonu en aza indirir ve normal doku \u00fczerinde de s\u0131n\u0131rl\u0131 etkiye sahiptir. Bu nedenle, di\u011fer sitotoksik sistemik tedaviler ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, Radyum-223 d\u00fc\u015f\u00fck miyelos\u00fcpresyon oranlar\u0131 ve daha az yan etki ile ili\u015fkilidir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Radyum-223 tedavisi, abirateron asetat ve prednizon\/prednizolon ile kombinasyonu kontrendikedir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Radyum-223, abirateron asetat ve prednizon\/prednizolonun es\u0327zamanl\u0131 olarak bas\u0327lat\u0131lmas\u0131n\u0131n klinik etkililik ve g\u00fcvenlilig\u0306i asemptomatik veya hafif semptomatik kastrasyona diren\u00e7li prostat kanseri ile kemik metastazlar\u0131 bulunan, kemoterapi almam\u0131s\u0327 hastalar\u0131n yer ald\u0131g\u0306\u0131 randomize, \u00e7ift k\u00f6r, plasebo kontroll\u00fc \u201cERA-223\u201d \u00e7al\u0131s\u0327mas\u0131nda deg\u0306erlendirilmis\u0327 ve \u00f6n veriler, abirateron asetat ve prednizon\/prednizolon ile kombinasyon halinde plasebo alan hastalara k\u0131yasla abirateron asetat ve prednizon\/prednizolon ile kombinasyon halinde Radyum-223 alan hastalarda k\u0131r\u0131k ve \u00f6l\u00fcm insidans\u0131n\u0131n artt\u0131\u011f\u0131n\u0131 g\u00f6stermis\u0327tir. Ayn\u0131 \u00e7al\u0131s\u0327mada bifosfonatlar\u0131n veya denosumab\u0131n es\u0327zamanl\u0131 kullan\u0131m\u0131 her iki tedavi kolundaki k\u0131r\u0131k insidans\u0131n\u0131 azaltt\u0131\u011f\u0131 da g\u00f6sterilmi\u015ftir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Radyum-223 tedavisi, son abirateron ve prednizon\/prednizolon dozunu takip eden ilk 5 g\u00fcn i\u00e7inde uygulanmamal\u0131d\u0131r. Benzer \u015fekilde, sonraki sistemik kanser tedavisine de, son Radyum-223 uygulamas\u0131ndan sonra 30 g\u00fcn boyunca ba\u015flan\u0131lmamal\u0131d\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Uzun s\u00fcreli k\u00fcm\u00fclatif radyasyon al\u0131m\u0131, artan kanser riski ile ili\u015fkili olabilir. \u00d6zellikle osteosarkom, miyelodisplastik sendrom ve l\u00f6semi riski artabilir. Bununla birlikte klinik \u00e7al\u0131\u015fmalarda, 3 y\u0131la kadar olan takiplerde Radyum-223 kaynakl\u0131 kanser vakas\u0131 bildirilmemi\u015ftir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Radyum-223 diklor\u00fcr\u00fcn fekal at\u0131l\u0131m\u0131 nedeniyle, beraberindeki radyasyon akut enflamatuar ba\u011f\u0131rsak hastal\u0131\u011f\u0131n\u0131n alevlenmesine yol a\u00e7abilir. Bu nedenle akut enflamatuar ba\u011f\u0131rsak hastal\u0131\u011f\u0131 olan hastalarda dikkatli bir yarar-risk de\u011ferlendirmesinden sonra uygulanmal\u0131d\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">\u00c7ene osteonekrozu, bisfosfonatlar\u0131n nadir g\u00f6r\u00fclen fakat \u00f6nemli bir yan etkisidir. Bu nedenle bifosfonatlar\u0131n, Radyum-223 birlikte kullan\u0131larak tedavi edildi\u011fi hastalarda, \u00e7ene osteonekrozu geli\u015fme riski artar. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p7\"><span class=\"s1\"><b>Radyum-223 Tedavisi \u00d6ncesi Haz\u0131rl\u0131k <\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Kemik ili\u011fi s\u00fcpresyonu nedeniyle; Radyum-223 tedavisine ba\u015flamadan \u00f6nce ve her dozdan \u00f6nce kan say\u0131m\u0131 yap\u0131l\u0131r. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\"><b>\u0130lk uygulamadan \u00f6nce;<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Mutlak n\u00f6trofil say\u0131s\u0131<span class=\"Apple-converted-space\">\u00a0 <\/span>\u22651,5 x 10<\/span><span class=\"s2\"><sup>9<\/sup><\/span><span class=\"s1\">\/L <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Trombosit say\u0131s\u0131 \u2265100 x 10<\/span><span class=\"s2\"><sup>9<\/sup><\/span><span class=\"s1\">\/L<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Hemoglobin \u226510 g\/dL olmal\u0131d\u0131r<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\"><b>Sonraki uygulamalardan \u00f6nce;<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Mutlak n\u00f6trofil say\u0131s\u0131<span class=\"Apple-converted-space\">\u00a0 <\/span>\u22651 x 10<\/span><span class=\"s2\"><sup>9<\/sup><\/span><span class=\"s1\">\/L <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Trombosit say\u0131s\u0131 \u226550 x 10<\/span><span class=\"s2\"><sup>9<\/sup><\/span><span class=\"s1\">\/L olmal\u0131d\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Radyum-223 diklor\u00fcr\u00fcn en son k\u00fcr\u00fcn\u00fcn uygulanmas\u0131nda sonraki 6 hafta i\u00e7inde, standart bak\u0131m yap\u0131lmas\u0131na ra\u011fmen, hedeflenen de\u011ferlerde iyile\u015fme olmazsa, sonraki tedavi kesilmelidir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Radyum 223 karaci\u011ferde metabolize olmad\u0131\u011f\u0131ndan ve hepatobiliyer at\u0131l\u0131m\u0131 olmad\u0131\u011f\u0131ndan, karaci\u011fer yetmezli\u011finin 223 diklor\u00fcr\u00fcn farmakokineti\u011fini etkilemesi beklenmemektedir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">\u0130drarla at\u0131l\u0131m minimal oldu\u011fundan ve ana eliminasyon d\u0131\u015fk\u0131 yoluyla oldu\u011fundan, b\u00f6brek yetmezli\u011finin Radyum-223 diklor\u00fcr\u00fcn farmakokineti\u011fini etkilemesi beklenmemektedir. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Radyum-223 diklor\u00fcr ile tedaviye ba\u015flamadan \u00f6nce ve tedavi s\u0131ras\u0131nda hastalar\u0131n kemik durumu (\u00f6rn. kemik sintigrafisi, kemik mineral yo\u011funluk \u00f6l\u00e7\u00fcm\u00fc ile) ve k\u0131r\u0131k riski (\u00f6rn. osteoporoz, 6&#8217;dan az kemik metastaz\u0131, k\u0131r\u0131k riskini art\u0131ran ila\u00e7 kullan\u0131m\u0131, d\u00fc\u015f\u00fck v\u00fccut k\u00fctle indeksi vb.) de\u011ferlendirilmelidir. Olgular\u0131n takibi en az 24 ay devam etmelidir. Ba\u015flang\u0131\u00e7ta k\u0131r\u0131k riski y\u00fcksek olan hastalarda, riske kar\u015f\u0131 tedavinin yarar\u0131 dikkatlice de\u011ferlendirilmelidir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Bifosfonatlar\u0131n veya denosumab\u0131n e\u015fzamanl\u0131 kullan\u0131m\u0131n\u0131n, Radyum-223 diklor\u00fcr ile tedavi edilen hastalarda k\u0131r\u0131k insidans\u0131n\u0131 azaltt\u0131\u011f\u0131 bildirilmi\u015ftir. Bu nedenle, Radyum-223 diklor\u00fcr ile tedaviye ba\u015flamadan veya devam etmeden \u00f6nce bu t\u00fcr \u00f6nleyici tedbirler dikkate al\u0131nmal\u0131d\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Omurilik bas\u0131s\u0131 veya kemik k\u0131r\u0131\u011f\u0131 olan olgularda, Radyum-223 tedavisi \u00f6ncesinde bu hastal\u0131klar\u0131n standart tedavisi yap\u0131lmal\u0131d\u0131r.<b> <\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Radyum-223 ba\u011f\u0131rsaktan at\u0131ld\u0131\u011f\u0131 i\u00e7in enflamatuar ba\u011f\u0131rsak hastal\u0131\u011f\u0131 (\u00fclseratif kolit, Crohn hastal\u0131\u011f\u0131 vb.) olan ve ba\u011f\u0131rsak t\u0131kan\u0131kl\u0131\u011f\u0131 riski y\u00fcksek olan hastalarda tedavi s\u0131ras\u0131nda dikkati olunmal\u0131d\u0131r. Kab\u0131zl\u0131\u011f\u0131 olan hastalar\u0131n da dikkatli izlemi ve ek destekleyici \u00f6nlemlerin al\u0131nmas\u0131 gerekebilir.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p7\"><span class=\"s1\"><b>Radyum-223 Tedavisi Nas\u0131l Uygulan\u0131r?<\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Standart uygulama: 4 haftal\u0131k aral\u0131klarla toplam 6 k\u00fcr, her bir k\u00fcr i\u00e7in uygulanmas\u0131 \u00f6nerilen miktar, hasta v\u00fccut ag\u0306\u0131rl\u0131g\u0306\u0131n\u0131n\u0131n kilogram\u0131 bas\u0327\u0131na 55 kBq (1.49 \u03bcCi) Radyum-223 diklor\u00fcrd\u00fcr. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p10\"><span class=\"s1\"><b><i>Prosed\u00fcr<\/i><\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Kullan\u0131ma haz\u0131r Radyum-223 diklor\u00fcr \u00e7\u00f6zeltisi, N\u00fckleer T\u0131p Klini\u011finde, yerle\u015ftirilen periferik \u0130V damar yoluyla enjekte edilir. Enjeksiyon i\u00e7in kal\u0131c\u0131 kateterler (\u00f6rn. Hickman kateter, inf\u00fczyon portu vb.) kullan\u0131lamaz.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p8\"><span class=\"s1\">Radyum-223 uygulamadan \u00f6nce, damar yolunun a\u00e7\u0131kl\u0131\u011f\u0131, en az 10 ml serum fizyolojik ile y\u0131kanarak kontrol edilir. Radyum-223, 1 dakika boyunca yava\u015f intraven\u00f6z enjeksiyon \u015feklinde uygulan\u0131r ve sonras\u0131nda, damar yolu yine en az 10 ml serum fizyolojik ile y\u0131kan\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">\u0130ntraven\u00f6z enjeksiyondan sonra Radyum-223 diklor\u00fcr h\u0131zla kandan temizlenir ve \u00f6ncelikle kemik ve kemik metastazlar\u0131nda tutulur veya ba\u011f\u0131rsa\u011fa at\u0131l\u0131r.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p10\"><span class=\"s1\"><b><i>Advers Reaksiyonlar <\/i><\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p2\"><span class=\"s1\">Radyum-223 tedavisi uygulanan hastalarda g\u00f6r\u00fclen en yayg\u0131n advers reaksiyonlar (\u2265% 10) bulant\u0131, ishal, kusma ve periferik \u00f6demdir. En s\u0131k g\u00f6r\u00fclen hematolojik laboratuvar anormallikler (\u2265% 10) ise; anemi, lenfopeni, l\u00f6kopeni, trombositopeni ve n\u00f6tropenidir<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"p10\"><span class=\"s1\"><b><i>Hasta Talimatlar\u0131\/E\u011fitimi:<\/i><\/b><\/span><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li class=\"p8\"><span class=\"s1\">Hastalar\u0131n kan say\u0131m\u0131 takip randevular\u0131na uyumu sa\u011flanmal\u0131, hastalara kanama veya enfeksiyon belirtileri bildirilmelidir.<\/span><\/li>\n<li class=\"p8\"><span class=\"s1\">\u0130yi hidrasyon sa\u011flanmal\u0131 ve oral al\u0131m, s\u0131v\u0131 durumu ve idrar \u00e7\u0131k\u0131\u015f\u0131 takip edilmelidir.<\/span><\/li>\n<li class=\"p8\"><span class=\"s1\">Dehidratasyon, hipovolemi, idrar retansiyonu veya b\u00f6brek yetmezli\u011fi belirtileri bildirilmelidir.<\/span><\/li>\n<li class=\"p8\"><span class=\"s1\">Tedavi sonras\u0131 di\u011fer insanlarla temas konusunda herhangi bir k\u0131s\u0131tlama yoktur.<\/span><\/li>\n<li class=\"p8\"><span class=\"s1\">Radyum-223 al\u0131rken ve son enjeksiyondan sonra en az 1 hafta boyunca hijyen uygulamalar\u0131na dikkat edilmelidir.<br \/><\/span><span class=\"s1\">&#8212; Hastalar klozeti oturarak kullanmal\u0131 ve her kullan\u0131mdan sonra sifon en az 2 kez \u00e7ekilmelidir.<br \/><\/span><span class=\"s1\">&#8212; Hastan\u0131n fekal madde veya idrarla kirlenmi\u015f giysileri derhal ve di\u011fer k\u0131yafetlerden ayr\u0131 olarak y\u0131kanmal\u0131d\u0131r.<\/span><\/li>\n<li class=\"p8\"><span class=\"s1\">Bak\u0131c\u0131lar, kontaminasyonu \u00f6nlemek i\u00e7in v\u00fccut s\u0131v\u0131lar\u0131n\u0131 tutarken eldiven ve \u00f6nl\u00fck gibi hasta bak\u0131m\u0131 i\u00e7in evrensel \u00f6nlemleri almal\u0131, sonras\u0131nda ellerini y\u0131kamal\u0131d\u0131r.<\/span><\/li>\n<li class=\"p8\"><span class=\"s1\">Cinsel olarak aktif olanlar hastalar prezervatif kullanmal\u0131 ve \u00fcreme potansiyeli olan kad\u0131n partnerleri tedavi s\u0131ras\u0131nda ve tedavinin tamamlanmas\u0131n\u0131 takip eden 6 ay boyunca etkili bir do\u011fum kontrol y\u00f6ntemi uygulamal\u0131d\u0131r.<\/span><\/li>\n<\/ul>\n<p>[\/et_pb_accordion_item][\/et_pb_accordion][et_pb_code _builder_version=&#187;4.4.8&#8243;][\/et_pb_code][et_pb_button button_url=&#187;https:\/\/www.intheranostics.com\/prof\/ru\/naf-%d0%bf%d1%8d%d1%82-%d0%ba%d1%82\/&#187; 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