Peritoneal metastazlı over karsinomu: Yaklaşımın yeniden düşünülmesi

Öz

Epitelyal tipte over karsinomu (EOK), genellikle ileri evrelerde teşhis edilen bir kanser türüdür. Bugüne kadar, EOC'nin standart tedavisi neoadjuvan veya adjuvan platin ve taksan bazlı sistemik kemoterapi ile kombine edilen cerrahi’dir. EOC'nin tekrarlaması durumunda hipertermik intraoperatif intraperitoneal kemoterapi (HİPEK) düşünülmektedir. HİPEK, over ve apendiks kaynaklı psödomiksoma peritonei tedavisinde altın standart olarak kabul edilmiştir. Son zamanlarda, randomize bir klinik çalışma, HIPEK'in, cerrahi serilerde yumurtalık kanserinin (OK) peritona metastazı (PM) için umut verici bir tedavi seçeneği olduğunu desteklemektedir. HİPEK'in ayrıca primer ve nüks OK'nin PM vakalarında etkili bir tedavi seçeneği olduğu bildirilmektedir. Sonuç olarak, HİPEK tekniğinin standardizasyonu ve optimizasyonu, tedavilere yanıt veren OK’nin PM'si olan hasta alt gruplarının belirlenmesi, kişiselleştirilmiş değerlendirme ve multidisipliner ekip tarafından hali hazırda yürütülen tedavilerin hala yeniden değerlendirilmesi gerekmektedir. Bu derlemede over kanserinin peritona metastazı durumunda standart tedavi yaklaşımı ile birlikte uygulamadaki sistemik tedaviler ve cerrahi ile kombine edilmiş HIPEK tedavi yaklaşımlarının güncellenmesi amaçlanmıştır.

Anahtar Kelimeler

• Periton Metastazı
• over kanseri
• sitoredüktif cerrahi
• hipertermik intraperitoneal intraoperatif kemoterapi

Ovarian Carcinoma with Peritoneal Metastasis: Rethinking of Management

Abstract

Epithelial Ovarian Carcinoma (EOC), a type of cancer that is usually diagnosed in advanced stages. To date, standard treatment of EOC is surgery with neoadjuvant or adjuvant platin and taxane based systemic chemotherapy. Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) is considered in cases of recurrence of EOC. HIPEC has been accepted as a gold standart for the treatment of pseudomyoxoma peritonei of ovarian and appendiceal origin. More recently, a randomized clinical trial supports that HIPEC is a promising treatment option for peritoneal metastasis (PM) of ovarian cancer (OC) in surgical series. HIPEC is also reported to be an effective treatment option in primary and recurrent cancer cases with PM of OC. As a result, the standardization and optimization of the HIPEC technique, determination of patient subgroups with PM of the OC responding to treatments, personalized evaluation and the treatments currently carried out by the multidisciplinary team still need to be re-evaluated. In this review, it is aimed to update the standard treatment approach in case of peritoneal metastasis of ovarian cancer, along with the systemic treatments and HIPEC treatment approaches combined with surgery.

Keywords

• Peritoneal metastasis
• ovarian cancer
• cytoreductive surgery
• hyperthermic intraperitoneal intraoperative chemotherapy

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