GENETİK MUTASYON TAŞIYICILARINDA MEME KANSERİ TEDAVİSİ: CERRAHİ TEDAVİ, PROFİLAKTİK MASTEKTOMİ

Abstract

Amaç: Meme kanseri kadınlar arasında en sık görülen kanser tipi olup son yıllarda genetik mutasyonların saptanmasıyla risk azaltıcı tedaviler önem kazanmıştır. Yöntem: Ocak 2018- Ocak 2023 arası genetik mutasyona sahip olduğu için kliniğimizde proflaktik mastektomi yapılan hastalar retrospektif olarak değerlendirildi. tüm hastalara yapılan cerrahi prosedürler, ameliyata ikincil gelişen komplikasyonlar, hastaların adjuvan tedaviye gönderilme zamanları, ikincil operasyon gerekliliği, hastalıksız sağ kalım süreleri değerlendirildi. Bulgular: Proflaktik mastektomi yapılmış 15 genetik mutasyonlu hastaların 4'ünde tümor oluşmadan bu ameliyat uygulanıştır. 6 hastada beklenen komplikasyonlardan kapsül kontraktürü, cilt nekrozu ve meme başı nekrozu gibi komplikasyonlar gelişmiş olup 4 hastada re-operasyon gerekliliği olmuştur. Tüm hastaların takiplerinde onkolojik prensiplere bağlı kalınmış olup hiç birinde nüks veya metastaz görülmemiştir. Sonuç : Genetik mutasyon panelinin genişlemesi ile hastalar zaman kazanmaya başlamış olup, hekim olarak bu kişilere onkolojik prensiplere uygun yol göstermemiz gerekmektedir. proflaktik mastektomi tümörsüz sağ kalım için bizim bu çalışmamızda önerdiğimiz yöntemdir.

Keywords

• BRCA
• proflaktik mastektomi
• risk azaltıcı cerrahi

BREAST CANCER TREATMENT IN GENETIC MUTATION CARRIERS: SURGICAL TREATMENT, PROPHYLACTIC MASTECTOMY

Abstract

Objective:Breast cancer is the most common type of cancer among women, and risk-reducing treatments have gained importance in recent years with the detection of genetic mutations. Method: Patients who underwent prophylactic mastectomy in our clinic between January 2018 and January 2023 were evaluated retrospectively. Surgical procedures performed on all patients, complications developing secondary to the surgery, the time of sending the patients to adjuvant treatment, the necessity of secondary operation, and disease-free survival were evaluated. Results: In 4 of the 15 patients with genetic mutations who underwent prophylactic mastectomy, this surgery was performed before tumor formation. Complications such as capsular contracture, skin necrosis and nipple necrosis developed in 6 patients, and reoperation was required in 4 patients. In the follow-up of all patients, oncological principles were adhered to, and no recurrence or metastasis was observed in any of them. Conclusion:With the expansion of the genetic mutation panel, patients have started to gain time, and as physicians, we need to guide these people in accordance with oncological principles. prophylactic mastectomy is the method we recommend in this study for tumor-free survival.

Keywords

• Brca
• Prophylactic Mastectomy
• risk-reducing surgery

References

1. Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30
2. Greene MH. Genetics of breast cancer. Mayo Clin Proc . 1997;72:54–65. doi: 10. 4065/72.1.54 .
3. Pashayan N, Antoniou AC, Ivanus U, et al. Personalized early detection and prevention of breast cancer: ENVISION consensus statement. Nat Rev Clin Oncol . 2020;17:687–705. doi: 10.1038/s41571- 020- 0388- 9 .
4. Tung N, Battelli C, Allen B, Kaldate R, Bhatnagar S, Bowles K et al (2015) Frequency of mutations in individuals with breast cancer referred for BRCA1 and BRCA2 testing using next-generation sequencing with a 25-gene panel. Cancer 121(1):25–33
5. Grignol VP, Agnese DM. Breast cancer genetics for the surgeon: an update on causes and testing options. J Am Coll Surg 2016;222(5):906–14.
6. Fayanju OM, Stoll CRT, Fowler S, et al. Contralateral prophylactic mastectomy after unilateral breast cancer: a systematic review and meta-analysis. Ann Surg . 2014;260:1000–1010. doi: 10.1097/SLA.0000000000000769.
7. Casella D, Di Taranto G, Marcasciano M, Sordi S, Kothari A, Kovacs T et al ( 2018) Nipple-sparing bilateral prophylactic mastectomy and immediate reconstruction with TiLoop ® Bra mesh in BRCA1/2 mutation carriers: a prospective study of long-term and patient reported outcomes using the BREAST-Q. Breast 39:8–13
8. Pek W-S, Tan B-K, Ru Ng YY, Kiak Mien Tan V, Rasheed MZ, Kiat Tee Tan B, et al (2018) Immediate breast reconstruction following nipple-sparing mastectomy in an Asian population: aesthetic outcomes and mitigating nipple-areolar complex necrosis. Arch Plast Surg 45(3):229–238

9. Jerome-D’emilia B, Trinh H. Socioeconomic factors associated with the receipt of contralateral prophylactic mastectomy in women with breast cancer. J Women’s Heal . 2020;29:220–229. doi: 10.1089/jwh.2018.7350 .
10. American Society of Breast Surgeons. Consensus Guideline on Genetic Testing For Hereditary Breast Cancer. https://www.breastsurgeons.org/about/statements/PDF_Statements/Hereditary_Genetic_Testing_Patients_With_Without_Breast_Cancer.pdf. Accessed March 10, 2019.
11. Tung N, Lin NU, Kidd J, et al. Frequency of germline mutations in 25 cancer susceptibility genes in a sequential series of patients with breast cancer. J Clin Oncol. 2016;34:1460-1468.
12. Carbine NE, Lostumbo L, Wallace J, et al. Risk-reducing mastectomy for the prevention of primary breast cancer. Cochrane Database Syst Rev . 2018;2018. doi: 10.1002/14651858.CD002748.pub4 .
13. Rachel Hae-Soo Joung, Timothy W Mullett, et all Evaluation of a National Quality Improvement Collaborative for Improving Cancer Screening JAMA Netw Open 2022 Nov 1;5(11):e2242354. doi: 0.1001/jamanetworkopen.2022.42354.
14. Terribile DA, Mason EJ, Murando F, et al. Surgical management of BRCA pathogenic variant carriers with breast cancer: a recent literature review and current state of the art. Minerva Surg . 2021. doi: 10.23736/S2724- 5691.21.09009- 2 .
15. De Jong MM, Nolte IM, Te Meerman GJ, et al. Genes other than BRCA1 and BRCA2 involved in breast cancer susceptibility. J Med Genet . 2002;39:225–242. doi: 10.1136/jmg.39.4.225 .
16. Hunt KK, Euhus DM, Boughey JC, et al. Society of surgical oncology breast disease working group statement on prophylactic (risk-reducing) mastectomy. Oncol . 2017;24:375–397. doi: 10.1245/s10434- 016- 5688- z .
17. Eck DL, Perdikis G, Rawal B, et al. Incremental risk associated with contralateral prophylactic mastectomy and the effect on adjuvant therapy. Ann Surg Oncol 2014;21(10):3297–303.