LENFATİK HARİTALAMANIN SERVİKS KANSERİ YÖNETİMİNDEKİ ÖNEMİ

Abstract

Serviks kanseri tüm dünyada 40 yaş altı kadınlar arasında görülen ikinci en sık kanserdir. Erken evre serviks kanserlerinde en sık uygulanan tedavi radikal histerektomi ve pelvik lenf adenektomidir. Radikal cerrahi uygulanan hastaların %90’ında lenf nodu (LN) metastazı bulunmamaktadır. Dolayısıyla pek çok hastada yapılan lenf adenektominin hastanın prognozuna olumlu katkısı olmaz, diğer yandan lenf adenektomiye bağlı morbiditenin artma riski vardır. Günümüzde preoperatif dönemde LN metastazını kesin olarak belirleyecek bir yöntem bulunmamaktadır. Ancak son yıllarda serviks kanseri olgularında lenfatik haritalama yöntemi kullanılarak seçilmiş hastalarda cerrahiye lenf adenektomi eklenip, diğer hastalarda lenf adenektomi komplikasyonlarından kaçınmayı amaçlayan çalışmalar yapılmıştır. Bu derlemede serviks kanseri yönetiminde lenfatik haritalamanın önemi araştırılmıştır. Değişik araştırmacılar lenfatik haritalama tekniğinde mavi boya, sintigrafi ve kombine yöntemler kullanılarak sentinel lenf nodu araştırılması yapmış en başarılı sonuçlar kombine yöntemde elde edilmiştir. Teorik olarak SLN biyopsisi negatif ise lenf adenektomi yapılmamalı, radikal histerektomi yapılmalıdır. SLN biyopsisi pozitif ise lenf adenektomi yapılmalı, radikal histerektomi yapılmamalıdır. Lenfatik haritalama ve SLN identifikasyonu uygulaması kolay ve iyi tolere edilen, erken evre serviks kanserlerinde uygulanabilir bir yöntem gibi gözükmektedir. Bu gruptaki hastalar LN metastaz oranları düşük olduğu için selektif nodların araştırılmasından yarar görebilirler.

Keywords

• Lenfatik haritalama, serviks kanseri, yönetim

References

1. Ayhan A, Tuncer ZS, Yarali H. Complications of radical hysterec- tomy in women with early stage cervical cancer: clinical analy- sis of 270 cases. Eur J Surg Oncol. 1991; 17:492-494.
2. Bader AA, Winter R, Hass J, Tamussino KF. Where to look for sentinel lymph node in cervical cancer. Am J Obstet Gynecol. 2007;197:1 -7.
3. Benedet J, Odicino F, Maisoneuve P, Beller U, Creasmen WT, He- inzt AP, Ngan HY, Pecorelli S. Carcinoma of the cervix uteri. Int J Gynaecol Obstet. 2003;1:41-78.
4. Burgharth E, Baltzer J, Tulusan AH, Haas J. Results of surgical treatment of 1028 cervical cancers studied volumetry . Cancer 1992;70:648-655.
5. Coleman RL, Whitten CW, O’Boyle J, Sıdhu B. Unexplained dec- rease in measured oxygen saturation by pulse oximetry fallo- wing injection of lymphazurin %1 (isosulfan blue) during a lymphatic mapping procedure. J Surg Oncol 1999;70:126-129.
6. Dargent D, Martin X, Roy M, Mathevet P. Identification of senti- nel node with laparoscopy in cervical cancer 31. Meet Soc Gynecol Oncol Abst. 2000;41:241-244.
7. Delgado G, Bundy BN, Fowler EC, et al. A prospective surgical pathological study of stage 1 squamous carcinoma of cervix: A Gynecologic Oncology Study Group. Gynecol Oncol 1989;36:314-320.
8. Di Stefano AB, Acquaviva G, Garozza G, Barbic M, Cvjeticanin B, Meglic L, Kobal B, Rakar S. Lymph node mapping and sen- tinel node detection in patients with cervical carcinoma: a 2-ye- ar experience. Gynecol Oncol. 2005;99:671-679.

9. Finan M, DeCesera S, Fiorica J et al. Radical hysterectomy for sta- ge 1B1 vs 1B2 carcinoma of the cervix: Does the new staging system predict morbidity and survival? Gynecol Oncol 1996;62:139-147.
10. Frumowitz M, Coleman RL, Gayed IW, Ramirez PT, Wolf JK, Gershenson DM, Levenback JF. Usefullnes of preoperative lymphoscinticgraphy in patients who undergo radical hysterec- tomy and pelvic lympadenectomy for cervical cancer. Am J Obs- tet Gynecol , 2007;197:116.
11. Hacker NF, Wain GF, Niklin JF. Resection of bulky positive lymph nodes in patients with cervical carcinoma. Int J Gynecol Cancer 1995;5:250-256.
12. Hill AD, Mann GB, Borgen PI, Cody HS 3rd: Sentinel lympha- tic mapping in breast cancer. J AM Coll Surg 1999;188:545-549.
13. Inoue T, Morita K. The prognostic significance of number of po- sitive nodes in cervical carcinoma stages IB, IIA and IIB. Can- cer 1990;65:1923-1927.
14. Joosten JJ, Strobbe LJ, Wauters CA, Pruszczynski M, Wobbes T, Ruers TJ. Intraoperative lymphatic mapping and the sentinel no- de concept in colorectal carcinoma. Br J Surg 1999;86:482-486.
15. Kinney WK, Hodge DO, Egorshin EV, Ballard DJ, Podratz KC. Surgical treatment of patients with stages IB and IIA carcinoma of the cervix and palpably positive pelvic lymph nodes. Gynecol Oncol. 1995;57:145-149.
16. Krag D, Weaver D, Ashikaga T, Moffat F, Kimberg VS, Shiriver C, Feldman S, Kusmimsky R, Gadd M, Kuhn J, Harlow S, Be- itsch P. The sentinel node in breast cancer. A multicenter valida- tion study. N Engl J Med 1998;339:941-946.
17. Kushner DM, Connor JP, Wilson MA, Hafez GR, Chappell RJ, Sarah L. Stewart and Ellen M. Hartenbach. Laparoscopic senti- nel lymph node mapping for cervix cancer-A detailed evaluation and time analysis. Gynecologic Oncology 2007;106:507–512
18. Lambaudie E, Collinet P, Narducci F, Sonoda Y, Papageorgiou T, Carpentier P, Leblanc E, Querleu D. Laparoscopic identifica- tion of sentinel lymph nodes in early stage cervical cancer: Pros- pective study using a combination of patent blue dye injection and technetium radiocolloid injection. Gynecologic Oncology, 2003;89: 84-87
19. Levenback C, Coleman RL, Burke TW, Lin WM, Erdman W, Deavers M, Delpassand ES. Lymphatic mapping and sentinel node identification in patients with cervix cancer undergoing ra- dical hysterectomy and pelvic lymphadenectomy. J Clin Oncol 2002;15:20-26.
20. Little AG, DeHoyos A, Kirgan DM, Arcomano TR, Murray K. Intraoperative lymphatic mapping for non-small cell cancer: The sentinel node technique. J Thorac Cardiovasc Surg 1999;117:220-234.
21. Malur S, Krause N, Köhler C, Schneider A. Sentinel lymph no- de detection in patients with cervical cancer. Gynecol Oncol 2001;80:254-257.
22. Morton DL, Wen DR, Foshag IJ, Essner R, Cochran A. Intraope- rative lymphatic mapping and selective cervical lympadenec- tomy for early stage melanoma of the head and neck. J Clin On- col 1993;11:1751-1756.
23. Noguchi H, Shiozawa I, Sakai Y Yamazaki T, Fukuta T. Pelvic lymph node metastasis of uterine cervical cancer. Gynecol On- col 1987; 27:150-158.
24. O’Boyle JD, Coleman RL, Bernstein SG, Lifthitz S, Muller CY, Miller DS. Intraoperative Lymphatic Mapping in Cervix Cancer Patients Undergoing Radical Hysterectomy: A Pilot Study. Gynecol Oncol 2000; 79:238-243.
25. Parker SL, Tong T, Bolder S, Wingo PA. Cancer statistics, 1997. CA Cancer J Clin 1997; 47:810.
26. Pitman KT, Jonhson JT, Edington H, Barnes EL, Day R, Wagner RL, Myers EN. Lymphatic mapping with isosulfan blue dye in squamous cell carcinoma of the head and neck. Arc Otolaryngol Head Neck Surg 1998;124:790-793.
27. Samlal RA, Van Der Velden J, Van Eerden T, Schilthius MS, Gonzales Gonzales D, Lammes FB. Recurrent cervical carcino- ma after radical hysterectomy: an analysis of clinical aspects and prognosis.Int J Gynecol Cancer 1998;8:78-84.
28. Trappen POV, Gyselman VG, Lowe DG, Ryan A, Oram DH, Bosze P, Weekes AR, Shepherd JH, Dorudi S, Bustin SA, Jacops IJ. Molecular quantification and mapping of lymph node micro- metastases in cervical cancer. The Lancet 2001;357:15-20.
29. Van Dam PA, Hauspy J, Vanderheyden T, Sonnemans H, Spa- epen A, Eggenstein G, Dirix L, Verkinderen L. Intraoperative sentinel node identification with Technetium-99m-nanocolloid labeled in patients with cancer of the uterine cervix: a feasibility study. Int J Gynecol Cancer 2003;13:182-186.
30. Verheijen RH, Pijpers R, van Diest PJ, Burger CW, Buist MR, Kenemans P. Sentinel node detection in cervical cancer. Obstet Gynecol 2000;96:135-137.
31. Veronesi U, Paganelli G, Galimberti V, Viale G. Sentinel-node biopsy to avoid axillary disection in breast cancer with clinically negative lymph-nodes. Lancet 1997;349:1684-1687.