Kemik Metastazlarında Tanı ve Tedavi

Yıl 2008, Cilt: 41 Sayı: 1, 1 - 6, 01.04.2008

Yıldız Güney Sercan Yılmaz Ümmühani ÖZEL Türkçü Cengiz Kurtman

Öz

Advanced cancers frequently metastasise to the bone, and the resulting bone destruction is associated with a variety of skeletal complications, including pathologic fractures, bone pain, impaired mobility and spinal cord compression. Bone metastases are distant relapses from many types of malignant tumours, especially from cancers of the lung, breast, and prostate Direct invasion by tumor and lymphatic and hematogenous metastases to the bone occur. Technetium (Tc 99m) bone scintigraphy and direct radiographs are widely regarded. Computed tomography, magnetic resonance imaging and positron emission tomography are useful tools for diagnosis and treatment. Present treatment options for patients with bone metastases include radiation therapy, surgery, bisphosphonates, radionuclides and analgesics, in addition to Standard anticancer therapy. The primary goal of therapy is to minimise bone pain and morbidity and improve mobility and quality of life. Single fraction radiotherapy (RT) is as safe and effective as a multifraction regimen for the palliation of metastatic bone pain. The greater convenience for the patients and the department single fraction RT is preferred.

Anahtar Kelimeler

Bone metastases, diagnosis, treatment.

Diagnosis and Treatment o f Metastatic Bone Disease

Öz

İleri evre kanserler sıklıkla kemiğe metastaz yaparlar ve kemik destrüksiyonu kemik ağrısı, hareket kısıtlılığı, patolojik kırık ve spinal kord kompresyonu gibi iskelet morbiditelerine yol açar. Kemik metastazları kadınlarda en çok meme kanserlerine, erkeklerde ise prostat ve akciğer kanserlerine bağlı gelişir. Tümör genellikle kemiklere hematojen yolla yayılmakla birlikte, lenfatik ve direkt yayılımda görülebilir. Tamda kemik sintigrafisi (Teknesyum 99m) ve direkt grafiler standart yöntemlerdir. Bilgisayarlı tomografi, manyetik rezonans görüntüleme ve pozitron emisyon tomografiside tanıda ve takipte kullanılmaktadır. Günümüzde kemik metastazlarının tedavi seçenekleri standart antikanser tedavisinin yanında radyoterapi (RT), cerrahi, bifosfanatlar, radyonüklid ve analjezikleri içermektedir. Esas amaç; ağrıyı azaltmak, patolojik fraktür gelişmesini önlemek, mobiditeyi azaltırken fonksiyonu iyileştirmek ve yaşam kalitesini yükseltmektir. Tek doz RT, tedavi süresinin kısa olması ile tedavi stresini azaltmakta, hem hastanın hem de departmanın yükünü hafifletmektedir. Seçim yapılırken hastanın genel durumu, yaşam kalitesi, yaşı, tedaviye uygunluğu, ışınlanacak volüm göz önüne alınmalıdır ve en uygun şema seçilmelidir.

Anahtar Kelimeler

Kemik metastazları, tanı, tedavi.

Kaynakça

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