Çiğdem PAPİLA, İrfan PAPİLA, Firuz ÇELİKOĞLU, İ.Seyhan ÇELİKOĞLU

Endobronşiyal girişimsel yöntemler ve intratümöral kemoterapinin akciğer kanserinin tedavi stratejisindeki yeri

Son yıllarda yapılan klinik araştırmalar “küçük hücreli dışı akciğer kanserinde” proksimal hava yollarında tümör yerleşimine bağlı obstrüksiyonun hastanın prognozunu olumsuz yönde etkilediğini, buna karşılık havayolu obstrüksiyonunun girişimsel bronkoskopi yöntemleri ile ortadan kaldırılmasının standart kanser tedavilerinin daha başarılı olmasını ve hastaların yaşam süresinin uzamasını sağladığını göstermiştir. Bu derleme yazısında girişimsel endobronşiyal tedavi yöntemleri aşağıdaki gibi iki ana guruba ayrılarak incelenmiştir: 1- non-spesifik yöntemler: a) termik yöntemler: elektro koter, lazer foto rezeksiyonu, argon plazma koagülasyonu ve krioterapi; b) mekanik yöntemler: forseps rezeksiyonu, balon kateter ile dilatasyon ve stent uygulaması. 2- kanser hücrelerini (normal hücreleri zedelemeden) spesifik olarak etkileyen yöntemler: brakiterapi, fotodinamik tedavi, endobronşiyal intratümöral kemoterapi. Yazıda yeni bir paradigma olan “endobronşiyal intratümöral kemoterapinin” tanımlaması yapılarak endikasyonları ve bronkoskopik girişimsel yöntemler arasındaki yeri belirlenmiştir. Endobronşiyal intratümöral kemoterapinin etki prensibinin fotodinamik tedavi ve brakiterapide olduğu gibi kanserli hücreleri normal hücrelere zarar vermeksizin nekrozlaştırdığı için spesifik olduğu vurgulanmıştır. Buna ek olarak, endobronşiyal intratümöral kemoterapinin loko-rejyonal neoadjuvant bir kemoterapi olarak radyoterapi, intravenöz kemoterapi ve diğer endobronşiyal girişimsel yöntemler ile eş zamanlı veya birbiri ardına kullanılmasının potansiyel yararları gözden geçirilmiştir

The place of endobronchial interventional procedures and intratumoral chemotherapy in the therapeutic strategy of lung cancer

The clinical studies in the last decades have demonstrated that the obstruction in the proximal airways due to non-smallcell- lung-cancer influences a negative effect on the outcome of disease. Moreover the clinical studies have demonstrated that the alleviation of the obstruction in the airways by the available interventional bronchoscope procedures ameliorates the efficiency of the standard therapeutic modalities of lung cancer as well as the survival rates of patients. In this present paper the advantages and disadvantages of different interventional endobronchial therapeutic modalities in the treatment of endobronchial malignancies were reviewed. Especially the effectiveness of using different methods sequentially or concomitantly in the same patient is emphasized. The interventional endoscopic procedures were studied in two main groups: 1- Ablative destructive methods with non-specific effects on the tissue: a) thermic procedures, such as electrocautery, laser photoresection, argon- plasma coagulation, cryotherapy; b) mechanical procedures, such as piecemeal resection with forceps, dilatation with balloon catheter, installation a stent. 2- Procedures with specific effects, destroying exclusively the cancerous cells: brachytherapy, photodynamic therapy. In addition to these, the novel paradigm of endobronchial intratumoral chemotherapy was described as interventional therapeutic modalities with specific effect on malignant cells alike brachytherapy and photodynamic therapy. The potential synergistic efficiency of EITC when combined with standard lung cancer therapies, brachytherapy and with photodynamic therapy was discussed.

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