Ömer YERCİ, Nesrin UĞRAŞ, Fatma ATALAY ÖZ, Gonca ÖZGÜN

Rektum Karsinomlarında Neoadjuvant Kemoradyoterapinin Yarattığı Histopatolojik Değişiklikler ve Tedavi Öncesi Tümör Evresi ile İlişkisi

Amaç: Neoadjuvant kemoradyoterapi lokal ileri rektal kanserlerdeki standart tedavi seçeneklerinden biridir. Kemoradyoterapi tümöral dokularda ve çevre dokularda çok çeşitli değişikliklere ve cevaplara neden olmaktadır. Bu çalışmanın amacı farklı tedavi seçeneklerinin tümör yatağında yarattığı değişiklikleri incelemektir. Gereç ve Yöntemler: Uludağ Üniversitesi'nde Ocak 2005-Temmuz 2012 arasında rektal adenokarsinom nedeniyle tedavi edilmiş, ortalama yaşları 62.4 olan 57 hasta değerlendirildi. Hastaların 23 tanesi pre-operatif kemoradyoterapi sonrası cerrahi rezeksiyon yapılan, 34 tanesi ise sadece cerrahi rezeksiyon yapılan hastalardı. Bulgular: Tümör yatağında stromal yanıtlar, neoadjuvant kemoradyoterapi sonrası cerrahi rezeksiyon yapılan hastalar ile sadece cerrahi rezeksiyon yapılan hastalar arasında değerlendirildiğinde, fibrozis ve inflamatuvar hücre infiltrasyonu açısından istatistiksel olarak anlamlı farklar bulundu. Kalsifikasyon, hemosiderin yüklü makrofajlar ve müsin gölcüklerinin varlığı açısından da belirgin farklar saptandı. Neoadjuvant kemoradyoterapi alan hasta grubunda, klinik T evreleri arasında değişkenler açısından fark mevcut değildi. Sonuç: Tümör yatağındaki stromal cevap neoadjuvant kemoradyoterapi ile artış göstermektedir ancak bu artmış yanıtın tümör evresi ile ilişkisi saptanmamıştır.

Histopathological Changes of Neoadjuvant Chemoradiation and Relation with the Pre-Treatment Tumor Stage in Rectal Carcinoma

Objective: Neoadjuvant chemoradiotherapy has considered one of the standard treatment modalities for locally advanced rectal cancers. Chemoradiotherapy has a variety of different effects and responses on tumor, tumor bed and peritumoral tissues. The purpose of the present study was to evaluate the stromal responses in tumor bed between the different treatment modalities and different clinical T stages. Methods: Fifty-seven consecutive patients with median age of 62.4 years were treated for rectal adenocarcinoma between January 2005 and July 2012 in Uludağ University Medical Faculty. Twenty-three of the patients were treated with neoadjuvant chemoradiation therapy and following surgery, 34 patients treated with surgery only. Results: When we compared the stromal responses in the tumor bed between the two different treatment modalities, the amount of fibrosis and intensity of inflammatory cell infiltration were found considerably marked. The existence of calcification, hemosiderin-laden macrophages and mucin lakes were found also significant marked. There was no difference found in between the patients with different clinical stages which were received neoadjuvant CRT. Conclusion: The stromal response in the tumor bed increases with the neoadjuvant chemoradiotherapy but the excess of the response doesn't have any relation with the clinical T stage.

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