Niyazi Volkan DEMİRCAN, Muhammed Ertuğrul ŞENTÜRK, SERAP ÇATLI DİNÇ, Oya AKYOL, DİCLEHAN KILIÇ

Meme kanserli olgularda adjuvan radyoterapinin tiroid fonksiyonları üzerine etkisi

Amaç: Meme kanseri görülme sıklığı yıllar içerisinde artmasına rağmen meme kanserine bağlı ölüm oranlarında belirgin azalma dikkat çekmektedir. Buna bağlı olarak artan genel sağkalım süreleri, meme kanseri tedavisinde görülen yan etkilerin önemini arttırmıştır. Bu çalışmada meme kanseri nedeniyle adjuvan radyoterapi (RT) uygulanan olgularda, RT’nin tiroid fonksiyonlarına etkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Bölümümüzde 2009-2017 yılları arasında meme kanseri nedeniyle RT uygulanmış 87 hastanın demografik verileri, tümör evreleri, tedavi modaliteleri, tiroid hacimleri, tedavi öncesi ve sonrası TSH, T3 ve T4 değerleri, RT doz ve hacimleri ile tiroid bezinin doz-volüm değerleri hasta dosyaları, planlama sistemi ve Gazi Üniversitesi Tıp Fakültesi elektronik veritabanından toplanarak değerlendirildi.Veriler SPSS 22.0 dosyasına aktarılarak hipotiroidizm ile RT doz-hacim, tiroid hacmi ilişkisi ki-kare ve parametrik olmayan testlerle analiz edildi. Bulgular: Medyan yaş 50 idi. 87 hastanın 85’i kadın (%98), 2 tanesi erkekti (%2). 59 hastanın metastatik lenf nodu (%59) mevcuttu. 53 hastada (%61) supraklaviküler alan (SKF) tedavi hacmi içerisindeydi. Toplamda 12 hastada (14%) RT’ye bağlı hipotiroidizm görüldü. Lenf nodu pozitifliği, ve buna bağlı olarak yapılan SKF ışınlaması hipotiroidizm gelişmesi ile anlamlı olarak ilişkili saptandı (sırasıyla p=0.013, p=0.003). Çok değişkenli analizde sadece ortalama doz (Dort=24Gy) ve V30 (%30) değerleri hipotiroidizm gelişmesi açısından istatistiksel olarak anlamlı bulundu (sırasıyla p=0.038, p=0.044). V30 değerlerinin >%30 olduğu olgularda hipotirodizm gelişme riskinin daha yüksek olduğu gözlendi (p

Objective: Despite the increasing incidence of breast cancer, mortality ratio due to the disease is prominently reduced so far.In this regard, prolonged overall survival is required to focus on side effects of breast cancer treatment more seriously. To evaluate the effect of adjuvant radiotheraphy (RT) on thyroid gland functions in breast cancer patients was aimed. Material and Methods: Demographic data of patients, tumor stages, treatment modalities, thyroid volumes, pre- and posttreatment TSH, T3 and T4 values, RT dose and volumes and dose volume values of the thyroid gland of 87 breast cancer patients were collected from patients files, planning system and Gazi University Medical Faculty electronic database and analyzed. Statistical analysis was done to detect between the RT dose volume parameters and hypothyroidism. Results: Median age was 50 years. Of the 87 patients, 98%were female. 59%had metastatic lymph nodes. In 53 patients, supraclavicular area (SCF) was in the treatment volume.Radiation-related hypothyroidism was detected in 14%.Lymph node involvement and consequent SCF irradiation were found to be associated with the development of hypothyroidism (p = 0.013, p = 0.003, respectively). Onlymean dose (Dmean=24 Gy) and volume of 30 Gy (V30) valueswere found statistically significant on the development of hypothyroidism in multivariate analysis (p = 0.038, p = 0.044, respectively). Risk of hypothyroidism due to RT were seemed higher in patients with V30 ≥ 30 % values of thyroid gland volume (p

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