Adrenokortikal Karsinomlarda Tedavi Ve İzlem

Adrenokortikal karsinom nadir görülen bir endokrin malignitedir. Hastalar hormon aşırı salınımına veya kitlenin lokal etkisine bağlı semptomlar ile başvurur. Agressif bir tümördür ve nüks riski kitlenin tam rezeksiyonuna rağmen yüksektir. Başta lokal nüks olmak üzere nüks gelişme oranı laparoskopik adrenalektomi sonrası daha sıktır ve özellikle operasyon sonrası ilk iki yıl içinde gözlenir. Yüksek nüks oranları nedeniyle çoğu hasta radikal rezeksiyon sonrası adjuvan tedaviye ihtiyaç duyar. Adjuvan tedavide üç yaklaşım önerilir: Mitotan, mitotan-kemoterapotik ilaç kombinasyonu ve tümör yatağına radyoterapi. Adjuvan mitotan medikal tedavide birinci basamaktır. Ancak yan etkileri mevcuttur ve terapotik aralığının dar olması nedeniyle yakın takip gerektirir. Yan etkiler ilaç dozunun azaltılmasıyla kontrol altına alınabilir. Adrenokortikal karsinomlu hastalar radikal cerrahi sonrası en az 10 yıl olmak üzere düzenli takip edilmelidir.

The Treatment and Follow up of Adrenocortical Carcinoma

Adrenocortical carcinoma is a rare endocrine malignancy. Patients present with hormone excess or a local mass effect. The tumor is agressive and characterized by a high risk of recurrence even after complete resection. Recurrence rate (particularly local recurrence) is higher in laparoscopic adrenalectomy and most recurrences occur in the postoperative first two years. Because of the high recurrence rates, most patients need adjuvan treatment after radical resection. Three adjuvant therapotic approach have been suggested: Mitotane, mitotane plus chemotherapeutic agents and radiotherapy of the tumor bed. Adjuvant mitotane is the first line medical treatment but it is associated with some adverse events and in all patients a strict follow up is required because of the drug's narrow therapeutic index. Adverse events are manageable through reduction of the mitotane dose. Patients with adrenocortical carcinoma should be followed up regularly at least 10 years after radical surgery.

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