D2 Rezeksiyonlu Mide Kanserlerinde Adjuvan Kemoradyoterapi

Lokal ileri evre mide kanserli hastalarda multidisipliner tedavi yaklaşımı etkin hastalık kontrolü ve yüksek yaşam kalitesi bakımlarından oldukça önemlidir. Radyoterapi (RT) ile birlikte birçok kemoterapotik ajan preoperatif veya postoperatif dönemlerde uygulanabilse de en doğru zamanlama, rejim ve dozlar halen tartışmalıdır. Southwest Oncology Group/Inter group 116 (SWOG/INT 116) çalışması adjuvan kemoradyoterapinin (KRT) lokal ileri evre mide kanserinin multidisipliner tedavi yaklaşımındaki rolünü belirleyen temel çalışma olarak kabul görmektedir. Ancak adjuvan KRT’nin D2 lenfatik diseksiyon uygulanmış R0 gastrektomili hastalardaki gerekliliği belirsizliğini korusa da mevcut prospektif randomize çalışma ve metaanaliz sonuçları postoperatif KRT’nin lokal bölgesel nüksü azalttığı ve buna bağlı olarak hastalıksız sağ kalımı uzattığını göstermektedir. Ancak tedavi kararı alınırken tümör evresi, nodal tutulum durumu ve histopatolojik özellikler gibi prognostik faktörlerin cerrahi sonrası KRT alması gereken alt grupların belirlenmesinde etken olduğu ve dolayısıyla kişiye özgü tedavilerin gerekliliği unutulmamalıdır. Eldeki verilerin görece sınırlı olması postoperatif KRT’den fayda görebilecek hastaların doğru olarak belirlenebilmesi için büyük ölçekli prospektif randomize çalışmalara olan ihtiyacı vurgulamaktadır.

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