Keywords
radioterapia
biologia molekularna
radioterapia śródoperacyjna
How to Cite
Abstract
W ciągu ostatniego stulecia radykalna mastektomia stanowiła główną metodę terapii pacjentów z nowotworem piersi. Dopiero pod koniec dwudziestego wieku mastektomia została zastąpiona przez zastosowanie oszczędzającego zabiegu chirurgicznego połączonego z frakcjonowaną radioterapią zewnętrzną (ang. external beam radiation therapy, EBRT), co znacznie obniżyło ryzyko wystąpienia u pacjentów wznowy miejscowej [1]. Pomimo osiągania dobrych wyników leczenia bez występowania ciężkich skutków ubocznych, czas trwania terapii EBRT stanowi poważne ograniczenie. Pacjenci mieszkający w dużej odległości od ośrodka radioterapii lub pacjenci wycieńczeni po przebytej chemioterapii często nie otrzymują radioterapii po wycięciu guza lub poddawani są zabiegowi mastektomii [2]. Rozwiązaniem tego problemu może być zastosowanie śródoperacyjnej radioterapii (ang. intraoperative radiotherapy, IORT), która podawana jest w jednej dawce w trakcie zabiegu chirurgicznego do loży po wycięciu guza. Rezultaty badań klinicznych ELIOT i TARGIT-A pokazały, że zastosowanie tej metody w odpowiednio wyselekcjonowanej grupie pacjentów może przynieść lepsze wyniki niż zastosowanie techniki EBRT [3, 4]. Jednak efekty działania śródoperacyjnej radioterapii na mikrośrodowisko guza nie są dobrze poznane. Wykazano, że proces zapalny wywołany zabiegiem chirurgicznym może stymulować wzrost pozostałych po zabiegu operacyjnym komórek nowotworowych [5]. Co więcej, najnowsze wyniki badań sugeruje, że proces ten może być hamowany poprzez zastosowanie radioterapii [6]. Lepsze zrozumienie interakcji zachodzących pomiędzy komórkami nowotworu piersi i mikrośrodowiskiem guza w odpowiedzi na napromieniowanie może pozwolić na odkrycie nowych strategii terapii nowotworów piersi.
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