Radyoterapide Hipertermi

.: PREFACE
Ön Söz
Preface
Prof. Dr. Metin GÜDEN
İstanbul Okan Üniversitesi Tıp Fakültesi, Radyasyon Onkolojisi ABD, İstanbul
Article Language: TR
Isı; kanser tedavisinde küratif amaçlı kullanılan en eski yöntemdir. Edwin Smith'in papirüslerinde milattan önce 3000 yıl öncesine dayanan belgelerde, memede tümörü olan bir hastanın sıcak ütüler şeklinde ısı ile tedavi edildiğini tarif eder.

Eski Yunan (Hipokrat 400 M.Ö.) ve Roma (Galen 200 M.S.) çevirilerinde benzer şekilde tedavilerde ısının kullanıldığını kaydetmiştir.

17. yüzyılın sonlarında, bulaşıcı hastalıkları olan hastalarda tümör regresyonu gözlenmiş; 19. yüzyılın sonunda Coley toksinlerin oluşturduğu ateşe bağlı çok sayıda tümör regresyonu bildirimi yapmıştır.

Günümüzde sıcak ve soğuk uygulanarak yapılabilen bu tedavi; neoplazileri de içine alan birçok hastalık grubunda uygulanabilmektedir.

Kanser; günümüzde tedavisi zor olan ölümcül hastalıkların başında gelmektedir. Tanı, tedavi ve takibi için yüksek teknoloji ve bilgi birikimi gerekli olmaktadır. Tüm çabalara rağmen tedavisinde beklenen başarılara ulaşılamamıştır. Bu nedenle kanser tedavileri ile ilgili yeni gelişmeler ve var olan tedavi modalitelerini daha iyiye doğru götürecek araştırmalar çok uzun yıllar boyunca ilgi odağı olmaya devam edecek gibi görünmektedir. Cerrahi, radyoterapi ve kemoterapi gibi konvansiyonel onkolojik yöntemlere intoleransın varlığı durumlarında ya da bu yöntemlerden herhangi birinin veya bir kaçının etkinliğini artırmak üzere ek olarak uygulanabilen termal tedavi, etkinliğini kanıtlamış bir yöntem olarak onkoloji disiplininde kendine yer bulmuştur.

Tek başına tümör hücresini apopitoza gönderebildiği gibi radyoterapi ve bazı kemoterapi ajanlarının etkinliğini de artırmaktadır. Aynı zamanda immün sistemin aktive olmasına da sebep olmaktadır. Ancak istenilen hedefin ısıtılırken homojen ısı dağılımının sağlanamaması, kritik organları koruyacak teknolojinin bugüne kadar geliştirilememesi, hedefte ve kritik organlardaki ısı değerlerinin ancak birkaç noktadan invaziv yöntemlerle ölçülebilmesi, standart kanser tedavisinde yerini almasına engel olmuştur.

Günümüzde noninvaziv termometrelerin gelmekte olması, çoklu açılardan hedef ısıtılarak kritik organların daha çok korunması, ısıtma süresince eş zamanlı ısı değişiminin takip edilebilmesi kanser tedavisindeki hakettiği yerini alması için umut olmaktadır. Uluslararası yayınlanan tedavi rehberlerinde de meme kanseri gibi birçok kanserin tedavi protokollerinde yerini almaktadır.

Türkiye Klinikleri yetkilileri bu gelişimi görmüş, ülkemizde ilk defa 'Hipertermi' ile ilgili bu çalışmayı yayınlamaya karar vermişlerdir. Ben Türk tıbbı için bunun önemli bir adım olduğunu düşünüyor; çalışmada emeği geçen herkese teşekkür ediyorum.

Ayrıca hipertermiyi bilimsel olarak araştıran, yorumlayan ve çok değerli zamanlarını harcayarak yazdıkları makalelerle çalışmanın yayınlanmasına sebep olan tüm yazarlara teşekkür ediyorum.

Prof. Dr. Metin GÜDEN
Editör
Heat is the oldest method used for curative purposes in cancer treatment. In Edwin Smith's papyruses, documents dating back 3.000 years before Christ describe that a patient with a breast tumor was treated with heat in the form of hot irons.

He noted that in Greek translations (before Hippocrates 400 BC) and Rome (Galen 200 BC), the heat was similarly used in treatments.

At the end of the 17th century, tumor regression was observed in patients with infectious diseases; At the end of the 19th century, Coley reported a large number of tumor regressions related to fever caused by toxins.

Today, this treatment can be done by applying hot and cold. It can be applied in many disease groups including neoplasms.

Cancer is one of the fatal diseases that are difficult to treat today. High technology and knowledge are necessary for diagnosis, treatment, and follow-up. Despite all efforts, the expected success of the treatment has not been achieved. For this reason, new developments in cancer treatments and researches that will improve the existing treatment modalities will continue to be the focus of attention for many years. Thermal treatment, which can be applied to conventional oncological methods such as surgery, radiotherapy, and chemotherapy in the presence of intolerance or to increase the effectiveness of any one or more of these methods, has found its place in the discipline of oncology as a proven method.

It not only sends tumor cells to apoptosis but also increases the efficacy of radiotherapy and some chemotherapy agents. It also causes the immune system to be activated. However, homogeneous heat distribution cannot be achieved while heating the desired target, the technology to protect critical organs has not been developed to this day, the target and critical organs can be measured by invasive methods to measure the heat values from a few points, has prevented its place in the standard cancer treatment.

Today, non-invasive thermometers are coming, multiple targets are heated to protect more critical organs, heating during the simultaneous heat exchange can be followed to follow the deserved place in the treatment of cancer is hope. Internationally published treatment guidelines also take place in the treatment protocols of many cancers such as breast cancer.

Turkiye Klinikleri officials has seen the development of our country have decided to publication this study about hyperthermia for the first time. I think this is an important step for Turkish medicine; I thank everyone who contributed to this study.

In addition, I would like to thank all the authors who have reviewed the hyperthermia scientifically and contributed to the publication of the articles with their valuable time.

Prof. Dr. Metin GÜDEN
Editor

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