Radyoterapi almış meme kanserli hastalarda radyasyonun omuz eklemine etkisinin ultrasonografi ile araştırılması
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Dosyalar
Tarih
2010
Yazarlar
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Meme kanseri nedeniyle opere olmuş ve Trakya Üniversitesi Tıp Fakültesi Hastanesinde göğüs duvarı ve aksilla-supraklavikuler bölgeye radyoterapi alan 36 olgunun omuz eklemi ultrasonografik ve klinik olarak değerlendirildi. Omuz kuşağı tendon ve yumuşak dokularındaki değişiklikler radyoterapi öncesi, radyoterapi sonrasında ise 6.hafta, 3. ay ve 6. ayda olmak üzere toplam 4 kez incelendi. Biseps uzun başı tendonu, rotator kaf tendonları ve ciltaltı yağ doku kalınlıkları ölçüldü. Sonografik olarak tüm olgularda tendonlarda minimal ve geçici ödem; en fazla bisepste olmak üzere 10 olguda geçici tenosinovit saptandı. Sadece 1 olguda 6.ayda supraspinatus tendonunda yırtık saptandı. Sonografik bulgusu olan olgularda klinik korelasyon düşük bulunmuştur. 23 olguda ultrasonografik ve/veya klinik hiçbir patolojik bulgu saptanmadı. 3 olguda radyoterapiye başlamadan önce biseps tenosinoviti vardı ve takipler süresince de değişmedi. Subkutan yağlı doku kalınlığı radyoterapinin akut döneminde azalmış olup subakut dönemde eski değerine dönmüştür. 6. ayda 2 hastada hareket kısıtlılığı gelişti. Aksiller-supraklavikular radyoterapi, en fazla biseps tendonunda hasar oluşturmaktadır. Bu hasar klinik olarak manifest olmayan geçici bir tenosinovittir. İleri çalışma ile kronik dönemde, geç dönem komplikasyonu olan hareket kısıtlılığı ile radyasyonun sebep olabileceği fibrozan tenosinovit arasındaki muhtemel ilişki araştırılmalıdır. Kanser hastalarında yaşam kalitesini arttırmak için, modern radyoterapi sistemleri ile biseps tendonunun korunmasına yönelik yeni protokoller geliştirilebilir. Anahtar Kelimer: Meme Tümörü; Omuz; Radyoterapi,Yüksek Enerjili; Tendon; Tenosinovit; Ultrasonografi.
Abstract
Shoulder joints of 36 patients which been operated for breast cancer and got radiotherapy to chest wall and axillary-supraclavicular region at Trakya University Medical Faculty Hospital were evaluated ultrasonographically and clinically. Changes in tendons and soft tissues on shoulder girdle were examined four times; before the radiotherapy, following the 6th week, 3th and 6th months of radiotherapy. The long head of the biceps tendon, rotator cuff tendons, thicknesses of subcutaneous fatty tissue were measured. In all subjects minimal transient edema of the tendons and in 10 patients transient tenosynovitis, mostly in biceps tendon, observed sonographically. Only in one patient supraspinatus tendon tear detected at the 6 th month. The degree of the correlation of the sonographic signs with the clinic manifestation was low. In 23 patients no sonographic nor clinic pathologic sign or symptom detected. In 3 patients biceps tenosynovitis was already existed before the radiotherapy and had not been changed during the follow-ups. The subcutaneous fat tissue was decreased in thickness on acute period and improved on subacute period. Decreased range of motion occurred 6 th month in two patients. Supraclavicular-axillary radioterapy gives the most damage the biceps tendon. This damage is a temporary tenosynovitis which is not manifest clinically. Further studies should research the possible relationship between limitation of movement and fibrosing tenosynovitis caused by radiation should be researched at the chronic period. With the aid of modern 48 radiotherapy systems, new protocols focusing on protection of the biceps tendon should be improved to increase the quality of live of the cancer patients. Keywords: Breast neoplasms; Radiotherapy, High Energy; Shoulder; Tendons; Tenosynovitis; Ultrasonography.
Abstract
Shoulder joints of 36 patients which been operated for breast cancer and got radiotherapy to chest wall and axillary-supraclavicular region at Trakya University Medical Faculty Hospital were evaluated ultrasonographically and clinically. Changes in tendons and soft tissues on shoulder girdle were examined four times; before the radiotherapy, following the 6th week, 3th and 6th months of radiotherapy. The long head of the biceps tendon, rotator cuff tendons, thicknesses of subcutaneous fatty tissue were measured. In all subjects minimal transient edema of the tendons and in 10 patients transient tenosynovitis, mostly in biceps tendon, observed sonographically. Only in one patient supraspinatus tendon tear detected at the 6 th month. The degree of the correlation of the sonographic signs with the clinic manifestation was low. In 23 patients no sonographic nor clinic pathologic sign or symptom detected. In 3 patients biceps tenosynovitis was already existed before the radiotherapy and had not been changed during the follow-ups. The subcutaneous fat tissue was decreased in thickness on acute period and improved on subacute period. Decreased range of motion occurred 6 th month in two patients. Supraclavicular-axillary radioterapy gives the most damage the biceps tendon. This damage is a temporary tenosynovitis which is not manifest clinically. Further studies should research the possible relationship between limitation of movement and fibrosing tenosynovitis caused by radiation should be researched at the chronic period. With the aid of modern 48 radiotherapy systems, new protocols focusing on protection of the biceps tendon should be improved to increase the quality of live of the cancer patients. Keywords: Breast neoplasms; Radiotherapy, High Energy; Shoulder; Tendons; Tenosynovitis; Ultrasonography.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Radyoloji, Nükleer Tıp, Radiology, Nuclear Medicine, Yüksek Enerjili, Tendon, Tenosinovit, Ultrasonografi
