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I. Ulusal Meme Kanseri Konsensusu I. ULUSAL MEME KANSERİ KONSENSUSU I. ULUSAL MEME KANSERİ KONSENSUSU Editör Prof. Dr. Ayfer Haydaroğlu 1 I. ULUSAL MEME KANSERİ KONSENSUSU I. ULUSAL MEME KANSERİ KONSENSUSU Ağustos 2007 Prof. Dr. Ayfer HAYDAROĞLU Yazışma Adresi : Ege Üniversitesi Radyasyon Onkolojisi Anabilim Dalı, Bornova - İZMİR Telefon : 0 232 390 32 70 Fax : 0 232 388 86 00 E mail : [email protected] 15 - 19 KASIM 2006 TARİHLERİ ARASINDA, BODRUM’DA GERÇEKLEŞTİRİLEN, “I. ULUSAL MEME KANSERİ KONSENSUS TOPLANTISI”NDA TARTIŞILAN UZLAŞMA KONULARINI VE SONUÇLARINI İÇEREN BİR KİTAPTIR. Bu kitap Meme Dernekleri Koordinasyon Kurulu ve İzmir Meme Hastalıkları Derneği adına I. Ulusal Meme Kanseri Konsensusu Toplantısı Başkanı Prof. Dr. Ayfer HAYDAROĞLU’nun editörlüğünde derlenmiş ve 1000 adet basılmıştır. İSBN: 978-975-01491-0-8 Bu kitap Kongre Basımevi Matbaası’nda basılmıştır. Bu kitabın tamamı veya bir bölümü izin alınmadan kullanılamaz. Her türlü yayın hakkı İzmir Meme Hastalıkları Derneği ve Editöre aittir. 2 I. ULUSAL MEME KANSERİ KONSENSUSU Değerli Meslektaşlarımız , Kurulduğu günden beri pek çok ilke imzasını atan Meme Dernekleri Koordinasyon Kurulu (MDKK) 2006 Kasım ayında yeni bir girişime daha önder olmuştur. Türkiye‘ nin dört bir yanından gelen ve meme kanserini kendilerine uğraş alanı olarak seçen Genel Cerrah, Tıbbi Onkolog, Radyasyon Onkoloğu, Radyolog ve Patolog meslektaşlarımız Bodrum‘ da toplanarak bir ulusal uzlaşı metni oluşturmak için yoğun çaba harcadılar. Yurt dışında katıldığımız ve buruk bir şekilde izlediğimiz bu tip bir toplantıyı ülkemizde gerçekleştirmek kolay olmadı. Bu toplantı için yoğun uğraşlar verildi ve çabalar harcandı. Sonuçta hepimizin katkılarıyla ortaya bize ait olan ulusal bir ortak metin çıktı. Bu ortak metinin paylaşılması ve hayata geçirilmesi bundan sonra yapılacak uzlaşı toplantılarının önünü açacaktır. İşte bu kitap meme kanseri konusunda ulusal uzlaşı metinimiz olarak sizlerin hizmetinize ve görüşlerinize sunulmaktadır. Mükemmeli ararken öncekinin eksikliklerini görmek, ondan ders çıkarmak fakat onu yok farz etmemek kanımca ortak ilkemiz olmalıdır. Bu ilk uzlaşı toplantısının organizasyonunda ve bunun bir kitap haline getirilerek sizlere sunulmasında başta Prof. Dr. Ayfer Haydaroğlu ve İzmir Meme Hastalıkları Derneği üyelerini ve de tüm emeği geçenleri en içten dileklerimle kutlamak isterim. Yeni bir uzlaşı toplantısında sizlerle tekrar bir araya gelmek dileklerimle saygılarımı sunarım. Prof. Dr. Semih Baskan Meme Dernekleri Koordinasyon Kurulu Eş Başkanı 3 I. ULUSAL MEME KANSERİ KONSENSUSU Sayın Meslektaşlarım, Meme Dernekleri Koordinasyon Kurulu (MDKK) Ulusal Meme Hastalıkları Kongrelerinin arasında 2 yılda bir meme kanseri uzlaşı toplantıları yapılması kararlaştırılmış ve bu görev İzmir Meme Hastalıkları Derneği ve Aydın Meme Hastalıkları Derneği’ne verilmiştir. I. Ulusal Meme Kanseri Konsensus Toplantısı (I. UMKK) 15 - 19 Kasım 2007 tarihleri arasında Bodrum’da gerçekleştirilmiş, meme kanserinin tanı ve izlemi yanı sıra her evresinde tedavilerle ilgili önemli çalışma sonuçları sunulmuş, katılımcılarca tartışılmış, sonunda ülkemiz koşullarında bizim için en doğru yöntemler ve protokoller, katılımcıların tartışmaları dikkate alınarak Uzlaşı Kurulunca oylanmıştır. Uzlaşı Kurulu tüm ülke çapında meme kanseri ile ilgili çalışan, çeşitli ulusal ve uluslararası toplantıları izleyen, bu konuda yayınlar yapan, meme kanseri eğitimi veren ve MDKK’yı oluşturan dernek yönetimlerinin önerileri dikkate alınarak oluşturulmuştur. Ulusal bir meme kanseri uzlaşısı’ na varabilmek için oluşturulan çalışma grupları meme kanseri tanı ve tedavi yöntemlerinde çokdisiplinli olarak en geniş katılımla, kanıta dayalı tıp ilkeleri doğrultusunda tartışma konuşmalarını hazırlamışlardır. Konuşma özetleri konsensus özet kitabında yer almaktadır. Uzlaşı Kurulunca yapılan oylamalarda bazı konularda fikir birliğine varılmış, bazı konular ise tartışmalı kalmıştır. Bu Toplantının sonucu olarak %80 üzeri oy alan konularda fikir birliği olduğu ve “uzlaşı” sağlandığı kabul edilmiştir. Uzlaşı kurulu tarafından %50-80 arasında oy alan konular ise “genellikle kabul gördüğü” şeklinde yorumlanmıştır. Ayrıca verilen oylar branşlar göz önüne alınarak yeniden değerlendirilmiştir. Burada amaç farklı disiplinlerdeki meslektaşların oylarının sonucu etkilememesidir. Ancak bir konu hakkında kesin fikri olmayan farklı branştan meslektaşlar genellikle o konuda oy vermemeyi tercih ettikleri için branşlara göre dağılımda önemli değişiklikler olmamıştır. Uzlaşı kitabında konuşma özetlerinin bir kısmı ile oylama sonuçları, raportörlerin raporlar, algoritmalar ve fikir birliği sağlanan sonuçlar sunulmuştur. Bu uzlaşı toplantısında emeği geçen terim kurulu raportörü Ragıp KAYAR’a, tarama grubu raportörü Ümit BAYOL’a, tanı ve izlem grubu raportörü Ayşenur OKTAY’a, duktal karsinoma insitu raportörü İlknur Bilkay GÖRKEN’e, erken evre meme kanseri raportörü Erhan GÖKMEN’e, yerel ileri evre meme kanseri raportörü Ulus ŞANLI’ya, yerel yineleme ve metastatik evre raportörü Zeynep ÖZSARAN’a, onkoplastik cerrahi raportörü Mehmet Ali KOÇDOR’a, yan etkiler grubu raportörü Kemal ATAHAN’a ve tüm düzenleme kurulu üyelerine teşekkür ederim. 4 I. ULUSAL MEME KANSERİ KONSENSUSU Konsensus toplantısının gerçekleşmesinde katkıda bulunan başta MDKK yönetim kurulu ve MDKK yı oluşturan dernekler olmak üzere branş dernekleri olan Türk Genel Cerrahi Derneği, Türk Radyoloji Derneği, Türk Patoloji Derneği, Türk Radyasyon Onkolojisi Derneği, Anadolu Medikal Onkoloji Derneği ve Türk Onkoloji Grubu Derneği’ne şükranlarımı sunarım. Konsensus kitabındaki terim ve dil düzeltilmesindeki katkıları için Ragıp KAYAR’a, basımındaki desteği için Sanofi-Aventis Firmasına, I. UMKK toplantısının mükemmel organizasyonu için GLOBAL TURİZM’e, gerek organizasyonda gerekse kitabın basımında özverili çalışmaları için GLOBAL Turizm’den Kıvanç AYLI’ya düzenleme kurulu adına teşekkür ederim. I.Ulusal Meme Kanseri Konsensusu Toplantısının meme kanseri üzerine ulusal uzlaşımıza katkıda bulunmasını diliyor, saygılar sunuyorum. Prof. Dr. Ayfer HAYDAROĞLU 1. Ulusal Meme Kanseri Konsensus Toplantısı Başkanı E-posta : [email protected] Tel : 0 232 388 86 00 5 I. ULUSAL MEME KANSERİ KONSENSUSU İÇİNDEKİLER • I. UMKK Hakkında Genel bilgiler…………………………………………………….………..…... 8 o UMKK Düzenleme Kurulu o UMKK Raportörler o Uzlaşma Kurulu o Katılım Hakkında Genel Bilgiler • Meme Hastalıkları Terimleri………………..………………………………………...…………… 11 o Terim Kurulu Oylamaları Üzerine Yorumlar o Sonuç • Meme Kanseri Tarama Yöntemleri……………………………………….…………………….. 13 o Taramada Uzlaşı Oylama Sonuçları Üzerine Yorumlar o Sonuç • Meme Kanserinde Tanı …………………………………………………………………………… 15 o Tanıda Standartlar ve Tanı Basamakları o Tanı İçin Uzlaşı Oylamaları Üzerine Yorumlar o Sonuç • Meme Kanserinde İzlem ………………………………………………………………………….. 23 o İzlemde Standartlar o İzlem Basamakları o İzlem İçin Uzlaşı Oylamaları Üzerine Yorumlar o Sonuç • Duktal Karsinoma İn-Situ ……………………………………………………...…………………. 30 o Tanı ve Tedavide Standartlar o DKİS’da Tedavi Basamakları o DKİS İçin Uzlaşı Oylamaları Üzerine Yorumlar o Sonuç • Erken Evre Meme Kanseri………………………………………………………………………… 37 o Yerel Tedaviler o Sistemik Tedaviler o Erken Evrede Meme Kanserlerinde Tedavi Basamakları o Erken Evre Meme Kanserinde Uzlaşı Oylamala Sonuçları o Sonuç • Yerel İleri Meme Kanseri……………………………………………………………………..…… 55 o Tedavilerde Standartlar o Yerel İleri Meme Kanseri Tedavi Basamakları o Yerel İleri Meme Kanseri Uzlaşı Kurulu Oylamaları Üzerine Yorumlar o Sonuç 6 I. ULUSAL MEME KANSERİ KONSENSUSU • Meme Kanserinde Onkoplastik Cerrahi ……………………………………………………..… 63 o Onkoplastik Cerrahide Standartlar o Onkoplastik Cerrahi Uzlaşı Oylamaları Üzerine Yorumlar o Sonuç • Meme Kanserinde Yerel-Bölgesel Yineleme ve Metastatik Evre ....……………….……… 68 o Yerel-Bölgesel Yineleme Yaklaşım Basamakları o Metastatik Meme Kanserine Yaklaşım Basamakları o Lokal Bölgesel Yinelemede Tedavi Basamakları o Metastatik Meme Kanserinde Tedavi Basamakları o Yerel-Bölgesel ve Metastatik Evre Oylama Sonuçları o Sonuç • Yan Etkiler ve Destek Tedaviler………………………………………………………………….. 79 o Yaşam Niteliği o Yanetkiler o Destek Tedavileri o Yanetkiler ve Destek Tedavilerinde Uzlaşı Oylamalar Üzerine Yorumlar o Sonuç • MDKK Hasta Onam Formları……………………………………………………………………... 84 o Cerrahi Onam Formu o Radyoterapi Onam Formu o Kemoterapi Onam Formu o Hormonoterapi Onam Formu • Meme Hastalıkları Terimleri ……………………………………………………………………… 93 o Yabancı Terim Dizini (A-Z) o Türkçe Karşılık Dizini (A-Z) • Konu Dizini……………………………………………………………………………………….… 137 7 I. ULUSAL MEME KANSERİ KONSENSUSU I. UMKK HAKKINDA GENEL BİLGİLER UMKK DÜZENLEME KURULU BAŞKAN ÜYELER Ayfer Haydaroğlu Hilmi Alanyalı Şükrü Boylu SEKRETERYA Murat Çobanoğlu Kemal Atahan Erdem Göker Erhan Gökmen İlknur Bilkay Görken Mehmet Ali Koçdor Osman Güngör Zeynep Özsaran Ömer Harmancıoğlu Murat Kapkaç SAYMAN Ragıp Kayar Atilla Çökmez Ercüment Tarcan YEREL DANIŞMA KURULU Mehmet Alakavuklar Mehmet Ali Önal Arif Aras Orhan Özbal Pınar Balcı Emin Özdedeli Ümit Bayol Necmettin Özdemir Tülay Canda Serdar Saydam Binnaz Demirkan Ulus Şanlı Sümer Deniz Mustafa Tireli Yıldız Erhan Esin Emin Üstün Hüdai Genç Rasih Yılmaz Münir Kınay Uğur Yılmaz Ayşenur Oktay UMKK RAPORTÖRLER Ragıp Kayar Terim Kurulu Ümit Bayol Tarama Grubu Ayşenur Oktay Tanı ve İzlem Grubu İlknur Bilkay Görken Duktal Karsinoma İnsitu Grubu Erhan Gökmen Erken Evre Meme Kanseri Grubu Ulus Şanlı Yerel İleri Evre Meme Kanseri Grubu Zeynep Özsaran Metastatik Evre Meme Kanseri Grubu Mehmet Ali Koçdor Onkoplastik Cerrahi Grubu Kemal Atahan
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