Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Meme Kanserli Türk Kadınlarında Meme Koruyucu Cerrahi ve Modifiye Radikal Mastektomi; Yaşam Kalitesine Yönelik İleriye Dönük Bir Analiz
Breast Conserving Surgery and Modified Radical Mastectomy in Turkish Women with Breast Cancer: A Prospective Analysis of Quality of Life
Metin KEMENTa, Cem GEZENa, Ayla AŞIKa, Alev KARAÖZa, Başak ÖVEN USTAALİOĞLUb, Ahmet BİLİCİb, Mustafa ÖNCELa,c
aGenel Cerrahi Kliniği, bOnkoloji Kliniği, Kartal Eğitim ve Araştırma Hastanesi, İstanbul cGümüşhane Üniversitesi, Sağlık Yüksekokulu, Gümüşhane
Turkiye Klinikleri J Med Sci. 2011;31(6):1377-84
doi: 10.5336/medsci.2010-20018
Article Language: TR
Full Text
ÖZET
 Amaç: Kliniğimizde meme koruyucu cerrahi (MKC) ve sonrasında radyoterapi uygulanan hastalar ile modifiye radikal mastektomi (MRM) uygulanan hastaların ameliyat sonrası yaşam kalitelerini karşılaştırmak. Gereç ve Yöntemler: Çalışmaya kliniğimizde Ocak 2006 ile Ocak 2008 tarihleri arasında meme kanseri tanısı ile ameliyat edilen hastalar alınmıştır. Neoadjuvan kemoterapi alan ve modifiye radikal mastektomi sonrası radyoterapi gereken hastalar ile ASA 3 ve 4 hastalar çalışmadan çıkarılmışlardır. Birinci gruba modifiye radikal mastektomi (MRM grubu), ikinci gruba ise meme koruyucu cerrahi ve sonrasında radyoterapi (MKC grubu) ile tedavi edilen hastalar alınmışlardır. Hastaların yaşam kaliteleri, tedavi süreçleri (cerrahi, radyoterapi, kemoterapi) tamamlandıktan altı ay sonra Tıbbi Sonuç Çalışması-Kısa Form 36 (MOS SF-36) formu kullanılarak değerlendirilmiştir. Bulgular: Gruplar arasında yaş ve değerlendirilen sosyoekonomik (eğitim, gelir, eşin durumu) ve klinik parametreler (evre, komplikasyon, adjuvan kemoterapi endikasyonu) arasında anlamlı fark yoktu (tüm karşılaştırmalar için p> 0.05). MKC uygulanan hastaların (s= 27) yaşam kaliteleri sekiz SF-36 ölçeğinin altısında (canlılık, sosyal işlev hariç) genel Türk toplumundan, yedisinde (canlılık hariç) ise Ulusal Cerrahi Adjuvan Meme ve Bağırsak Projesi Protokol-B6 (NSABP BCPT) çalışmasındaki normal bireylerin ortalama değerlerinden daha kötüydü. Bunun yanında MKC grubunda fiziksel alan skoru genel toplumdan daha kötüyken (45.3'e karşın 52.6), mental alan skoru genel toplumla nispeten benzerdi (53.4'e karşın 51.7). MRM uygulanan hastalar (s= 23) ile MKC uygulanan hastaların yaşam kaliteleri karşılaştırıldığında ise tüm ölçeklerde MKC grubunun ortalama değerlerinin MRM grubundan daha iyi olduğu, ve sekiz ölçeğin altısında (canlılık ve sosyal işlev hariç) aradaki farkın istatistiksel olarak anlamlı olduğu bulunmuştur (p< 0.05). Sonuç: Meme kanseri nedeniyle meme koruyucu cerrahi ve radyoterapi uygulanan hastaların yaşam kalitelerinin sağlıklı bireylere kıyasla fiziksel açıdan bozulduğu, ancak mental açıdan değişmediği söylenebilir. Bunun yanında, meme koruyucu cerrahi uygulanan hastaların yaşam kalitelerinin modifiye radikal mastektomi uygulanan hastalardan hem fiziksel hem de mental açılardan daha iyi olduğu söylenebilir.

Anahtar Kelimeler: Meme tömörleri; yaşam kalitesi; mastektomi, segmental
ABSTRACT
 Objective: The aim of this study is to compare the postoperative quality of life of the patients who underwent breast conserving surgery followed by radiotherapy (BCT) and the patients who underwent modified radical mastectomy (MRM) in our clinic. Material and Methods: The patients who were operated on with diagnosis of breast cancer in our clinic between January 2006 and January 2008 were included in the study. Those who received neoadjuvant therapy and who required radiotherapy after modified radical mastectomy and those in ASA classes 3 and 4 were excluded. The patients who were treated with modified radical mastectomy were included in the first group (Group MRM) and the patients who were treated with breast conserving therapy and radiotherapy thereafter were included in the second group (Group BCT). Ouality of life of the patients were assessed using Medical Outcome Syudy-Short Form 36 (MOS SF-36) form six months after their treatment (surgery, radiotherapy, chemotherapy) was completed. Results: There were no significant differences between two groups in terms of age, evaluated socioeconomic parameters (education, income, marital status) and clinical parameters (stage, complications, adjuvant chemotherapy). Quality of life of the patients who underwent BCT (n= 27) was worse than that of general Turkish population in six of eight (except vitality and social function) SF-36 scale and worse than mean values of normal individuals in NSABP BCPT trial in seven of eight (except vitality) scales. Besides, while physical component score was worse than that of general population (45.3 vs 52.6), mental component score (MCS) was relatively similar to general population (53.4 vs 51.7). When quality of life of the patients who underwent MRM (n= 23) and BCT were compared, mean values of BCT group were found to be better in all scales and the difference was found to be statistically significant in six out of eight (except vitality and social function) scales (p< 0.05). Conclusion: It can be stated that quality of life of the patient who underwent BCT due to breast cancer is impaired in terms of physical status, however did not change in terms of mental status. It can also be stated that quality of life of the patients who underwent breast conserving therapy were better than the ones who underwent modified radical mastectomy in terms of both physical and mental status.

Keywords: Breast neoplasms; quality of life; mastectomy, segmental

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