pELviKRABDoMvoSARKoMA
oLGU
TEDAvisi
sonnestceg oONeuxotvtpr-ixAsyoNL.ARr:
SUNUMU
FS
O L L O W I NT
GR E A T M E NO
T F P E L V I CR H A B D O M Y C l J A ' i C C M
CA JE
LONG-TERC
MO M P L I C A T I O N
REPORT
l b r a h i mU L M A N T
A h m e tQ E L I K l
S a l i hQ E T I N K U R 9 U N l
F i k r i0 z T o P 2
FroltlALlK l
Trp Fak0ltesi,Bornova,lzmir
Ege Universitesi
l Q o c u kC e r r a h i sAi n a b i l i mD a l r
2 P a t o l oA
l i n a b i l i mD a l r
postradyasyon
Anahtar S6zcUkler:postradyasyon
komplikasyonlarr
sarkomu,rabdomyosarkom,
postradiation
Key Words: postradiation
complications
sarcoma,rhabdomyosarcoma,
OZET
Radyoterapive kemoterapinintedavidekietkinliQirabdomyosafuonta
rgin 6nenlencerrahi iglentlertlr..
or'r,tnl dt'r;ilthlt[.terr
neden olmugtur. Multidisiplineryaklaymlar sonucunda yagam oranlan eskiye oranla belirgin etritsg::::lermiglir Ancai
kemoterapiile birtikteolan radyasyonundzelliklegocuklarda1nemli yan etkileri gitr}lebilir. Bu galrgrnadaur,:yitlrnda tker
pelvik rabdomyosarkomtants alank bagarrltbir gekildetedavi edilen bir hastada, uzun sAre sortu ot!.iyi.)gri<t'tnvaJtrtit
Hastada tedavidenoniki ytl sonra orlaya Qtkanp():;traiir'asfons.trkctrnL,
okluzyonve sekondermaliQnNmdr tantmlanmtgtrr.
yumugakdoku fim6rlerinde uzun sureliizlemin 1nentinivurgulantaktadtr.
SUMMARY
The efficiencyof ndiation therapyand chemotherapyhas had a major impact on the surgicalproceduresre,comntenderi
fo
rhabdomyosarcoma.Wth multidisciplinaryregimens,survival rates have improved significantlyqontpareclto tltose in tht
past. However, radiation therapy in conjunction with chemotherapymay have deletenous side r,fecls i)at;,:Ltlarl',il
tor:i,t
children.In lhis repod,a case who presentedwith vaginalocclusion,and a secondarymalignantturrtctr
a[ler:;ucce]:;sn,
pelvic
treatmentof a
rhabdomyosarcomaat 3 years of age is descnbed.The impoftanceof long tenn {'::tlc'"';-u1.,
in sot li: -sr.i.
sarcomasof childhoodis emphasizedby this postradiationsarcomawhich has developedtwelve ytsr:, ,tfrarrttr ,tl trt'al
ment.
ciRig .
S e g m e n t eo l m a m r gi n d i f e r a n s i ym
e e z o d e r m d e kno k e na l a n 1 5 a r a s t n d ai k e n , m u l t i a j a nk e r n o t e r : r rt .l r,A. r j , , n . l s , i ) e
r a b d o m y o s a r k o mgao, c u k l u kg a Q r n d a ks io l i dt U m o r l e r i%
n 5 - a c t i n o m y c i n - Dc, y c l o p h o s p h a m l C\e' , -: o { ) us e ' , / , r O ) v r
8 ' i n io l u g t u r u( r1 1 ) O n b e g y a ga l t r n d a kgro c u k l a r renn y a y g t n r a d y o t e r a p i neiknl e n m e sril e% 8 0 l e i r ; . a i , r : i l ' t - r l r0riei k i , . d r
y u m u g a k d o k u s a r k o m u v e t u m g o c u k l u kg a Q r m a l i g n ( 6 ) .A n c a kb u y t i k s e ky a g a mo r a n l a riil e b r i k t c ,t r o s t r a d , a s
(6,11). Son y o n s a r k o m ug i b i s e k o n d e rk a n s e r l e rdr e r c e r e ng r : gd o r e n r
tUm6rlerininise 0/o4-8'irabdomyosarkomlardrr
yirmiytl iginderabdomyosarkomlarrn
tiplendirilmesi,
tedavisi k o m p l i k a s y o n l a rot r t a y a g r k m a y a l r s g l ; r n 1 5 1 1( 9
r ) Bu
ve izlemleri konularrnda Ozellikle IRS'nin (lntergroup g a l t g m a d ap r e g n o z u a g r s r n d a ni l g i r t r : l a n b i r a l v e i l e
Rhabdomyosarcom
Sat u d y )g a l r s m a l a irlre 6 n e m l ig e l i g m e l e rr a b d o m y o s a r k o m
o l g u s u s u n u l a r a kt i r r . r a vs o r r r a go l d i , . . g i ,
k a y d e d i l m i g t iG
r e g m i gy r l l a r d ay a l n r zc e r r a h iy o n t e m l e ri l e g e Qb r r d d n e m d eo r l a y ag r k a nk o r r o l; r s y ' , , r r l ri rl r: .rl r t e l, t , J .
t e d a v ie d i l m e y g
e a l r g r l aonl g u l a r d2a y r l l r ky a g a mo r a n r% 5 - rg r Q
r n d at a r tgr r l mr 9 rlr
/.)
R u l i n k a n v e i d r a r i n c e l e m e l e r is, e r t r n rf : i F r , " e i H t r r z e yi . r i
n o r m a l s r n r r l a r d ai d i . B u b u l g u l a r l . i ) ! i l j , l n e k : r p l c r a t l s
S a g k a s r g r n d a9 i 9 l i ky a k r n m a s irl e p o l i k l i n i g ge e t i r i l e n3 l a p a r o t o m i d e k i t l e n i nh e m a t o k o l p o s al . r , r Qrl r, l c i u 0 Lvr a J e r r r n
y a g r n d a k i k r z h a s t a n r n o z g e g m ; g i n d eo n g u n o n c e h y m e n d e n 3 c m r E e r i d ed r g a r r d a n b e l l r o l r r , i y ; r c a k b g i m . - j e
f a r k e d i l m ibgu k i t l ed r g r n d ab i r o z e l l i ks a p t a n m a d S
r . a g s p i n a t a m a m e n k a p a l r o l d u g u a n l a g r l d rV. a l i n a lc r r . l ' , i z y odnU g u r r u i l i a k a a n t e r i o rs u p e r i o rr l z e r i n d e ,3 x 2 x 1 c m b o y u t l a r r n d al,e r e k h a s t a y a p u l l t h r o u g h v a j i n o p l a s t r u i , . 1 ' - r l : r n dP
r rinrer
s e r t ,a l n s r z ,d u z g 0 nk e n a d r a, l t t a ng e v r ed o k u l a r ay a p r g r kv e a m e n o r e s i o l a n h a s t a a m e l i y a t s o r ) t . l s d l , z e r i m e , t s
h a r e k e t s i zk r t l e d r g r n d af i z i k m u a y e n e b u l g u s u y o k t u . g o r m e y e b a g l a d r .H a s t a i k j y r l s o n r a s . r t k : , ;r a i i a . . i t i . -s, . i $
K i t l e d e na l r n a nb i y o p s i n i nh r s t o p a t o l o liink c e l e m e sai l v e o l e r b a c a k t a u y u g m a , z a y r f l a m a v e i g t a h s : ; ' l r k/ a i " , r n r , a i a nl e
r a b d o m y o s a r k o ms o n u c u n u v e r d i . R u t i n k a n v e i d r a r t e k r a r b a g v u r d u . F i z i k m u a y e n e d e , e s i . . c ; : , ' : r : r s y , , ,yre r l e
i n c e l e m e l e r i n d ep a t o l o j i k b u l g u s a p t a n m a d r . O l g u y a u y a n b o l g e d e 2 5 x 2 Q x 2 Qc m b o y u t l a r r r r : i a; e ' t a i t r s r z ' / e
Cyclophosphamide15 mg/kg, Vincristine2 mg/kg, Act- h a r e k e t s i zk i t l e s a p t a n d r .D i r e k g r a f i ( $ e l i l ' . 1) , t , t r a s o n o g ' 1 f i
inomycine-0
D. 0 1 5m g / k gd o z u n d a6, a y l r kt e d a v ig e m a s ri l e , v e b i l g i s a y a r l rt o m o g r a f i ( $ e k i l 3 ) i l e i l c l , , l t n . j j k t e n s o l r a
C y c l o p h o s p h a m i d e + V i n c r i sht ianfet a d at e k d o z , A c t i n o m y -y a p t l a n e k s p l o r a t r i s l a p a r a t o m i d e ' . i t l ' , ' r r n . i , e z e k , r b l
c i n e - Dh a f t a d a5 g u n v e h e r a y b i r h a f t as u r e y l e( 1 2 3 , 5 , o l d u Q u n a k a r a r v e r i l e r e k b i o p s r u y g L i r r n r i i i s t , ; p 1 l e l 61-1, 1
7 , 1 0 . a y l a r ) b a g l a n d r K e m o t e r a p r n r3n g u n u g e n e l r n c e l e m e d e p, o s t r a d y a s y o ns a r k o n r u t . i . n' -c r ' l s a r k c l n g r a r t e
a n e s t e zai l t r n d at u m d rr e z e k s r y o nuuy g u l a n d rO. p e r a s y o n
v e l l ) o l d u Q ub e l i r l e n d iT e d a v i o n e n l e r ia r , ' s r i . r r r i i r n l u nk a : u l
p a t o l o j r k i n c e l e m e b u l g u l a r r s o n r a s l t u m o r I R S e d i l m e y e nh a s t a n r n3 a y s o n r a e k s i t u so i r i L r r joi rr . l r e ; , : l d r
OLGU
k l a s i f i k a s y o n u n ag o r e E v r e l l a o l a r a k d e Q e r l e n d i r i l d i .
K e m o t e r a p i n ib
n a g l a n g r c r n d abni r a y s o n r a , t o p l a m 3 6 0 0
c G r a y r a d y o t e r a p im u l t i m o d a l t e d a v i p r o t o k o l u i E i n d e
u y g u l a n d rK. l i n i k o l a r a kd L i z e l e no l g u k o n t r o l l e r ge e l m e k
r z u n s u r e k o n t r o l l e rgee l r n e y e on l g u o n y r l
u z e r eq t k a r r l d U
s o n r ak a n n a Q r r s rs,o l k a s r kv e u y l u ka g r r s yr a k r n m a l airl re
t e k r a rb a g v u r d uF i z i kb a k r d a s, a g a l t e k s t r e m i l e dket s a l r kv e
k a s a t r o f i s i t, u g e d er e k t u mo n d u v a r r n ab i t i g i k5 c m g a p l r ,
l a s t i k k r v a m r n d a ,d U z g 0 n k o n t u r l u k i t l e s a p t a n d t .P e l v i k
u l t r a s o n o g r a f i du
e t, e r u s u na n t e v e r tv e s a g l a t e r a l ei t i l m i g
o l d u g us, o l a d n e k s i aal l a n d a5 0 m m g a p l rs o l i dk i t l el e z y o n u
b u l u n d u Qbui l d i r i l d( $i e k i l1 )
9 e I L l 2 S e k o n d e r1 r ] r n o r akli l l e n r nd r r e kg r a i ' t . ( r
gorrrnumr.l.
ultrasonografik
9ekil 1 Krtlenin(hematokolpos)
tt4
E 9 I 1 rD e . r s r
TARTT9MA
S e k o n d e r n r a l i g n i t eg e l i g i m i n d er a d y o t e r a p J L l t n d a h a s t : t y e r
n ycloa i t d i g e r f a k t d r l e r d e r o l a l a b i l i r . H a s t : i d a r . . u l l a n r l aC
R a b d o m y o s a r k o m uonz e l l i k l e2 . e v r e d e nd a h a i l e r io l g u l a r - p h o s p h a m i d e v e A c t i n o m y c i n - D ' n i nc i i - 'e l K l t o l n r a s r m L r m i u l t i m o d atl e d a v i n r nu g a n a k u n d u r . A y r t c a r a d y o t e r a p i v e k e r ' : , t e r . t f ) rb I r K t e r u i .
d a k i t e d a v i s i n d er a d y o t e r a pm
o g e s i n d e nb i r r o l a r a k k l a s i k l e g m i g t( i6r 11 ) A n c a k g o k l a n r l d r Q r n dsae k o n d e rm a l i g r t i t er t s k t: r r l r o r ir i 1 : )
e s k i d e nb e r i b i l i n e nb i r d i g e r g e r g e ki s e t e r a p o t l kr a d y a s y o n u n m a l i g n n e o p l a z mg e l i g i m i n en e d e n o l a b i l m e s i d T
r ru m p e d i a t r i kk a n s e r l e r i nt e d a v i s r n c j t :sro' I c t r n - r k s e i o n
( 9 , 1 0 ) .S e k o r r d etr0 m o ro l g u l a r r n dgae g n r i g trea d y o t e r a puiy - d e r k a n s e r l e rk e m i k s a r k o m l a n o l u p l , u r ; . y r . l n r l r g acki ' . . , k r
g u l a n m r go l m a o r a n ry a k l a g r k% 9 0 o l u p g o k g e n i gs e r i l e r d e s a r k o m l a ni z l e r( 1 5 ) . O l d u k E ae t r d e rg o r . r l , - 'oi 'l q u l r r d a t t . r i a r
y a p r l a n g a l r g m a l a r d at u m s e k o n d e r k a n s e r l e r i n% 5 ' i n i n s e k o n d e r m a l i g n r t e l e r d e2 y t l l t k s u r v ' / t t i ! u , r r r t e , , : t k
"'
r a d y a s y o nbaa Q l or l d u Q us a p t a n m r $ t(r4r, 5I 1 0 ) E n y a y g r n m a m a k t a d r r( 6 , 7 9 1 0 ) O l g u s e k o n r i c rl u i r i I l a t r r, i I ' o n t u k
p r i n r etru m o rt r p ir e t i n o b l a s t o m
o lau pb u n uH o d g k i nl e n f o n r a ,t a n l r g a y s o n r a k a y b e d t l m i g t t rA r l l r t i 1 i , , ' t yk i i b u e t
y u m u g a kd o k u s a r k o m l a r rW, i l m s t u m o r r iv e s a n t r a ls i n i r m e n r i go l m a s r n l ns r ) r v i y ni e d e r e c c r i i :1 r k 1, . ' r rr o i i q L rt . i n
s r s t e ml iu m o r l e rrrz l e r( 1 5 ) .B i r b a g k ag a l r g m a
d a r s ep r r m e r m e m e k t e d i r .
tumor tipi olarak en srk Wilms tumoru ve noroblastoma
b i l d i r i l m e k t er,a b d o m y o s a r k o m a n rdna i g r n d e b u l u n d u $ u H a s t a d a c e r r a h r a g t d a n i l g i n q o l a n d Q t : ' p r 3 : 1 e 1 3p1ri ,n t e
y u m u g a kd o k u s a r k o m l a ror l g u l a r r n
%10'urro
u l u g l u r m a k i a d rtru m 6 r d e n o n y r l s o n r a p u b e r t e d e . " a ) ' ! r K a r r h e n r , r t o
( 1 0 ) P r i m e rt u m 6 r i l e s e k o n d e rn e o p l a z mt a n r s ra r a s r n d a k o l p o s t u r L. j t e r a t L i r d eE,o c u k l u kQ a 0r ' i : , rn : i . j i I t U r l L ' o s ly l r
g e Q e ns u r e d e Q r g igk a l r g r r r a l a r1d0a- 1 7y r l a r a s r n d ab u l u r r -r a d y o t e r a p iv e k e m o t e r a p i v e r i l n r i gv i . ' - u . , , r : , u r r . z l e r l e ;
r , 39 , 1 0 ) s o n r a s r a d o l e s a n g a g d a h e n t a t o r r ' ' 1 ' or l. p c s l a b l g v , r a r
m u g o l u p o l g u 1 2 y r l i l e o u s r n r r l a rgai r m e k t e d(i 2
B i r b a g k ag a l r g r n a dias e b u s u r eo r t a l a m a1 0 y r l b i r a y ( 5 - 2 1 o l g u l a rb i l d i r i l m t g l (i rB ) . A y r t c a b t r o l g i r i, a , . n { j p L ' ' i lIt o i , r a f
y r l ) b i l d i r i l m i g t(r1r ) . H e l l m a nr a d y a s y o nd o z u i l e s e k o n d e r t e d a v r e d i l e n v a l i n a l o k l u z y o n ( 1 2 ) , t i r i r , r g k ar : r p o r d ad ,
t u m o r r n s i d e n sai r a s r r r d ab i r d o g r u o r a n t r< . r l d u g u nbui l d i r - o n c e d e n p e l v i k r a d y a s y o na l m t g b i r o l q r t d i iq e i r e l r l ,s t r a s r r t d .
m e k t e d i (r 7 ) R a d y a s y o n
t i p r( o r t ov o l t a vj e y am e g av o l t a j )i l e c r d d l s o r u n l a r b i l d i r i l m i g t i(r1 4 ) . K l i n k v ; ' p l t o i l r l r k o l : r r a i .
s e k o n d e rm a l i g n i t er i s k i n i ni l i g k r skr o n u s u n d ai s e g e l i g k i l ki a n r t l a m a km l j m k u n o l m a s a d a h a s i : r d a , l o ' u l er | e n l t c
r a p o r l a rv a r d r r( 4 , 1 3 ) A y r r c ar a d y o t e r a pnre k a d a r g e n g k o l p o s u n r a d y o l e r a p iv e k e n t o t e r z r J s, oj : ; i s , ( j l ' l r \ ' r l u \b
y a g t au y g u l a r r r r s ea k o n d etru m o rg e l r g m res k i o k a d a ra r l a r v a l i n a lo k l u z y o n ab a g l to l d L t Q cui L t g u r , rlrsr . r 1 r
(s)
O n k o l e n i ke t k r s ro l r n a s r n ar a g r n e n .o i r , r r ) 1 "l y ' d a r : rr ,o c r i ' . l u
S e k o n d e r b r r m a l i g r r t u m 6 r i i n p o s t r a d y a s y o ns a r k o m u g a Q rk a n s e r i n d er a d y o t e r a p ih, a s t a l r ( r f k . r i , t t , : , l;uc t e d , v r :
s a y r l a b i l m ei g
s i nC a h a nv e a r k a d a g lranrr n ' 91 4 8 ' d ek o y d u g u i n d e o n k o l o . j i n i rel n o n e m l i s i l a h l a r r n r . i ; ri rtt i o l n r i r o z e r g i r
k r i t e r l e rLi a s k r rvr e a r k a d a g l a n
r rr o 0 i f i y e t r n i g l e r d(i6r ) B u k o r u m a k t a d r rP. r i n r e rt u m o r u nt e d a v r : , ' : j e . r ! L a dl l r y a t ( ) t l a :
g
u
n
l
a
r
d
r
r
,
knterler
a ) d a h a o n c e r a d y a s y o an l m r go l m a k ,b ) s e k o n d e r r n a l i g n r t er i s k i i l e k a r g r t a grt r I r r , a r a k i . a r J a ti a ;
n C y a s y osn^ h : r s { n dgae l i g m iogl n t a s r ,l a dr r .
s e k o n d enr e o p l a z n r r a
r rlaya
c ) r a d y a s y o nu y g u l a m a s irl e s e K c n o e rt u n r c r u r o
g r k r n a sar r a s r n d ae n a z i k r y r l o l m a s r ,d ) p r r m e rl e z y o ni l e Q o c u k l u k E a Q t t u m o r l e r r n d e u z L r n : . l f ( : . l e l r l t o t \ i , ' n r
i kg r d a n b e l i r g i n p r i m e r t u m o r u n t e d a v i s i n d e n o t t r f : r y l l s c i r a s e k o r r d i .
s e k o n d e r l e z y o n a r a s r n d a h i s t o p a t o l o . la
f a r k l r l rok l m a s r O l g ub u k r i t e r l e r itnu m u n eu y m a k l a d r r ,
m a l i g n i t ei l e g e l e n b u h a s t a i l e b r l k r : ' :d i r ' , - . .' r' . r rl r i . t r t n ' 9 t r
KAYNAXLAR
, ^ , o m e rR B O s l e o s a r c o r n aa s a s e c o n d n r a l l g r r a n nt e o p i a s m r n c h l d . e r r J g o n e . l - .
1
E e c h l e r J R k ; s g r t 5 9 6 v . ' , ^ . 'l.r i e a d c , . r s^ T
2
S y r d R L a l e e ' r e c t s o f t r e a l r l e n l o f c a n c e r I n c h r l d r e n P e d r a t rC I n N o r t h A m 3 2 8 3 5 - 8 5 7 19 8 5
3
30
OavrdsonT.'^estburyG.HannerCL.Radratron-rnducedsofltrssuesarcoma.BrJSurgT
38
1-309 1986
t
D e V a t h a r r eF F r a n c o r sP H r t iC S c n r , e r s g u t hO . i i o d a r y C , S a r r a z r nD , O b e r h n O , B e u r t h e r e tC , D u l r e r xA , F l a m a n t R R o l s : . '
1083 199?
4
. . . t ; . 1. r .
c h e m o t h e r a p y I n t h e n s k o f s : c c r d m a l r g n a n ln e o p i a s m s a l l e r c a n c e r I n c h r l d h o o d B r J C a n c e r 5 9 7 9 2 - 7 9 0 . 1 9 8 9
5
H a l l E J P r , n . r p r e sc f c a r c r n o E e r , : i r s 1 n D e ' r r ( a i ' T f r e i i . n a n S . R o s e n b e r g S A ( e d s ) C a n c e r P r r l g p l p . a l g l f l a r l t e _ f l ! : : , - - . _ ,
',
L l u g i n c o t l ! 9 3 g A ? 1 3 - ' i 2i
6
l - r a y sD i v i R ' r d b d o n i y c s d r c c n ) J r l r \ ^ ' e l c h K J e l a l ( e d s ) P e C a t r r c S u r g s r v j l l _ h l l l Y e a r b o o k [ 4 e d r c i ] lP u D l r s h { - { sl 9 E r j | ;
7
r,ellmanS i)rrncrpleso' iadralronTherapy In DevrtaVl ,flellmanS,RosenbergSA(eds)
, , 1 - 2 . : ) t t ,: ) r ; ) l ' l a
-B
.'
aa!Ee!_EtAq.al9_S_"!!_fue|!lL.:::.
.!!:
. trJ-
l[L:
P h r l a d e l p h r aJ B L r p p r n c o l t .1 9 9 3 . p p 2 4 8 - 2 7 5 .
L
K a s t e S C G r o n e m e y e r S A , M u r a m D : V a g r n a l o c c l u s r o nr n d u c e db y c a n c e r l h e r a p y P e d r a t rR a d r o l 2 3 ( 5 ) : 3 6 9 - 3 7 0 . I 9 9 3
9
L a s x r n W B S r t v e r m a nT A . E n z j n g e r F M P o s t r a d i a t r o ns o f l t i s s u e s a r c o m a s : A n a n a l y s i so f 5 3 c a s e s C a n c e r 6 2 2 3 3 0 - 2 3 4 3 i r : 3
10
L r F P C a s s a d v J R J a f t e f ' l R r s k o l s e c o n o l u , n o r s r n s u r v r v o r so f c h r l d h o o dc a n c e r C a n c e r 3 5 12 3 0 - 12 3 5 19 7 5
C r l t3 5 . S a y r( 3 - 4 ) .T e m m u z - E k r m1.9 9 6
17
ll
P i z z o A P e t a lS
: o l i d t u m o r s o f c h i l d h oIondD e V r t a V T , H e l l m a n S , R o s e n b e r g S A (Ceadnsc) e rp n n c t p l e s a n d p r a c t r c e o f
O i . l ! t l . - . I t -. l. l1j i i . a c e t p r r r
J B L i p p i n c o t t1.9 9 3 ,p p 1 7 7 2 - 1 7 7 9
1 2 . P o m aP A : P o s t r a d i a t J o
n g r n aol c c l u s r o nN: o n o p e r a t i vmea n a g e m e nItn. tJ G y n a e c oOl o s t e t1 6 :9 0 - 9 2 1 9 8 0
va
l3
PotishRA'DehnerLP'Haselo.rRE,KimTH,LevittsH,NesbitM.Theincidenceofsecondneoplasmsfollowrngmegavoltagerarairo;,r.iplrdrati
clumo,:,
Cancer56. 1534-1537. 1985.
l4
P r i d i i a n G , R i c n N E , M a n t a g APGr e: g n a n c y h e m o p e n t o n e u m a n d p l a c e n t a p e r c r e a t a i n a p a t i e n t w i t h p r e v i o u s p e l v i s i r r a d i a t r o n : r r . . t o , , . r ' r a l ' f a r l i
Arn.
ObstetGynaecol162: 1205-i206,1990
1 5 T u O k e r M AS: e c o n d a r y c a n c eIrns D e v t t a v T , H e l l m a n S , R o s e n b e r g S A ( C
e dasn)c e rP: n n c i p t e s a n d p r a c t i c o
en
o cf o t o o y . l i :i ., 1. r - I - , . l o u l p h -J. ; - l
L r p p r n c o t1t9, 9 3 .p p . 2 4 0 7 . 2 4 1 6
t/o
| 9e
p )e(E.,1
Download

Ulman İ, Çelik A, Çetinkurşun S, Öztop F, Balık E. Pelvik