DOLAŞIMDAKİ TÜMÖR DNA’SININ SESSİZ İZLERİ MİNİMAL REZİDÜEL HASTALIK, NÜKS VE KLONAL EVRİMİN MOLEKÜLER İZLENMESİ
Özet
Circulating tumor DNA (ctDNA) has emerged as a promising non-invasive biomarker for monitoring the molecular dynamics of cancer. As a tumor-derived fraction of cell-free DNA, ctDNA can carry somatic mutations, copy-number alterations, genomic rearrangements, and epigenetic changes that reflect the molecular characteristics of the tumor. Serial ctDNA analysis provides an opportunity to assess tumor burden, treatment response, minimal residual disease, molecular recurrence, and the emergence of treatment-resistant clones over time. In particular, the detection of ctDNA after curative-intent treatment may indicate the persistence of molecular residual disease even in the absence of radiological evidence and may help identify patients at increased risk of recurrence.
Recent advances in highly sensitive molecular technologies, including droplet digital PCR, next-generation sequencing, molecular barcoding, error-correction strategies, and tumor-informed approaches, have improved the detection of low-frequency tumor-derived variants. ctDNA analysis also provides a dynamic perspective on tumor heterogeneity and clonal evolution by enabling longitudinal monitoring of emerging, disappearing, or treatment-selected molecular alterations. However, its clinical implementation remains limited by low ctDNA shedding, particularly in early-stage disease, preanalytical and analytical variability, clonal hematopoiesis, false-negative and false-positive results, and the lack of standardization across testing platforms.
This review discusses the biological basis and molecular characteristics of ctDNA, its role in minimal residual disease detection, early identification of recurrence, monitoring of clonal evolution and treatment resistance, currently available molecular technologies, major clinical applications across solid tumors, and the principal limitations affecting routine clinical use. Future integration of standardized ctDNA assays with advanced sequencing, bioinformatics, and multimarker approaches may further strengthen the role of ctDNA in personalized cancer surveillance and treatment management.
Anahtar Kelimeler: circulating tumor DNA; ctDNA; minimal residual disease; molecular recurrence; clonal evolution; liquid biopsy; treatment resistance; personalized oncology.
Konu Alanı: Biyoloji -> Biyoloji (diğer) -> Biyokimya
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