Izindlela ezintsha zokuhlinzeka ngemishanguzo yokwelashwa okuningi Ngokuqondile
Ukwelashwa kwezidakamizwa kubalulekile ekwelapheni izinhlobo eziningi zomdlavuza. Izinhlobo ezihlukahlukene zemisebe zisetshenziselwa ukuzama ukukhomba amaseli namathisayi amabi. Ngokuvamile, ama-photons (ama-x-ray) asetshenziselwa inqubo ebizwa ngokuthi i-external radiation therapy, noma i-EBRT.
Kunezici eziningi ezihlukahlukene zokwelashwa kwemishanguzo emisha, futhi ezinye zazo zibonise isithembiso ngokubhekelela ngokucophelela izicubu zomdlavuza ngenkathi zivikela izakhiwo ezizungezile.
Amasu amasha afaka phakathi ama-Proton Beams no-4D Ukulinganisa
- I-PBT ibhekisela ekwelapheni kweproton.
- I-EBRT ehambisana ne-3D ibhekisela ekubandakanyekeni kokuhlaziywa kwe-imaging yekhompuyutha ukuhlela ukulethwa kwesilinganiso semisebe ngokuqondile ngqo ekuhlosweni kwayo.
- I-IMRT imelela ukwelashwa kwemisebe eguquguqukayo, futhi lena yindlela ehlelwe ukubhubhisa izicubu zomdlavuza kodwa ugcine izicubu ezizungezile.
- I-IGRT imele ukwelashwa kwama- radiated-oriented , futhi kuhilela ukusebenzisa i-imaging scans ngenkathi kusetshenziselwa ukwelashwa kwemisebe, ukuqondisa imisebe emibhalweni yangempela ye-imaging eyakhiwe ngesikhathi sesigaba sokuhlela ukwelashwa kwe-radiation therapy.
- I-RMM ibhekisela kuzinhlelo zokuphefumula zokuphefumula kuma-rayotherapies okulandisa ukuhamba kwendonga yesifuba, imisipha ye-diaphragm, nezinye izakhiwo ezihamba ngesikhathi sokuphefumula ukuze imisebe ifike endaweni efanele ngisho noma indawo ehlosiwe ihamba.
- I-4D CT ukulinganisa isebenzisa isimiso esifanayo naso ku-RMM lapho isithwebuli sitholakala ngenkathi isiguli siphefumula, futhi ivolumu ehlosiwe ihlolisisa zonke izikhundla zesifo ngesikhathi sesifundo sokucabanga, ngokuhamba kwesikhathi.
Uphi Ukwelashwa Kwe-Proton Beam?
Ezinye izikhungo zomdlavuza ziqala ukusebenzisa imishini yemisebe ehambisa imithwalo yeproton esikhundleni se-photons, noma ama-x-ray.
Imisindvo yeProton iyisisindo sezinhlayiya ezithweswe kahle eziletha amandla ngaphakathi kwesikhashana. Ngokwalokho, ama-proton angase afinyelele izicubu ngaphakathi emzimbeni engalimazi amathisisi aseduze.
Izinhlangano ezinjengeNational Comprehensive Cancer Network, noma i-NCCN, ziqala ukufaka ukwelashwa kwe-proton, noma i-PBT, ezihlahlandlela nezincomo. Ngokwesibonelo, ngokuphathelene namacala athile we-T-cell lymphomas, i-NCCN radiotherapy compendium ihlanganisa ukubhekisela kwamaphrotoni nezinye izindlela zokusanda "ukufeza [ukusatshalaliswa kwemithi ehambisana nokubaluleka kokubaluleka okubalulekile ezigulini ezinokwelapha ezinokulinda isikhathi eside. " Ngamanye amazwi, kukhona ukulindela ukuthi ukuletha imisebe endaweni esinqunywe ngokuqinile futhi uvikele izicubu ezizungezile kuzoholela emiphumeleni engcono kanye nezinkinga ezimbalwa zesikhathi eside zokwelapha imishanguzo.
Iziphi Izinzuzo Zingase Zithole Ukwelapha Njengomnikelo we-PBT?
Kuze kube manje, ukusetshenziswa okuvamile kwe-PBT akukhuthazwa ekwelapheni i-lymphoma. Kodwa iziguli ezine-lymphoma, noma kunjalo, inqubo efana ne-proton yokwelapha ingase ikhethwe ngelinye ilanga ukuba i-photons ngezimo ezithile nangezizathu ezihlukahlukene. Nakuba kusebenza kahle, i- chemotherapy esetshenziselwa ukwelapha i-lymphomas ingaba nobuthi obuhlungu kokubili kwenhliziyo namaphaphu.
Uma imishanguzo ingeziwe kumakhemikhali, izingozi ezingxenyeni ezinempilo zingakhula, ngoba izicubu ezisengozini zizwela kokubili imiphumela ye-chemotherapy kanye nomswakama.
I-Chemotherapy kanye nemisebe ye-radiation ivame ukuhlelwa ndawonye, kodwa ilawulwa ngokwehlukana, futhi ngokuvamile, eyodwa izolandela enye ekwelapheni i-lymphoma. Ukwelashwa kweproton kuklanyelwe ukunciphisa ukutholakala kwezicubu ezinempilo ezingase zenzeke ekuqondiseni ukulimala. Iziguli eziningi ezine-lymphoma zincane uma zixilongwa futhi ziphila isikhathi eside ngemva kokwelapha, ngakho zisengozini yokuphumula okuphuthumayo, imiphumela emibi yesikhathi eside ehambisana nemithi ejwayelekile.
Ngokusekelwe kulokho okuyaziwa mayelana nokwelashwa kweproton, abaningi bakholelwa ukuthi imiphumela emibi iyohliswa uma kuqhathaniswa nokwelapha okuvamile. Odokotela nabacwaningi nabo basebenzela ingxenye ye-chemotherapy ye-equation, bahlola ukusetshenziswa kwama-agent amasha anemiphumela emibi kakhulu, bebheke kunoma yimuphi umthelela emiphumeleni yesikhathi eside kanye nemiphumela emibi kakhulu.
Iziguli ezine- Hodgkin lymphoma , ikakhulukazi, zinamazinga aphezulu okuphulukisa, kepha nazo zivame ukwakhiwa kwemiphumela emibi yokwelapha evela kumakhemikhali kanye nemisebe. Eqinisweni, abasindile be-Hodgkin lymphoma abasencane bangamanye amaqembu engozini enkulu yokubhekana nezifo ezinzima noma ezisongela impilo, njengomdlavuza wesibili noma isifo senhliziyo . Lezi zingozi ezikhulayo zikholelwa ngenxa okungenani yingxenye yemiphumela yokuphela kwe-chemotherapy kanye ne-radiotherapy.
Ngenxa yokuthi ukwelashwa kwe-proton kuklanyelwe ukuba kube okucacile ekuhambiseni imisebe, ithemba liwukuthi isifo senhliziyo esingaphansi kanye namasekhondi ambalwa wesibili azokhula. Kuze kube manje, ekutadisheni okukodwa, izifo zamagciwane wesibili phakathi kwalabo abaphathwa nge-proton ngokusabalalisa imisebe zibonakala zifana, kodwa idatha ayinqunyelwe futhi kucwaninga olunye ulwazi.
Izwi elivela
Ama-oncologists asekela ukusetshenziswa kwe-proton yokwelapha i-Hodgkin lymphoma baye bachaza isenzo sokulinganisela esenziwa, phakathi kokubuyela emuva ngenxa yokwelapha okungenele ngakolunye uhlangothi kanye nokubulawa kanzima okuphuthumayo okuvela ekwelashweni okungaphezu kokuhlukunyezwa komunye.
Abanye bathi uma ukwandisa i-chemotherapy ukuze uhlaselwe ukungenawo ukwelashwa kwemisebe, cishe ngeke wenze noma yikuphi ukuzuza ngokwemibandela yesikhumba eside. Ukwengeza, bayeluleka ukuthi inkululeko yokuphindaphinda kwesibili kwe-lymphoma kuyisimo esibalulekile sokugcina amathebhu, njengoba abacwaningi bekusasa bezama ukulungisa izingozi nezinzuzo zezindlela ezintsha.
Ngokusho kocwaningo olwenziwa yiHoppe kanye nozakwethu, ukwelashwa kweproton kwanikeza amanani aphansi emisebeni yonke enhliziyweni, amaphaphu, amathumba, isifo, nezinye izakhiwo kubantu abaningi abathintekayo ngeHodgkin lymphoma. Isikhathi sodwa sizobe sitshela ukuthi ukwelashwa kweproton kuzoba njalo yini.
> Imithombo:
> Chung CS, Yock TI, Nelson K, Xu Y, Keating NL, Tarbell NJ. Isigameko sesibili sokuhlukunyezwa phakathi kweziguli eziphathwe nge-proton ngokususa imisebe ye-photon. I-Int J Radiat Oncol Biol Phys. 2013; 87 (1): 46-52.
> Hoppe BS, Flampouri S, Su Z, et al. Ukunciphisa izinga lokunciphisa izakhi zenhliziyo usebenzisa amaprotoni uma kuqhathaniswa ne-3DCRT ne-IMRT ku-Hodgkin lymphoma engaphakathi. I-Int J Radiat Oncol Biol Phys 2012; 84: 449-455.
> NCCN Radiation Therapy Compendium. 2017.