Kumvetsetsa Ubwino ndi Zoopsya za Proton Beam Therapy
Ngati dokotala wanu akulimbikitsa chithandizo cha proton chophimba khansara yanu, mwina mukuda nkhawa ndi kusokonezeka. Mosiyana ndi mankhwala ena a khansa, mankhwala a pulotoni ndi atsopano pazomwe zimachitika ndipo zambiri zochepa zimapezeka. Tiyeni tiwone momwe chithandizochi chikugwirira ntchito, ubwino ndi zovuta zokhudzana ndi mankhwala ena a khansa, ndi zotsatira zake zomwe mungathe kuzipeza.
Ngakhale kuti mankhwala a proton ochiritsira posachedwapa "adachotsedwa" ndi maofesi ochepa okha omwe amapereka chithandizochi, njirayi yakhala ikupezeka muzipatala ku United States kuyambira 1990.
Kodi Proton Beam Therapy Amagwira Ntchito Bwanji?
Kufotokozera mwachidule momwe mankhwala a proton amathandizira ndi-monga ofanana ndi mankhwala ochizira mazira-amagwiritsa ntchito mphamvu kuwononga kapena kuwononga maselo a khansa.
Kwa iwo omwe akufuna kuti amvetsetse momwe chithandizochi chikuyendera kwambiri, mankhwala a proton owombera ntchito amagwira ntchito mwa kuthamangitsa proton (zabwino particles) kudziko lamphamvu kwambiri pogwiritsa ntchito particle accelerator. Mtundu wapamwamba wa mphamvuwu umalola ma proton kuti ayende kudzera minofu molunjika ku chotupa; zomwe zimachititsa kuti mabomba a protoni apangidwe kwambiri.
Ma Protoni amaimbidwa mlandu wabwino ndipo amachititsa kuti anthu asamayesedwe. Pulotoni ikayambidwa pafupi ndi molekyu monga DNA, zigawo zosokoneza kwambiri za molekyu zidzakopeka ndi proton, motero zimadodometsa kuti mamolekyu amadziwika bwino.
Zotsatira za njirayi ndizo imfa ya maselo a khansa.
Kusiyanitsa Pakati pa "Zachibadwa" Njira Zamakono ndi Proton Therapy
Thandizo la Proton ndi mankhwala ochiritsira odzoza mazira onse amadziwika ndi ma radiation oncologists. Kusiyana kwakukulu kwambiri ndi malo a chithandizo. Thandizo la Proton limalondola malo enieni, omwe angapangitse kuti zisokonezeke kwambiri m'matenda ozungulira.
Mankhwala ochiritsira ochiritsira amatha kuchepa, ndipo maselo ambiri "ozolowereka" m'chigawo cha chotupa akhoza kuonongeka.
Thandizo la mtundu wa Proton si njira imodzi yokha ya chithandizo, koma pali mitundu yosiyana ndi njira. Mitundu yatsopano ya mankhwala a pulotoni monga kuthandizira kwa pensulo akuganiza kuti mankhwalawa ndi ovuta kwambiri.
Kodi Ndi Matenda Aakulu Otani Amene Amayendetsedwa ndi Proton Beam Therapy?
Mankhwala a Proton omwe amawagwiritsira ntchito nthawi zambiri amagwiritsidwa ntchito pa zovunda (siteji I, II, kapena III) ndipo amagwiritsidwa ntchito mosavuta poyerekeza ndi mapiritsi 4 (zotupa zomwe zafalikira kumadera ena a thupi). Mitundu ina ya khansara imene mankhwala a proton owombera angagwiritsidwe ntchito ndi awa:
- Khansara Yam'mimba: Ndi khansa ya m'mapapo, mankhwala a proton angagwiritsidwe ntchito kwa khansa ya m'mapapo yoyambirira yomwe singathe kuchiritsidwa ndi opaleshoni, kapena kuti kubwereza kachiwiri pamene mankhwala opangidwa ndi mazira ochiritsira aperekedwa kale.
- Khansara ya ubongo: Malo enieni omwe amaperekedwa ndi mankhwala a pulotoni akhoza kukhala opindulitsa pa zotupa za ubongo zomwe ngakhale zochepa zazing'ono zomwe zimakhalapo pafupi zingakhale ndi zotsatira zoyipa.
- Matenda a khansa a ana: Matenda a Proton owombera pansi, monga momwe tafotokozera m'munsimu, sangasokoneze kwambiri mankhwala omwe ali pafupi. Popeza kuti DNA imawononga maselo ochizira angayambitse khansa yachiŵiri, akuganiza kuti mankhwalawa angakhale abwino kwambiri nthawi zina kwa ana.
- Mutu ndi khansa ya khansa
- Kansa ya chiwindi
- Khansara ya Gallbladder
- Khansara ya Esophageal
- Khansara ya m'mimba
- Khansa ya prostate
Ubwino ndi Kuipa kwa Proton Beam Therapy
Pali mankhwala ambiri atsopano kwa khansara omwe adayamba zaka zambiri, ndipo izi ndi zodabwitsa. Pa nthawi imodzimodziyo, ngati pali njira zosiyana zothandizira, iwe ndi wanu oncologist mudzafunika kupanga chisankho chokhudza chithandizo chomwe chili chabwino kwa inu nokha.
Anthu ena amalemba mankhwala omwe angapangidwe ndikuyesera njira zomwe zingagwiritsidwe ntchito pochiza chithandizo komanso zotsatira zake (ndipo ndi zotsatira zotani zomwe zingakhumudwitse kwambiri).
Kulemba zotsatira ndi mankhwala a pulotoni kungathandize ndi ndondomekoyi.
Zotsatira za mankhwala a proton ndi awa:
Thandizo la pulotoni la Proton limapweteka ku malo enieni a minofu. Izi zingakhale zabwino makamaka kwa zotupa zomwe zimayankhula pafupi ndi zofunikira, monga zotupa za ubongo , kapena zotupa zamapapu zomwe ziri pafupi ndi mtima. Mutu ndi khansa za khansa, makamaka zokhudzana ndi papillomavirus (HPV) za anthu, zimakhala ndi moyo wochulukirapo kusiyana ndi ziwalo zosagwirizana ndi HPV, zomwe zikutanthauza kuti nthawi zambiri anthu amafunika kuthana ndi zotsatira za nthawi yaitali kwa zaka zambiri. Pachifukwa ichi, mankhwala opangidwa ndi proton akhoza kukhala opangidwa ndi ma radiation ochiritsira.
Chifukwa cha kutuluka kwa protoni, mlingo wapamwamba wa ma radiation ungaperekedwe ku chotupa ndi mankhwala a proton.
Malo enieni othandizira kutuluka kwa ma radi ndi mankhwala a proton amathandiza kuti asapweteke minofu yozungulira. Sikuti izi zimachepetsanso zotsatira zake (chifukwa cholephera kuwononga maselo abwino) koma zingachepetse mwayi wokhala khansa yachiwiri (khansa yomwe imayambitsidwa ndi khansa ya mankhwala monga radiation therapy ndi chemotherapy ). Zimaganizidwe kuti chiopsezo cha khansa yachiwiri chidzakhala chochepetsedwa ndi mankhwala a proton chowongolera kuposa mankhwala ochiritsira omwe amachititsa kuti awononge makamaka achinyamata omwe ali ndi khansa.
Matabwa a Proton ndi osavuta kuwongolera kuposa ma radiation ochiritsira. Kuwonjezera pamenepo, pokhapokha mtengo ukufika pa chotupacho, umasiya, m'malo mofalikira komanso kudutsa.
Thandizo la Proton lothandizira kawirikawiri limalekerera ndi zotsatira zocheperapo kusiyana ndi mankhwala ochizira.
Mankhwala a Proton (ndi radiotherapy kapena stereotactic body radiotherapy ) kapena a SBRT) angagwiritsidwe ntchito kwa khansa zoyambirira zomwe ziyenera kugwiritsidwa ntchito, koma zimawoneka kuti sizikutheka chifukwa cha malo omwe ali pafupi ndi zofunikira kapena munthu sali woyenera kwa opaleshoni.
Kugwiritsa ntchito mankhwala a proton kungaphatikizepo:
Chifukwa cha malo operekera kwa dzuwa, mankhwala a proton angaphonye madera ang'onoang'ono a maselo a khansa ndi metastases yomwe imakhala pafupi koma kunja kwa nthaka.
Pakalipano, mankhwala a proton owombera ndi okwera mtengo kawiri monga mankhwala ochizira odwala chifukwa cha ndalama zapamwamba (mankhwala a proton amafunika accelerator yaikulu). Pakali pano pamafunika ndalama zoposa 200 miliyoni kuti zimange malo.
Mavuto akuphatikizapo kuyendetsa kayendetsedwe ka kayendetsedwe ka zinthu komanso kusintha kwa thupi lomwe limakhalapo nthawi ndi nthawi.
Popeza kuti malo ochepa chabe a mankhwala a proton amapezeka ku United States, anthu amafunika kuyenda patali kuti alandire chithandizochi.
Njira Zosiyana ndi Proton Beam Therapy
Ngakhale mankhwala opangidwa ndi ma radiation ochiritsira amakhala ochepa kwambiri ndipo amachititsa "kubalalitsa" kuposa mankhwala a proton, njira zamakono zowonongeka zimaperekanso chithandizo chodziwika bwino cha ma radiation.
Chitsanzo chimodzi ndi thupi la stereotactic radiotherapy (SBRT). Ndi SBRT, mlingo waukulu wa ma radiation umaperekedwa kumalo enieni. SBRT ingagwiritsidwe ntchito ndi cholinga chochepetsera matenda omwe sungakhoze kuchitidwa opaleshoni chifukwa cha malo awo, kapena kuti "oligometastases" (masewera amodzi kapena ochepa okha ku ubongo, chiwindi, kapena mapapo kuchokera ku ziwalo zolimba).
Mu 2017 kukapenda kafukufuku poyerekeza ndi mankhwala a proton chowombera ndi SBRT, ofufuza sanapezepo kusiyana kulikonse komwe kumathandiza kuti njira ziwirizi zithetsere kansa yaing'ono ya m'mapapo.
Zovuta Zotsatira za Proton Beam Therapy
Mofanana ndi mankhwala ambiri a khansa, mankhwala a proton owombera amatha kuwononga zotsatira. Ngakhale kuti mankhwala a proton opangidwa ndi thovu amaperekedwa kumalo enieni, kuwonongeka kwa maselo omwe amakhala pafupi ndi chotupacho kumachitika. Zambiri za zotsatirazi zimakhala zofanana ndi zotsatira za mankhwala ochizira, koma chifukwa cha kuwonongeka kwakukulu, kungakhale kochepa kwambiri.
Zotsatira zoyipa zambiri zimaphatikizapo:
- Kutopa: Mofanana ndi mankhwala ochizira amachilendo, kutopa ndi chimodzi mwa zomwe zimawoneka kuti zizindikiro za mankhwala. Kutopa uku kumakhala kovuta kwambiri potsatira mankhwala omwe muli.
- Kufiira kwa khungu (radiation dermatitis): Kawirikawiri, kupweteka kwa khungu komanso kupweteka kwa khungu kungachitike ndi mankhwala a proton.
- Kutaya tsitsi: Kutayika tsitsi kumaphatikizapo dera limene proton lopiritsira mankhwala limaperekedwa, mwachitsanzo mutu pamene wagwiritsidwa ntchito pa khansa ya ubongo kapena chifuwa chogwiritsidwa ntchito pa khansa ya m'mapapo. Mosiyana ndi kukomoka kwa tsitsi lomwe limagwirizanitsidwa ndi chemotherapy, kupweteka tsitsi kumakhudzana ndi mankhwala a proton kumakhala kosatha.
- Kutupa kwa mapapo: Kutupa kwa mapuloteni kumatchulidwa kuti radiation pneumonitis ikhoza kuchitika pamene mankhwala a proton akugwiritsidwa ntchito pachifuwa. Kufunika kwa radiation pneumonitis ndikoyenera kuzindikiridwa ndi kuchiritsidwa kuti athe kuchepetsa chiopsezo cha pulmonary fibrosis (kuchepa kwa mapapo).
Kodi Proton Beam Therapy Imapezeka Kuti?
Palinso nambala yochepa ya malo opatsirana khansa ku United States komanso padziko lonse lapansi omwe amapereka chithandizo cha mankhwala a proton. Mapu a malo oteteza mankhwala a proton angakuwonetseni ngati mankhwalawa amaperekedwa pafupi ndi malo anu.
Kukonzekera Thandizo la Proton Beam
Musanayambe kulandira chithandizo ndi mankhwala a proton, mukumana ndi a radiation oncologist amene angakambirane zomwe mungathe kuyembekezera, komanso phindu lake. Mudzakhala ndi CT yowonongeka kuti mukapange mapu a m'dera lanu kuti muzitha kuchiritsidwa ndipo mudzakhala ndi chipangizo chopanda mphamvu (monga mankhwala ochiritsira). Mtundu uwu udzaikidwa pa gawo la thupi lanu kulandira ma radiation panthawi iliyonse ya mankhwala.
Mofanana ndi ma radiation ochiritsira, mankhwala ochizira mankhwala a proton amachitidwa tsiku lililonse sabata kwa magawo 20 mpaka 40. Ngakhale kuti gawo lodziwika bwino la maulendo a maulendowa limatenga miniti kapena awiri, kuika malo ambiri kumatenga mphindi 30 mpaka 45.
Thandizo la Proton silili lopweteka, ndipo palibe kusowa kwa anesthesia kofunikira (kupatulapo ana amene angafune kuti anthu azikhala osakondwa panthawi ya chithandizo).
Mawu Ochokera
Thandizo la Proton lalitali limaperekanso njira ina yothandizira khansa. Chifukwa chakuti amatha kuyang'ana mozama kwambiri ma radiation pa khansara, ubwino wake waukulu sikuthetsa khansa koma kuchepetsa chiopsezo cha zotsatirapo zokhudzana ndi mankhwala. Izi zikhoza kukhala njira yabwino kwa zotupa zomwe zili pafupi ndi zofunikira komanso kwa achinyamata omwe angathe kukhala ndi chiopsezo chochepa cha khansa yachiwiri ndi mankhwala a proton oyezera poyerekeza ndi miyendo yeniyeni.
Ikhoza kugwiritsidwanso ntchito pa zotupa zomwe kale zinkachiritsidwa ndi miyendo yowonongeka koma inabwereranso. Malo enieni ochiritsira amathandizanso kuti ma radiation aperekedwe pa mlingo wapamwamba kusiyana ndi kuwala kwachilengedwe.
Pakalipano pali kutsutsana pankhani ya kukhazikitsidwa mwamsanga ndi malo omwe amapereka chithandizochi monga nthawi zina zowonongeka kapena njira monga SBRT ikhoza kukhala yothandiza koma yopanda mtengo. Popeza kuti mankhwala a proton ndi othandizirabe, sitikupeza kuti maphunzirowa akutsitsimutsa ubwino wake wa mankhwala a proton pazinthu zina. Kambiranani ndi chithandizo ichi ndi wothandizira wanu kuti muwone ngati zili zoyenera kwa inu.
> Zotsatira:
> Diwangi, T., Mohindra, P., Vyfhuis, M. et al. Kupititsa patsogolo pa njira za Radiotherapy Njira ndi Kutumizidwa kwa Khansa Yopanda Kulimbitsa Khansa: Mapindu a Njira Yothandizira Mazira, Proton Therapy, ndi Stereotactic Body Radiation. Kafukufuku Wofufuza za Khansa Yamasulidwe . 2017. 6 (2): 131-147.
> Mohan, R., ndi D. Grosshans. Thandizo la Proton- Lero ndi Tsogolo. Kupititsa patsogolo Kugwiritsa Ntchito Mankhwala Osokoneza Bongo 2017. 109: 26-44.