Ma proton radiation ndi mtundu wambiri wa ma radiation umene umapezeka kuti umatchuka ndi khansa ya prostate. Amuna amene akuganiza za ma radiation a proton ayenera kuyerekeza ndi kuwasiyanitsa ndi mitundu yonse ya ma radiation kuti aone ngati mankhwala a proton ndi othandiza kwa iwo chifukwa cha zochitika zawo.
Mavitamini ambiri a proton amafunika mankhwala asanu pa sabata kupitilira masabata asanu ndi atatu kapena asanu ndi anai otsatizana.
Paulendo uliwonse, odwala ali pamaso pa chithunzi chosawoneka cha proton zomwe zimayendetsa prostate gland.
Proton ndi ma Photon Radiation
Ma proton radiation ndi osiyana ndi mitundu ina ya ma radiation , omwe amadalira photons. Mitundu itatu ya Photon imabwera m'magulu atatu: mphamvu yowonongeka yamagetsi (IMRT), ma radiation (radichythrapial), komanso mankhwala osokoneza bongo (SBRT). Nthawi zina kuphatikizapo ubongo wothandizira pogwiritsa ntchito mtundu wina wa dothi lopaka mazira kumagwiritsidwa ntchito.
Mitundu yonse ya ma radiation ndi yothandiza, zomwe zimachititsa imfa ya maselo a khansa. Zonsezi zingayambitse zotsatira zake, ngati miyendoyi imakhudza ziwalo zowoneka bwino, monga chikhodzodzo, kachilombo, ndi urethra.
Kuopsa kwa Kuwonongeka kwa Erectile
Pakalipano akatswiri sangathe kuvomereza kuti mtundu wina wa ma radiation umapitirirabe kuposa ena onse. Komabe, malingana ndi mitundu yosiyanasiyana ya zochitika zomwe odwala amakumana nazo, mtundu umodzi wa mankhwala ukhoza kukhala ndi ubwino kuposa enawo.
Zosankha zonse, zikaperekedwa ndi madokotala odziwa bwino ntchito, zimapindula mankhwala ochiritsidwa bwino ndipo zimakhala ndi zotsatira zochepa chabe-kupatulapo pangozi ya erectile dysfunction (ED).
Kuopsa kwa ED wosatha-kumatanthauzidwa ngati ED osamvetsera Viagra kapena mankhwala otero-ndi pafupifupi 50 peresenti ndi mitundu yonse ya ma radiation.
Mavutowa ndi apamwamba kwa amuna achikulire komanso amuna omwe ali ndi vuto logonana lachiwerewere. Mavutowa ndi otsika kwa amuna achichepere ndipo pamene ntchito yokhudzana ndi kugonana ndi yovuta. Chithandizo cha ED, chomwe chimapangitsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda, n'chothandiza koma sichichibadwa, ndipo chimafuna kuti jekeseni ya prostaglandin ipangidwe mu mbolo kapena kuikidwa ma prostate.
Chinthu chofunika kwambiri, ngakhale ED atachoka poizoni, sichikudziwika kuti ndi chodziwika pa kusankha mtundu wina wa ma radiation pamwamba pa wina. Izi zili choncho chifukwa chiopsezo cha ED ndi chimodzimodzi ndi mitundu yonse ya ma radiation. Poyerekeza zosankhidwa zamtunduwu, zimadalira pazifukwa zina monga machiritso ndi chiwerengero cha mavuto a chikhodzodzo.
Kuopsa kwa Mafuta Ovuta
Kalekale, pogwiritsa ntchito teknoloji yakale ya ma radiation, kutentha kwapadera kwa ma radiation kunali kofala ndipo kungawonongeke. Tsopano mu nthawi yamakono ino, chifukwa cha njira zabwino zowunikira, zopsereza zazikulu zamakono zakhala zosazolowereka. Pakalipano, mitundu yonse inayi ya ma radiation (proton radiation, IMRT, brachytherapy ndi SBRT) ili ndi ngozi yofanana (1 mpaka 2 peresenti) ya mavuto a nthawi yaitali.
Pali zosiyana ziwiri kuzinena izi. Choyamba, ena osati maphunziro onse a SBRT amati akhoza kukhala ndi chiopsezo chapang'ono cha kutentha kwa rectal kusiyana ndi njira zina zitatu, chiwopsezo pa 3 peresenti mpaka 4 peresenti.
Chiwiri chachiwiri ndi ma "radi" a proton. Zipangizo zakale za proton zimapereka mbali yowonjezereka ya ma radiation, omwe mwinamwake amachititsa kuti miyandamiyanda "overspray" mu rectum. Mankhwala a proton amasiku ano, omwe amatchedwa protocol therapy modulus (IMPT) amaperekedwa pogwiritsa ntchito mapulitsi ang'onoang'ono, ofanana ndi mtundu wamakono ogwiritsira ntchito IMRT. Magulu awiri a IMPT ndi IMRT angapange malo omwe amayendetsedwa ndi ma "curve" omwe angapangidwe kuti azigwirizana kwambiri ndi malire a prostate gland. Izi zimapangitsa kuti tizirombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda.
Geleni Yopewera Kutentha Kwambiri
Zomwe zimawonongeka nthawi zonse zimakhala zochepa, koma zingathe kukhumudwitsa kwambiri, zimapweteka, zimachotsa magazi, komanso zimawonongeka. Katswiri wamasinthidwe wotchedwa SpaceOAR amachepetsa kwambiri chiwopsezo chowotcha kwambiri pamtunda. SpaceOAR hydrogel imayikidwa pakati pa prostate gland ndi khoma la rectal ndipo imakhalabe mkati mwa nthawi yonse ya ma radiation. Hygirogel imasuntha khoma la rectal kutali ndi prostate gland ndi kunja kwa masentimita. Choncho, chiopsezo cha kutentha kwa dzuwa kumakhala pafupi kuchotsedwa.
Kuopsa kwa Mauthenga Oopsa Kumathandiza Mavuto Otani
Matenda a mitsempha pambuyo poizonika amaphatikizapo kupweteka pakutha, kukonzekera kwamtsinje, ndi kudzuka usiku kawirikawiri kuti ugwere. Kuopsa kwa zizindikiro pambuyo poizonika kumawonjezeka kwa amuna omwe ali ndi mavuto osakanikirana ndi amuna komanso amuna omwe ali ndi ziwalo zazikulu za prostate.
Kuopsa kwa mavuto a ubodzo kumaperekedwanso pamene zipangizo za mbewu zimagwiritsidwa ntchito. Izi zili choncho chifukwa mlingo wonse wa ma radiation woperekedwa ndi mbewu ndi wapamwamba. Mitsempha ya mitsempha yomwe imanyamula mkodzo kuchokera pachikhodzodzo kupita kunja kudzera mbolo, imayenderera pakati pa prostate. Choncho, kupsa mtima kwadzidzidzi panthawi ya ma radiation ndipo mwamsanga pambuyo poizoni ndizofala pakati pa zonse zomwe mungasankhe.
Zizindikiro za kutalika kwa nthawi yayitali zimachitika peresenti 10 kapena za amuna omwe ali ndi implants. Zizindikiro zamtundu wa nthawi yayitali zikhoza kuchitika ndi zina zomwe mungasankhe, koma osachepera asanu peresenti ya odwala, poganiza kuti alibe mitsempha yochuluka kwambiri kapena mavuto ovuta omwe amakhudza. Mankhwala othana ndi zizindikirozi za nthawi yayitali zimangokhala zothandiza. Pali chizoloŵezi cha zizindikiro za nthawi yaitali kuti ziziyenda bwino, ngakhale kuti kusintha kwakukulu sikutheka kwa zaka zingapo.
Zonsezi, kupatulapo zochepa zazing'ono zomwe tazitchula pamwambapa, chiopsezo cha zotsatira zoyipa za umtsinje ndi zam'mbali ndi chimodzimodzi ndi zonse zomwe mungasankhe. Izi zimatitsogolera kuchipatala, zomwe zimasiyana malinga ndi matenda a khansa. Amuna omwe amafunidwa ndi ma radiation, magawo awiri a khansara ya prostate akhala akufotokozedwa, "oopsa kwambiri" komanso "oopsa."
Mazira a Khansa ya Prostate yapamwamba kwambiri
Popeza kuti maphunziro abwino alipo chifukwa cha chiopsezo chachikulu, chisankho cha mankhwala sichikutsutsana kwambiri kusiyana ndi chiopsezo chapakati. Amuna omwe ali ndi chiopsezo chachikulu amakhala ndi chimodzi mwa zotsatirazi:
• Gulu la Gleason la 8 kapena kuposa
• PSA magazi oposa 20
• Kuyezetsa magazi kamodzi komwe kumasonyeza chivundi chachikulu kapena khansara kunja kwa prostate
Ndi matenda oopsa kwambiri, akatswiri amalimbikitsa njira yothetsera. Monga taonera pamwambapa, mbewu zamtunduwu zimatulutsa kuwala kwa dzuwa poyerekeza ndi zina zomwe mungasankhe. Mankhwala apamwamba amathandiza kuchiza mitengo. Kuphunzira kwakukulu komwe kumatchedwa kuti ASCENDE-RT kulandira chithandizochi kumatsimikizira izi. Kafukufukuyu anayerekeza mwatsatanetsatane IMRT ndi IMRT kuphatikizapo kuika mbewu. Kuphatikizidwa kwa mbeu kuphatikizidwa ndi IMRT kunapangitsa kuti peresenti ya mankhwala ochiritsidwa ndi 20 peresenti ikwaniritsidwe poyerekeza ndi mankhwala ndi IMRT okha. Momwemonso, chigwirizano ndi chakuti mbeu zamtunduwu zimagwiritsidwa ntchito ndi IMRT ndiyo njira yabwino kwambiri ya ma radiation kwa amuna omwe ali ndi chiopsezo chachikulu.
Popeza pali kusiyana kwakukulu pakati pa mankhwala a proton (IMPT) ndi IMRT, nkoyenera kuti m'malo mwa IMPT (kuphatikizapo mbeu) za IMRT komanso mbeu za amuna omwe ali ndi matenda oopsa. Komabe, kusinthanitsa koteroko sikungatsimikizidwe mu kuyesedwa kwachipatala. Mwina kuperewera kumeneku kumakhala kochepa chifukwa cha ubwino wina wamthupi womwe umadziwika kuti umagwirizanitsidwa ndi protoni poyerekezera ndi photons. Mphamvu yamagetsi yotumizidwa kudzera pulotoni kumbali ya prostate, kuchepetsa kutentha kwa dzuwa kumtundu wa mbali.
Mosiyana ndi zimenezi, kuwala kwa photon kumadutsa thupi lonse, kuwonetsetsa kuti thupi likhale lalikulu kwambiri. Mfundo yaikulu yogwiritsira ntchito mankhwala a proton m'malo mwa IMRT imachokera pazifukwa izi, kuti kuchepetsa kuchuluka kwa maselo a thupi omwe amawoneka ndi mazira.
Mafilimu a Khansa ya Prostate ya Kuopsa Kwambiri
Pali kusintha kwakukulu kwambiri kosankha ndi matenda omwe ali pakati. Zotsatira zabwino zakhala zikulembedwa ndi zosankha zonse. Komabe, akatswiri ambiri akuyamba kugawanitsa chiopsezo chapakati mwa magawo abwino komanso osavomerezeka. Pogwiritsa ntchito dongosolo lino, amuna omwe ali ndi subtype yabwino ayenera kukwaniritsa zofunikira izi:
• Gleason 3 + 4 (m'malo mwa Gleason 4 + 3)
• Zili ziwiri kapena zitatu zokha za biopsy cores zomwe zili ndi khansara
• PSA magazi osachepera khumi
• Ngati dokotala ali ndi nodule, ndizochepa komanso zilipo
Pogwiritsa ntchito ngozi, zonse zomwe mungasankhe-mbewu, SBRT, IMRT, ndi proton (IMPT) miyezi-zikhoza kukhala zomveka. Amuna omwe ali ndi mavitamini akuluakulu a prostate, oposa 60 cc mpaka 80 cc, kapena amuna omwe ali ndi zizindikiro zowopsa zamakono, amakumana ndi chiopsezo chachikulu chokhala ndi ubweya wa mitsempha kwa nthawi yaitali ndipo ayenera kusankha SBRT, IMRT kapena IMPT . Ngati SpaceOAR hydrogel imagwiritsidwa ntchito pofuna kuteteza kuwonongeka kwa mphutsi, SBRT ndi kusankha kosangalatsa kwambiri pa IMRT ndi ma protro radiation, chifukwa chiwerengero cha maulendo ochiritsira amafunika kwambiri ndi SBRT poyerekeza ndi IMRT ndi mankhwala a proton.
Khansara ya prostate yosavomerezeka yomwe imakhalapo pakati pathu imakhala ndi chiopsezo chapakati (Gleason 7, PSA kuyambira 10 mpaka 20 kapena mbolo ya prostate yochepa) koma sichitsata ndondomeko yoyenera yomwe yafotokozedwa pamwambapa. Zitsanzo ndi: Gleason 4 + 3, amuna omwe ali ndi chiopsezo choposa pakati ndi amuna omwe ali ndi biopsy cores ambiri omwe ali ndi khansara. Izi zimasonyeza mtundu wa matenda omwe angakhale achiwawa. Choncho, mankhwala ayenera kugwirizana ndi IMRT (kapena IMPT) kuphatikizapo kuika mbewu. Njira imeneyi ingawonekere mofanana ndi zomwe zinalangizidwa pamwamba pa matenda akuluakulu. Komabe, pali kusiyana kwakukulu-njira yopangira mahomoni imagwiritsidwa ntchito.
Mankhwala amodzi amodzi amafunika kuti amuna onse atenge ma radiation kupatula amuna omwe ali ndi chiopsezo chapakatikati. Kawirikawiri, mankhwala a Lupron kapena mankhwala a Lupron ayambitsidwa miyezi iŵiri isanafike poizoni ndi kupitilira pa nthawi ya mazira. Amuna omwe ali ndi chiopsezo chapakati pafupipafupi amapitilizabe mankhwala a hormonal kwa miyezi isanu ndi umodzi. Amuna omwe ali ndi chiopsezo chachikulu amapitirizabe, atasiya miyezi 18. Phunziro lolimbikitsidwa lofalitsidwa ku New England Journal of Medicine likuwonetsanso kuti mankhwala amphamvu otchedwa Zytiga ayenera kuperekedwa mogwirizana ndi Lupron kwa amuna omwe ali ndi chiopsezo chachikulu.
Proton Therapy Ubwino ndi Kuipa
Ma prothrodiyo a proton angayimire bwino kwambiri pa IMRT chifukwa cha kuchepa kwa ziwalo za thupi zomwe zimawoneka kuti zikhale zowonongeka. Choncho, mu zochitika zomwe tazitchula pamwambapa kumene IMRT iyenera kuganiziridwa, amuna angasankhe kusankha mankhwala a proton pa IMRT. Zopindulitsa za ma protro radiation pa IMRT zimakhala zosawerengeka ndipo zimakhala zosavomerezeka. Palibe mutu uliwonse wopitiliza maphunziro poyerekeza ndi IMRT ndi ma radiation a proton.
Zowonongeka zogwiritsidwa ndi proton radiation zimagwirizana ndi mtengo wake wapamwamba komanso kuti sikuti mapulogalamu onse a inshuwalansi amawunikira ma proton radiation. Kuonjezera apo, pali malo ochepa omwe amapanga ma proton radiation, kotero kuwonongeka kwa malo kungakhale chinthu chachikulu pakuwona kuti maulendo ambiri amafunika pa nthawi ya masabata 5 mpaka 9.
Amuna akulingalira chithandizo cha kansa ya prostate kuti achite ntchito yawo ya kusukulu. Zotsatirapo zochokera ku dzuwa zimakhala zosasinthika. Kusankhidwa kwa ma radiation opambana kumasiyana ndi zovuta. Zinthu zambiri ziyenera kuganiziridwa pamene kuwala kwa dzuwa kukufotokozedwa.
> Zotsatira:
> James, ND., Et al. "Abiraterone chifukwa cha kansa ya prostate yomwe siinatengedwe kale ndi mankhwala opanga mahomoni." New England Journal of Medicine (2017).
> Morris, JW, et al. "Androgen Suppression pamodzi ndi Kusankha Nodal ndi Dose Escalated Radiation Therapy (The ASCENDE-RT Mlanduwu): Kufufuza za mapeto opulumuka kwa mayesero angapo kuyerekezera mlingo wa mlingo brachytherapy mphamvu kwa mlingo wazitali kunja chithandizira kwambiri-ndipo khansa ya prostate yoopsa. " International Journal of Radiation Oncology * Biology * Physics 98.2 (2017): 275-285.
> Zelefsky, MJ., Et al. "Kuchita bwino kwa sildenafil pamlomo kwa odwala opatsirana erectile pambuyo pa radiotherapy kwa carcinoma ya prostate." Urology 53.4 (1999): 775-778.