Proton terapiyasi nima?

Proton terapiyasi nima?
Proton terapiyasi, shuningdek, proton nurlari terapiyasi sifatida ham tanilgan, o'simta hujayralarini yo'q qilish uchun ishlatiladigan radiatsiya davolash shaklidir. Muntazam radiatsiya bilan davolash kabi rentgen nurlaridan foydalanish o'rniga, u rentgen nurlanishidan ko'ra o'smalarni aniqroq nishonga oladigan yuqori energiyali nurlarni yuborish uchun protonlardan foydalanadi.

Bemorni davolashda shifokorlar va fiziklar proton nurini o'simtaning aniq hajmi va shakliga qaratish uchun birgalikda ishlaydi. Nur o'simta hujayralarini qatlam bo'ylab o'ldiradi va atrofdagi sog'lom to'qimalarni saqlaydi.

Proton nurlari terapiyasi qanday ishlaydi

Proton terapiyasi rentgen nurlari o'rniga protonlardan foydalanadigan radiatsiya davolashning ilg'or shaklidir.

Muntazam radiatsiya terapiyasida energiya nuri tanaga, o'simta orqali va boshqa tomondan chiqib ketadi. Radiatsiyaning bu "chiqish dozasi" o'simtadan tashqari sog'lom to'qimalarga ta'sir qilishi mumkin. Protonlar, aksincha, oddiy nurlanishda ishlatiladigan zarralardan kattaroq zarralardir. Ular o'zlarining ko'proq energiyasini o'simta ichida chiqaradilar. Ushbu energiya portlashi Bragg cho'qqisi deb ataladigan grafikda paydo bo'lishi mumkin.

O'simtaga energiya etkazib berilgandan so'ng, protonlar to'xtaydi: ular o'simtadan chiqmaydi va boshqa tomondan sog'lom to'qimalarga o'tadi.

Shunday qilib, proton terapiyasi radiatsiya ta'sirini va sog'lom to'qimalarga, ayniqsa miya, ko'zlar, orqa miya, yurak, asosiy qon tomirlari va nervlar kabi nozik sohalarda mumkin bo'lgan zararni kamaytiradi.

Proton terapiyasini olish qanday?
Proton terapiyasi ambulatoriya usuli hisoblanadi. Ko'pgina bemorlar bir necha seanslar kursida davolanadi va ba'zi davolanishlar boshqalarga qaraganda uzoqroq davom etadi. Hozirda proton nurlari faqat bir nechta ixtisoslashgan markazlarda mavjud.

Proton terapiyasiga tayyorlanish

Proton terapiyasi proton nurining nishonga tegishiga ishonch hosil qilish uchun ehtiyotkorlik bilan rejalashtirishni o'z ichiga oladi. Har bir seansdan oldin o'simta va uning atrofidagi joylarning rasmlarini taqdim etish uchun kompyuter tomografiyasi yoki MRI kabi ko'rish sinovlaridan o'tishingiz mumkin. Terapiya guruhi davolanish sohasini ta'kidlash uchun tanangizda belgilar qo'yishi mumkin - bular asosan vaqtinchalik.

Proton bilan ishlov berish maxsus xonada amalga oshiriladi. Ba'zi markazlarda gantry deb ataladigan katta mexanik qo'l stol ustida yotganingizda nurni atrofingizdan siljitishi mumkin. Bu radiatsiya terapevtlariga o'simtani bir necha tomondan davolashga yordam beradi.

Shishlar hajmi, joylashuvi va soniga qarab, siz davolanish xonasida taxminan 15 dan 30 minutgacha vaqt o'tkazasiz.

Proton nurlari bilan ishlov berish uchun joylashishni aniqlash

Tananing joylashishi juda muhimdir. Proton nurlari o'simtaning aniq joyiga etib borishiga ishonch hosil qilish uchun jamoa sizni ham, asboblarni ham sozlashi uchun bir necha daqiqa vaqt ketishi mumkin.

Davolanish davom etayotganda, siz stolda juda harakatsiz bo'lishingiz kerak. Jamoa sizni o'z o'rnida saqlashga yordam berish uchun siz bilan ishlaydi. Misol uchun, maxsus moslashtirilgan niqob miya shishi bilan davolanayotganlarga yordam berishi mumkin. Niqob to'rdan yasalgan bo'lib, bemorlarga ko'rish va nafas olish imkonini beradi.

Proton nurlari bilan ishlov berish paytida nima sodir bo'ladi

Tayyor bo'lganingizdan so'ng, terapevtlar proton nurlari mashinasini boshqarishi uchun xonani tark etadilar. Videokamera ularga sizni ko'rishga va eshitishga yordam beradi, shunda siz yolg'iz qolmaysiz.

Davolashning o'zi bir necha daqiqa davom etadi. Katta mashina protonlarni tezlashtiradi va energiya hosil qiladi. Proton nuri bu energiyani tanaga, o'simta joylashgan aniq chuqurlikka yo'naltiradi. Gantry tanangiz atrofida harakatlanishi va o'simtani bir necha pozitsiyadan davolashi mumkin.

Siz proton nurini tanaga kirganda yoki o'simtani davolayotganda his qilmaysiz.

Proton terapiyasining yon ta'siri

Mashg'ulotdan so'ng siz charchaganingizni his qilishingiz mumkin. Proton terapiyasining yon ta'siri boshqa radiatsiya davolash usullariga o'xshaydi. Texnika radiatsiyaga kamroq ta'sir qilishni anglatishi mumkinligi sababli, yon ta'siri an'anaviy radiatsiya bilan davolashga qaraganda kamroq bo'lishi mumkin.

Nojo'ya ta'sirlar davolanishdan keyin asta-sekin rivojlanishi mumkin va quyidagilarni o'z ichiga olishi mumkin:

Davolanish sohasi atrofidagi terining qizarishi, quyosh yonishi kabi ko'rinishi mumkin

Davolash sohasida soch to'kilishi
Charchoq yoki kam energiya
Qo'shimcha nojo'ya ta'sirlar, davolangan hududga qarab, bosh og'rig'i va ovqatlanish va ovqat hazm qilish bilan bog'liq muammolarni o'z ichiga olishi mumkin.

Proton terapiyasidan tiklanish

Proton nurlari bilan davolangandan so'ng, ko'pchilik uyga qaytib, o'z faoliyatini davom ettirishi mumkin. Ba'zi o'smalar uchun shifokoringiz davolanishning o'simtaga qanday ta'sir qilishini aniqlash uchun testlarni buyurishi va kerak bo'lganda davolanishingizni sozlashi mumkin.

Proton terapiya mashinasi

Jons Xopkins proton terapiyasi markazi
Vashingtondagi Sibley Memorial kasalxonasida joylashgan bizning markaz ilg'or proton terapiyasi texnologiyasini, eng so'nggi tadqiqot va g'amxo'r mutaxassislarni birlashtiradi, ular turli xil kattalar va bolalar saratoni uchun moslashtirilgan davolash usullarini taqdim etadi.

Jons Xopkins proton terapiya markazida saraton kasalligini davolash haqida ko'proq bilib oling

Qaysi o'smalarni proton terapiyasi bilan davolash mumkin?
Proton terapiyasi bolalar va kattalardagi saraton va saratonsiz o'smalarni davolash uchun ishlatiladi. Bu, ayniqsa, tez-tez azob chekadigan bolalarda miya va o'murtqa o'smalari haqida gap ketganda qimmatli bo'lishi mumkin
r zaharli saratonni davolashdan uzoq davom etadigan yon ta'siri.

Proton nurlari davolash uchun ishlatilishi mumkin:

Sarkomalar, ayniqsa bosh suyagi, umurtqa pog'onasi yoki retroperitoneum tagida

Ko'krak saratoni
Prostata saratoni
Rabdomyosarkoma, melanoma va ko'z atrofidagi boshqa saraton
O'pka saratoni va limfoma yoki timoma kabi boshqa ko'krak saratoni
Bosh va bo'yin saratoni
Jigar saratoni
Oshqozon osti bezi saratoni
Yaxshi o'smalar
Tadqiqotchilar proton nurlari terapiyasining saratonning boshqa turlariga potentsial afzalliklarini o'rganishmoqda.

Proton terapiyasining afzalliklari qanday?

Muntazam va protonli radiatsiya terapiyasi saraton hujayralarining DNKsini buzadi, ammo proton terapiyasining ikkita asosiy afzalligi bor: o'simtaga ko'proq energiya yo'naltirish va yaqin atrofdagi sog'lom to'qimalarga kamroq radiatsiya ta'sir qilish.

Radiatsiyadan kamroq sog'lom to'qimalar ta'sir qilsa, yon ta'siri engilroq bo'lishi mumkin. Miya, yurak, og'iz bo'shlig'i, qizilo'ngach va orqa miya kabi nozik tuzilmalarning shikastlanishi kamayishi mumkin.

Proton terapiyasining kamchiliklari qanday?

Proton terapiyasi har qanday saraton turiga mos kelmaydi. Bu boshqa muolajalar atrofdagi sog'lom hujayralarga zarar etkazishi mumkin bo'lgan sezgir hududlardagi saraton kasalliklari uchun eng mos keladi.

Proton terapiyasi uchun mashinalar va uskunalar juda murakkab va ularni ishlab chiqarish va ishlatish qimmat. Sizning sug'urta provayderingiz bilan sug'urta qoplamasini tekshirish muhimdir. Ba'zi proton terapiya markazlarida maslahat uchun moliyaviy maslahatchilar bor.

Shifokoringiz saraton kasalligingiz uchun tegishli davolanishni tavsiya qiladi.

Abstract

In principle, proton therapy offers a substantial clinical advantage over the conventional photon therapy. This is because of the unique depth-dose characteristics of protons, which can be exploited to achieve significant reductions in normal tissue doses proximal and distal to the target volume. These may, in turn, allow escalation of tumor doses, greater sparing of normal tissues, thus potentially improving local control and survival while at the same time reducing toxicity and improving quality of life.
Protons, accelerated to therapeutic energies ranging from 70 to 250 MeV, typically with a cyclotron or a synchrotron, are transported to the treatment room where they enter the treatment head mounted on a rotating gantry. The initial thin beams of protons are spread laterally and longitudinally and shaped appropriately to deliver treatments. Spreading and shaping can be achieved by electro-mechanical means to treat the patients with “passively-scattered proton therapy (PSPT); or using magnetic scanning of thin “beamlets” of protons of a sequence of initial energies. The latter technique can be used to treat patients with optimized intensity modulated proton therapy (IMPT), the most powerful proton modality.
Despite the high potential of proton therapy, the clinical evidence supporting the broad use of protons is mixed. It is generally acknowledged that proton therapy is safe, effective and recommended for many types of pediatric cancers, ocular melanomas, chordomas and chondrosarcomas. Although promising results have been and continue to be reported for many other types of cancers, they are based on small studies. Considering the high cost or establishing and operating proton therapy centers, questions have been raised about their cost effectiveness. General consensus is that there is a need to conduct randomized trials and/or collect outcomes data in multi-institutional registries to unequivocally demonstrate the advantage of protons.
Treatment planning and plan evaluation of PSPT and IMPT requires special considerations compared to the processes used for photon treatment planning. The differences in techniques arise from the unique physical properties of protons but are also necessary because of the greater vulnerability of protons to uncertainties, especially from inter- and intra-fractional variations in anatomy. These factors must be considered in designing as well as evaluating treatment plans. In addition to anatomy variations, other sources of uncertainty in dose delivered to the patient include the approximations and assumptions of models used for computing dose distributions for planning of treatments. Furthermore, the relative biological effectiveness (RBE) of protons is simplistically assumed to have a constant value of 1.1. In reality, the RBE is variable and a complex function of energy of protons, dose per fraction, tissue and cell type, end point, etc.
These uncertainties, approximations and current technological limitations of proton therapy may limit the achievement of the true potential of proton therapy. Ongoing research is aimed at better understanding the consequences of the various uncertainties on proton therapy, and reducing the uncertainties image-guidance, adaptive radiotherapy, further study of biological properties of protons, and the development of novel dose computation and optimization methods. However, residual uncertainties will remain in spite of the best efforts. To increase the resilience of dose distributions in the face of uncertainties and improve our confidence in dose distributions seen on treatment plans, robust optimization techniques are being developed and implemented. We assert that, with such research, proton therapy will be a commonly applied radiotherapy modality for most types of solid cancers in the near future.