Daaweynta Proton kansarka beerka, badbaadada guud ee daba dheeraatay ee bukaanada qaba kansarka hepatocellular carcinoma proton therapy
Kansarka hepatocellular waa nooca ugu badan ee kansarka beerka, iyadoo in ka badan 700,000 ay u dhintaan adduunka oo dhan sannad kasta, dhacdooyinkana waa sii kordhayaan. Hababka lagu daweeyo kansarka hepatocellular waxaa ka mid ah beerka beddelka, qalliinka dib-u-soo-celinta, hababka qallafsan iyo daaweynta shucaaca (shucaaca sawir-qaadista ama daaweynta proton). Dhexdooda, qalliinka ayaa wali ah daaweynta la doorbiday, laakiin ilaha beerka ee loo isticmaali karo beerista waa ku yar yihiin bukaanno badanna ma aqbali karaan qalliinka qalliinka sababo la xiriira cirrhosis-ka beerka iyo sababo kale.
Daaweynta 'Proton therapy' waxay dheereyn kartaa guud ahaan badbaadada bukaanka
Isbitaalka Guud ee Massachusetts Nina Sanford, MD iyo koox dib u eegis ku sameysay ayaa isbarbar dhigay saameynta daweynta ee 133 bukaan oo qaba kansarka beerka ee aan shaqeyn karin ee soo maray radiotherapy dhaqameed dhaqameed ama daaweynta proton Isbitaalka Guud ee Massachusetts intii u dhaxeysay 2008 iyo 2017, kaas oo 49 ka mid ah kiisaska (37%)) Ka helaan daaweynta loo yaqaan 'proton therapy'. Tani waa daraasaddii ugu horraysay ee isbarbardhig ah daaweynta proton iyo daaweynta shucaaca photon ee kansarka hepatocellular.
Muddada dabagalka dhexdhexaadka ee daraasaddu waxay ahayd 14 bilood, qiyaasta irradiation-ka waxay ahayd 45 Gy / 15 ama 30 Gy / 5 ~ 6, da'da dhexdhexaadka bukaannaduna waxay ahayd 68 sano. Daraasaduhu waxay muujiyeen in badbaadada guud ee bukaanada ku jira kooxda daaweynta daaweynta ay kafiican tahay tan photon radiotherapy, oo leh waqtiyo badbaado dhexdhexaad ah oo ah 31 bilood iyo 14 bilood, siday u kala horreeyaan, iyo 24-bilood guud ahaan heerka badbaadada 59.1% iyo 28.6% , siday u kala horreeyaan. Isla mar ahaantaana, daaweynta proton waxay yareyn kartaa dhacdooyinka aan caadiga ahayn ee shucaaca ku dhaca beerka (RILD) marka la barbar dhigo shucaaca sawir-qaadaha. 21 bukaan oo ka mid ah bukaanka aan caadiga ahayn ee RILD, 4 ayaa helay proton therapy halka 17 kalena ay heleen shucaac sawir qaade ah; iyo daaweynta kadib Dhacdooyinka RILD ee bilaha 3 waxay la xiriireen guud ahaan badbaadada. Heerarka kontoroolka maxalliga ah ee kooxda daaweynta proton iyo kooxda shucaaca sawir qaadista ayaa ahaa 93% iyo 90%, siday u kala horreeyaan, mana jirin farqi weyn oo u dhexeeya labada koox.
The article indicates that the longer overall survival of patients in the proton therapy group may be due to the lower incidence of decompensated liver function after treatment. Dr. Sanford said that in the United States, patients with hepatocellular carcinoma are often accompanied by other liver diseases, making these patients unable to undergo surgery and making radiotherapy more difficult. The proton therapy has a lower radiation dose to normal tissues around the buro, so for patients with hepatocellular carcinoma, the non-target liver tissue receives less radiation dose. “We think this will reduce the incidence of liver injury. Because the cause of many hepatocellular carcinoma patients is other liver diseases, the lower liver injury rate in the proton therapy group can translate into better patient survival.”
Aqoonso saadaaliyayaasha dhaawaca beerka ka dib daaweynta proton
Daaweynta shucaaca ee cudurka kansarka 'hepatocellular carcinoma' ayaa wali muran ka taagan yahay sababta oo ah cirbadeynta badan ee burooyinka waxay sababi kartaa cudurrada kale ee beerka (RILD). MD Anderson Cancer Centre iyo shucaaca kansarka Cheng-En Hsieh, MD ee Isbitaalka Chang Gung Memorial Hospital ee Taiwan iyo kooxdiisa waxay aqoonsadeen saadaaliyayaasha RILD ka dib daaweynta proton.
Qiyaasta bartilmaameedka beerka ee aan caadiga aheyn / heerka cabirka beerka ee caadiga ah (ULV / SLV) histogram-saameyn-saameyn
Daraasaddan oo xarumo badan ka kooban ayaa waxaa ka mid ahaa 136 bukaan oo qaba cudurka kansarka 'hepatocellular carcinoma' oo aan u soo gudbin burooyinka intrahepatic ka dib daaweynta proton. Daaweynta proton waxaa loo qaybiyay 2 GyE. Falanqaynta iskudarsanaanta kaladuwan waxay muujisay in culeyska beerka ee aan bartilmaameedka ahayn / heerka cabirka beerka ee caadiga ah (ULV / SLV), mugga bartilmaameedka burooyinka, iyo kalasoocista Child-Pugh ay ahaayeen saadaaliyayaal madaxbannaan oo RILD ah, iyo qiyaasta celceliska beerka iyo qiyaasta gaarsiinta bartilmaameedka lama xiriirin Jinsi RILD. Baarayaasha ayaa rumeysan in qiimaha ULV / SLV uu yahay saadaaliyaha ugu muhiimsan ee RILD; soo-gaadhista ≥1 GyE waxay sababi kartaa dhibaatooyin beerka ah. Sidaa darteed, ka-hortagga iyo daaweynta cudurrada beerka, mugga beerka ee aan bartilmaameedka ahayn ayaa ka muhiimsan celceliska qiyaasta beerka.
"Xogtayadu waxay muujinaysaa in haddii beero ku filan la ilaalin karo, daawaynta proton waa badbaado ku filan oo khatarta RILD waa la yareyn karaa," Dr. Hsieh ayaa yidhi. "Waxay la mid tahay dib-u-noqoshada beerka, kaas oo xajiya beer ku filan Mugga weyn ee beerka ayaa si badbaado leh looga saari karaa unugyo. "
Muhiimadda xulashada bukaanka iyo daaweynta shaqsiyeed
Laura Dawson, MD, madaxweynaha la doortay ee ASTRO, wuxuu cadeeyay in cadeynta astaamaha saadaalinta ee la xariira halista sare ee dhaawaca beerka ay ka caawin karto shucaaca kansarka inuu isku dheelitiro faa'iidooyinka iyo halista daaweynta iyo inuu horumariyo istiraatiijiyad daaweyn shaqsiyeed
Both studies have emphasized the need for individualized radiotherapy for liver cancer,” Dr. Dawson said. “Although there are currently suitable patient types for proton therapy, there is still insufficient clinical evidence to treat proton therapy as the liver prior to photon radiotherapy. The preferred treatment for cell cancer. We still need randomized trials (such as NRG-GI003) to guide clinical practice and make it clearer which patients can benefit from proton therapy. “
Dr. Sanford wuxuu yiri: “Waqtigan xaadirka ah, daaweynta proton-ka weli waa daaweyn qaali ah oo leh ilo kooban. Sidaa darteed, waxaan u baahanahay inaan sii wadno baaritaanka si aan u hagaajino xulashada bukaanjiifka proton therapy oo ku saleysan qodobo caafimaad ama burooyinka biomarkers. ”
