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Maxaa ufiican medulloblastoma - shucaaca caadiga ah ama daaweynta proton?

Maxaa ufiican medulloblastoma - shucaaca caadiga ah ama daaweynta proton? Daaweynta 'proton therapy' ee daaweynta medulloblastoma. Qiimaha daaweynta proton ee daaweynta medulloblastoma.

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Myeloblastoma is one of the most common childhood tumors. Among children under 10 years of age, the incidence rate is about 20% to 30% of all tumors. The peak age of onset is 5 years, and men are slightly more than women. The buro is located in the posterior cervical fovea, near the cerebellar vermis and the fourth ventricle midline, and advanced tumors spread in the cerebrospinal fluid. Typical clinical manifestations are mainly related to the increased intracranial pressure caused by tumor occupying the posterior cranial fossa and blocking the fourth ventricle or midbrain aqueduct: headache, nausea, vomiting, blurred vision, and balance function caused by tumor compression on the cerebellum Obstacles, such as walking instability, ataxia, etc.

At present, the treatment of medulloblastoma should be based on the clinical stage and risk stage of the child, and comprehensive treatment methods: a reasonable combination of three treatment methods: surgery, radiation therapy and chemotherapy, to improve the cure rate of the tumor and reduce the damage to normal tissues. Growth and development, intellectual effects.
Maadaama inta badan medulloblastomas ay ku dhacaan carruurta oo ay aad ugu nugul yihiin shucaaca, daaweynta shucaaca waa mid ka mid ah hababka lama huraanka u ah daaweynta medulloblastomas. Carruurtu waxay ku jiraan marxaladda koritaanka iyo horumarka, daaweynta shucaaca lama huraan waxay dhaawac u geysataa koritaanka carruurta, endocrine iyo garaadka. Waqtigan xaadirka ah, radiotherapy conformal conformal ama radiotherapy-xoojiska modulated waxaa inta badan loo isticmaalaa in lagu yareeyo qiyaasta shucaaca ee maskaxda, dhegta gudaha, lafdhabarta ku-meel-gaadhka ah, gobolka hypothalamus-pituitary, iyo qanjirka tayroodh, la go'aamiyay in la qaato qadar ku filan. Cirridka. Goobta shucaaca waxaa lagu shiday maskax dhan, laf -dhabarka oo dhan iyo fossa cranial -ka dambe.
Qiyaasta shucaaca dhaqameed: maskaxda oo dhan iyo xudunta laf dhabarta oo dhan marka loo eego kooxda halista ah, qiyaasta ka hortagga shucaaca waa 1.8Gy / waqti, wadarta guud waa 30-36Gy, kooxda khatarta sare leh waa 36Gy, iyo fossa cranial dambe waa ayaa isbeddelay ilaa 55.8 Euro. Marka ay jirto metastasis guud oo ku dhaca nudaha maskaxda iyo/ama xudunta laf dhabarta, qiyaaso dheeri ah ayaa sidoo kale loo baahan yahay. Tignoolajiyada shucaaca ee laf dhabarta oo dhan maskaxda oo dhan waa tignoolajiyada shucaaca oo leh kala duwanaansho shucaac weyn ah, taas oo u baahan isocenters badan iyo goobo badan, waxayna u baahan tahay saxnaan sare oo meelaynta, qorshaynta, iyo meelaynta. Naqshadaynta qorshaha guud ahaan waxay isticmaashaa 6MV Raajooyin. Sababtoo ah aagga bartilmaameedka dheer, habka naqshadeynta guud ahaan wuxuu u baahan yahay saddex xarumood oo siman: maskaxda iyo xarumaha maskaxda, xarumaha ilmo-galeenka iyo dhuunta, iyo xarumaha dhuunta iyo caloosha. Si kastaba ha ahaatee, shucaaca dhaqameed si wax ku ool ah uma xakameyn karo dhammaan unugyada kansarka. Sababta ugu weyn ayaa ah in meesha buradu aad u qoto dheer tahay, qoto dheer ee shucaaca ugu badan ee burada waa 3 cm oo kaliya, unugyada burooyinka ayaa aad ugu adkeysanaya daaweynta shucaaca dhaqameed, burada ayaa caadi ahaan u nugul shucaac dhaqameed. Nudaha ayaa ku wareegsan, buradana si wax ku ool ah looma xakameyn karo.
Protons waa qaybo la dallacay. Inta ay sii bataan ion-yadu, waa ay sii weynaataa saamayntooda bayooloji. Cufkoodu waa qiyaastii 1836 jeer cufka elektarooniga. Wareejintooda tamartu waxay si rogan u dhigantaa labajibbaaran ee xawaaraha dhaqdhaqaaqa proton-ka. Luminta tamarta waxay ku dhowdahay dhammaadka xadka. Waa kan ugu sarreysa ee Bragg (oo lagu magacaabo ka dib markii uu soo saaray, ku guuleystay abaalmarinta Nobel ee Jarmalka William Henry Prague), qiyaasta ka dib marka ugu sarreysa Bragg waa eber, nabarkuna waxaa la dhigaa aagga ugu sarreeya inta lagu jiro daaweynta, taas oo heli karta saamiga faa'iidada daaweynta sare. .
First, daaweynta proton waa nooc ka mid ah shucaaca dibadda oo isticmaalaya shucaaca ionizing. Inta lagu jiro daawaynta, dardar-geliyaha walxaha ayaa burada ku iftiimiya buro borotoon ah. Qaybahaan la dacweeyay waxay sababaan jebinta hal-xadhigle ee DNA-da, waxay burburiyaan DNA-da unugyada burooyinka, waxayna ugu dambeyntii sababaan unugyada kansarka inay dhintaan ama farageliyaan awooddooda inay tarmaan. Heerka qaybsanaanta sare ee unugyada kansarka iyo hoos u dhaca awoodda hagaajinta DNA-da dhaawacan ayaa DNA-da si gaar ah ugu nugul weerar.
Marka labaad, astaamaha qiyaasta ee borotoonada:
1) Waxqabadka dhexgalka ee xoogga leh: Tamarta loo yaqaan 'Proton energy' waa la waafajin karaa iyadoo loo eegayo meesha iyo qoto dheer ee dhaawaca, sidaas darteedna dogobka barafku wuxuu gaaraa meel kasta oo qoto dheer oo ah bina-aadamka;
2) Waxyeellada unugyada caadiga ah way yar yihiin: qiyaasta horudhaca nabarku way hooseysaa, qiyaasta gadaal waa eber, mugga unugyada caadiga ahna waa la dhimay;
3) Qiyaasta sare ee aagga la bartilmaameedsanayo: Faafidda heerka sare ee loo yaqaan 'bragg peak (SOBP)' waxaa laga helaa iyada oo loo marayo ballaarinta Bragg peak, sidaa darteed nabarku wuxuu ku yaal aagga ugu sarreeya ee SOBP, taas oo markaa laga helayo qadar sare aagga la beegsanayo
4) Kala firdhinta dhinaca hoose: Caddadka badan ee borotoonada awgeed, waxaa ku yar kala firdhinta maaddada, sidaa darteed qiyaasta irradiation ee unugyada caadiga ah ee ku hareeraysan ayaa hoos u dhacaya.
Saddexaad, firfircoonaanta tamarta
Si loo daaweeyo burooyinka qotada dheer, xawaaraha loo yaqaan 'proton accelerator' waa inuu bixiyaa aaladda loo yaqaan 'proton beam' oo tamar sare leh, burooyinka dusha sarena waxaa loo adeegsadaa dogob tamarta hooseeya. Dardar-geliyeyaasha daaweynta Proton waxay caadi ahaan soo saaraan laydhadhyo proton leh tamar u dhexeysa 70 iyo 250 megaelectron volts (MeV). Adoo hagaajinaya tamarta protonka inta lagu jiro daweynta, fallaadhaha protonku wuxuu kordhin karaa dhaawaca unugyada burooyinka. Cadka oo u dhaw dusha jidhka marka loo eego buro waxa la siiyaa qiyaas yar oo shucaac ah sidaa darteedna dhaawac yar. Unugyada qotada dheer ee jidhka bini'aadamka si dhib leh looma bandhigo.
4. U ekaanshaha sare ee shucaaca burooyinka

Daaweynta mindida 'Proton'

Daaweynta shucaaca ee loo yaqaan 'proton-knife radiotherapy' casriga ah ayaa isku daraya 3D-CRT iyo tiknoolajiyadda IMRT si loo gaaro is waafajinta shucaaca burooyinka sare. Daaweynta shucaaca ee loo yaqaan 'Proton xoojinta' ee loo yaqaan 'radiotherapy' (IMPT) ayaa isku dhafan tiknoolajiyad buuxda oo ah 3D-CRT iyo tiknoolajiyada IMRT, samaynta shucaaca daawada ee loo yaqaan 'proton radiotherapy' ayaa lagu gaarayaa iswaafaqsanaanta ugu sareysa ee shucaaca burooyinka ilaa maanta, iyo qiyaasta unugyada caadiga ah ee ku hareeraysan burooyinka ayaa si weyn loo yareeyay.

Sidaa darteed, marka la barbar dhigo shucaaca caadiga ah, daaweynta mindida proton waxay leedahay astaamo jidheed iyo bayooloji oo wanaagsan, waxayna leedahay qiyaas shucaac ku filan si ay u gaarto burooyinka qaybaha qoto dheer ee jirka. Ionyada culus iyo proton -ku waxay gaari karaan unugyada 30 cm qoto dheer maqaarka hoostiisa, taas oo si weyn u hagaajinaysa awoodda lagu xakameeyo burada; marka la barbardhigo hababka shucaaca dhaqameedka, tamarta shucaaca ee gaareysa goobta burada ayaa si weyn loo kordhin karaa (mindida proton waxaa lagu kordhin karaa 20%), taas oo si weyn u yareyneysa cirifka burada. Waxyeellada iyo waxyeellada unugyada caadiga ah; yaree sunta unugyada caadiga ah iyada oo si isku mar ah loo isticmaalo daaweynta shucaaca iyo kiimoterabi; si weyn u gaabinaysa muddada daaweynta iyada oo kordhineysa qiyaasta shucaaca maalinlaha ah; yaree dhacdooyinka burooyinka asaasiga ah ee labaad.

 

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