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Yini engcono kwi-medulloblastoma - i-radiotherapy yendabuko noma i-proton therapy?

Yini engcono kumedulloblastoma - i-radiotherapy yendabuko noma i-proton therapy? Ukwelashwa kwe-Proton ekwelapheni i-medulloblastoma. Izindleko zokwelashwa kwe-proton ekwelapheni kwe-medulloblastoma.

Yabelana ngalokhu okuthunyelwe

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 isisu 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 i-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.
Njengoba ama-medulloblastomas amaningi enzeka ezinganeni futhi ezwela kakhulu emisebeni, ukwelashwa ngemisebe kungenye yezindlela ezisemqoka ekwelapheni ama-medulloblastomas. Izingane zisesigabeni sokukhula nentuthuko, ukwelashwa ngemisebe kubangela ukulimala ekukhuleni kwezingane, endocrine nasekuhlakanipheni. Njengamanje, i-radiotherapy enezinhlangothi ezintathu noma i-radiotherapy enamandla kakhulu isetshenziselwa ukunciphisa umthamo wemisebe yobuchopho, indlebe yangaphakathi, i-lobe yesikhashana, isifunda se-hypothalamus-pituitary, nendlala yegilo, nendawo yangaphakathi ye-cranial fossa floor sieve plate plate uzimisele ukuthola umthamo owanele. Imisebe. Isiza semisebe sasikhanyiselwa ubuchopho bonke, umgogodla wonke kanye ne-posterior cranial fossa.
Umthamo we-radiotherapy yendabuko: ubuchopho bonke kanye nomgogodla wonke ngokweqembu lengozi, umthamo wokuvimbela imisebe ngu-1.8Gy / isikhathi, inani eliphelele lingu-30-36Gy, iqembu elisengozini enkulu yi-36Gy, kanye ne-posterior cranial fossa zishintshiwe zaba ngu--55.8 Gy. Uma kukhona i-gross metastasis kuzicubu zobuchopho kanye / noma umgogodla, imithamo eyengeziwe nayo iyadingeka. Ubuchwepheshe be-irradiation yobuchopho obuphelele bomgogodla ubuchwepheshe be-radiotherapy enobubanzi obukhulu bokushiswa kwemisebe, obudinga ama-isocenter amaningi kanye nezinkambu eziningi, futhi kudinga ukunemba okuphezulu ekumiseni, ekuhleleni, nasekubekeni. Idizayini yohlelo ngokuvamile isebenzisa i-6MV X-ray. Ngenxa yendawo ehlosiwe ende, inqubo yokuklama ngokuvamile idinga izikhungo ezintathu ezilinganayo: izikhungo zobuchopho nobuchopho, izikhungo zomlomo wesibeletho kanye ne-thoracic, kanye nezikhungo ze-thoracic nesisu. Nokho, i-radiotherapy yendabuko ayikwazi ukulawula ngempumelelo wonke amangqamuzana omdlavuza. Isizathu esiyinhloko ukuthi indawo yesimila ijule kakhulu, ubukhulu bemisebe yokujula kwesimila bungamasentimitha amathathu kuphela, amangqamuzana esimila amelana kakhulu neradiotherapy yendabuko, futhi isimila ngokuvamile siyazwela emisebeni evamile. Izicubu zizungezwe futhi isimila asikwazi ukulawulwa ngempumelelo.
Ama-proton ayizinhlayiya ezishajiwe. Uma ama-ion emakhulu, kuba mkhulu umthelela wawo webhayoloji. Ubukhulu bawo bucishe buphindwe izikhathi ezingu-1836 ubukhulu bama-electron. Ukudluliswa kwawo kwamandla kuhambisana ngokuphambene nesikwele sejubane lokunyakaza leproton. Ukulahlekelwa kwamandla kuseduze nokuphela kobubanzi. Nansi i-The Bragg peak (eqanjwe ngomtholi wayo, owawina uMklomelo KaNobel waseJalimane uWilliam Henry Prague), umthamo ongemva kwe-Bragg peak unguziro, futhi isilonda sibekwe endaweni ephakeme kakhulu ngesikhathi sokwelashwa, esingathola isilinganiso esiphezulu sokuzuza kokwelashwa. .
Okokuqala, ukwelashwa kweproton uhlobo lwemisebe yangaphandle esebenzisa imisebe ye-ionizing. Ngesikhathi sokwelashwa, i-accelerator ye-particle igcwala i-tumor ngogongolo lwama-proton. Lezi zinhlayiya ezikhokhisiwe zidala ukugqashuka kwentambo eyodwa ku-DNA, kubhubhise i-DNA yamangqamuzana wesimila, futhi ekugcineni kubangele ukuthi amangqamuzana anomdlavuza afe noma aphazamise amandla awo okuzala. Izinga eliphakeme lokuhlukaniswa kwamangqamuzana anomdlavuza kanye namandla ancishisiwe okulungisa i-DNA elimele enza i-DNA yawo isengozini yokuhlaselwa.
Okwesibili, izakhiwo ze-dosimetric zamaprotoni:
1) Ukusebenza kokungena okuqinile: Amandla we-Proton angashintshwa ngokuya ngendawo nokujula kwesilonda, ukuze ugongolo lwe-proton lufinyelele kunoma yikuphi ukujula komzimba womuntu;
2) Ukulimala okujwayelekile kwezicubu kuncane: umthamo ophambi kwesilonda uphansi, umthamo ngemuva unguziro, futhi ivolumu ejwayelekile yezicubu iyancipha;
3) Umthamo ophakeme endaweni eqondiwe: Spread out bragg peak (SOBP) itholakala nge-Bragg peak, ukuze isilonda sitholakale endaweni ephakeme kakhulu ye-SOBP, ngaleyo ndlela sithole umthamo ophakeme endaweni eqondiwe
I-4) Ukusakazeka kohlangothi oluphansi: Ngenxa yobuningi obukhulu bama-proton, kuncane ukusabalala kokuqukethwe, ngakho-ke umthamo we-irradiation wezicubu ezijwayelekile ezizungezile uyancipha.
Okwesithathu, amandla we-proton energy
Ukuze welaphe izicubu ezijulile, i-proton accelerator kumele ihlinzeke ngogongolo lwe-proton yamandla aphezulu, kuthi kwizicubu ezingaphezulu kusetshenziswe umuthi we-proton low-energy. Ama-accelerator therapy we-Proton ngokuvamile akhiqiza imishayo ye-proton enamandla phakathi kwama-megaelectron volts angama-70 kuya kwangu-250 (MeV). Ngokulungisa amandla we-proton ngesikhathi sokwelashwa, ugongolo lwe-proton lungenza kakhulu umonakalo kumaseli wesimila. Izicubu eziseduze nobuso bomzimba kunokuba isimila sithola imithamo ephansi yemisebe ngakho-ke umonakalo omncane. Izicubu ezijulile zomzimba womuntu azivezwa neze.
4. Ukuhambisana okuphezulu kwe-tumor irradiation

Ukwelashwa kommese we-Proton

I-proton-knife radiotherapy yanamuhla ihlanganisa ubuchwepheshe be-3D-CRT kanye ne-IMRT ukufeza ukuvumelana okuphezulu kwesimila se-radiotherapy. I-Proton intension modulated radiotherapy (IMPT) ihlanganisa iqoqo eliphelele lobuchwepheshe be-photon 3D-CRT kanye ne-IMRT, okwenza i-proton radiotherapy ifinyelele ukuvumelana okuphezulu kakhulu kwe-tumor irradiation kuze kube manje, futhi umthamo wezicubu ezijwayelekile ezizungeze isimila wehliswe kakhulu.

Ngakho-ke, uma kuqhathaniswa ne-radiotherapy ejwayelekile, ukwelashwa ngommese we-proton kunezimpawu ezingcono zomzimba neziphilayo, futhi kunomthamo wemisebe owenele ukufinyelela izicubu ezingxenyeni ezijulile zomzimba. Ama-ion asindayo nama-proton angafinyelela kwizicubu ezijule ngamasentimitha angama-30 ngaphansi kwesikhumba, okuthuthukisa kakhulu ikhono lokulawula isimila; uma kuqhathaniswa nezindlela zemisebe yendabuko, amandla emisebe afinyelela endaweni yesimila angakhuphuka kakhulu (ummese we-proton ungakhuphuka ngama-20%), okunciphisa kakhulu ukutholakala kwesimila. Ukulimala nemiphumela emibi yezicubu ezijwayelekile; ukunciphisa ubuthi bezicubu ezijwayelekile ngokusetshenziswa kanyekanye kwe-radiotherapy kanye ne-chemotherapy; nciphisa kakhulu inkambo yokwelashwa ngokwandisa umthamo wemisebe yansuku zonke; ukunciphisa izehlakalo zezimila zesibili eziyinhloko.

 

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