Proton radiation ndiyo yakagadziridzwa yehutachiona inowanikwa pakuzivikanwa kwekurapa kenza yeprostate. Varume vari kufunga nezveproton radiation vanoda kuenzanidza nekuipikisa iyo nemamwe marudzi ose emararati kuti aone kana chirwere cheproton chinobatsira ivo nekuda kwemaitiro avo chaiwo.
Nzira yakazara yeproton radiation inoda kurapa shanu kwevhiki kwevhiki masere kana mapfumbamwe inotevera.
Pose pavanoshanyira, varwere vakamira pamberi pebasa risingaoneki reprotoni rinotarisa prostate gland.
Proton vs. Photon Radiation
Proton radiation yakasiyana nedzimwe mhando dzemahara , izvo zvinotsigira photons. Photon radiation inouya mumhando mitatu: yakasimba modulated radiation therapy (IMRT), radiactive mbeu yemazuva ano (brachytherapy), uye stereotactic radiation therapy body (SBRT). Dzimwe nguva kubatana kwechirchytherapy pamwe chete nedzimwe mimwe mienzaniso yemirairi yakashandiswa inoshandiswa.
Mhando dzose dzemazuva ano dzinoshanda, zvichiguma nekufa kwekenza masero. Zvose zvinogona kukonzera migumisiro yechirwere, kana miviri inobata pedo nhengo dzomuviri dzakadai, shanje, rectum, uye urethra.
Dambudziko reErectile Dysfunction
Kusvika parizvino nyanzvi haakwanisi kubvumirana kuti rumwe ruvara rwemazuva ano runopfuurira kune mamwe ose. Zvisinei, zvichienderana nemhando dzakasiyana dzemamiriro ezvinhu ayo varwere vanotarisana nawo, imwe nzira yerapi inogona kuva nezvakanaka kune vamwe.
Zvose zvingasarudzwa, kana zvichisunungurwa navanachiremba vane ruzivo, vanobudirira kurapa mazinga uye vane zvishoma zvisingagumi zvisingagumi-kunze kwengozi ye erectile dysfunction (ED).
Dambudziko rekusingaperi ED-rinotsanangurwa seD ED risingabvumiri kuViagra kana mishonga yakafanana-inenge 50 muzana nemhando dzose dzemahara.
Dambudziko iri rakanyanya kune varume vakwegura uye nevarume vane urombo hwepabonde hwepabonde. Ngozi inononoka kune varume vaduku uye kana kuita zvepabonde zvepreexist zvakanaka. Chirwere chemahara-induced ED chinoshanda asi chisina kusimba, uye chinoda kana jekesheni ye prostaglandin mupenisi kana kushandiswa kwepurojekiti yakagadzirwa.
Pasi pepamusoro, kunyange zvazvo ED mushure memazuva mashoma, haisi kuonekwa sechinhu chinogadzirisa pakusarudzwa kwemarudzi mamwe emirairo pane imwe. Ichi ndechokuti njodzi yeDD yakangofanana nemhando dzose dzehutachiona. Kuenzanisa kusarudzwa kwemahara, naizvozvo, kunobva pane zvimwe zvinhu zvakadai sekurapa mitero uye chiitiko chezvinetso zvekuvira kana rectal.
Ngozi yeRectal Burns
Nhoroondo yekare, achishandisa teknolojia yekare yakakura, rectal inopisa kubva pamagetsi yakawanda uye inogona kuparadza. Iye zvino munguva ino yemazuva ano, nekuda kwe nzira dzakanakisisa dzekutsvaga, zvakakomba zvikafu zvinopisa zvakave zvisingawanzoitiki. Parizvino, ose mana mavara emishonga (proton radiation, IMRT, brachytherapy uye SBRT) ane ngozi yakafanana (1 kusvika ku2 muzana) yezvinetso zvekare kwenguva refu.
Pane zvipfeko zviviri kune izvi. Kutanga, zvimwe asi kwete zvidzidzo zvose zveSBRT zvinoratidza kuti inogona kuva nehuwandu hwepamusoro hwekutsvaira kwemashure kune humwe hutatu husarudzo, pangozi mu3 kusvika ku4 muzana.
Chechipiri kunze kwe "yekare-kare" proton rairo. Imwe midziyo yakakura yeproton inoburisa danda rakakura remirairo, iyo inowanzoita kuti kuve nemirairo "overspray" mu rectum. Mazuva ano proton radiation, inonzi yakasimba modulated proton therapy (IMPT) inoshandiswa uchishandisa mapurisa maduku, akafanana zvikuru nemhando ye teknolojia inoshandiswa mukuendesa IMRT. Zvose IMPT uye IMRT zvinogona kugadzira "mashizha" emasvingo emvura anogona kuumbwa kuti abate zvakanyanya pedyo nemiganhu yakakwana ye prostate gland. Izvi zvinokonzera kuwandisa kwemazuva akawanda pamusoro penzira uye naizvozvo panjodzi yakaderera yekuparara kwemashure.
Gel Kuvhara Rectal Burns
Chimwe chemazuva ose chinopisa hachiwanzovi, asi chinogona kukanganisa zvikuru, zvichikonzera marwadzo, kubuda ropa, uye kurasikirwa kwemashure. A revolutionary teknolojia inonzi SpaceOAR inobatsira zvikuru kuderedza ngozi yekutsvaira zvakanyanya kusvika ku rectum. SpaceOAR hydrogel inoshandiswa pakati peprotate gland uye rectal rusvingo uye inoramba iri panzvimbo nguva yose yemayera. Hyrogrogel inofambisa rusvingo rwemasango kubva kune prostate gland uye kunze kwemasango erima. Nokudaro, njodzi yekudzivirira kwemazuva kusvika kune rectum inenge yabviswa.
Dambudziko reMidhi-Rakaita Kuti Matambudziko Aunogara Awedzere
Zvinetso zveUrinary mushure memasikati zvinosanganisira marwadzo panguva yekuzorora, kukurumidza kwekuvhota, uye kumuka usiku kazhinji kuti urinate. Ngozi yezviratidzo mushure mekuwedzera kwemazuva ano kuwedzera kune varume vane zvinetso zvekuvhenekera uye nevarume vane hukuru hwema prostate.
Ngozi yezvinetso zvekuvhenekera inowedzerwa kana mbeu inoshandiswa. Ichi ndechokuti chiyero chemazuva ose chakakonzerwa nembeu chakakwirira. Nhengo yehutachiona , iyo yerineni inotakura urinho kubva kumukati kuenda kunze kunze kwepenisi, inotarisana nepakati peprotate. Saka, kushungurudzika kwenguva pfupi panguva yemirairo uye pakarepo mushure memazuva akazara pakati pezvose zvinosarudzwa.
Nenguva refu zviratidzo zvekuvhenekera zvinowanikwa mu10 muzana kana zvakadaro zvevarume vane mbeu dzemazai. Nenguva refu zviratidzo zvekuvhenekera zvinogona kuitikawo nezvimwewo zvingasarudzwa, asi zvishoma ne5 kubva muzana zvevarwere, vachifunga kuti havana zvipembenene zvakakura kana kuti chiremba chakanaka chepreexisting urinary problems. Mishonga yekudzivirira zviratidzo izvi zvekare kwenguva refu inowedzera. Pane chimiro chekugara kwenguva refu zviratidzo zvishoma nezvishoma kuvandudza, kunyange zvazvo kuwedzerwa kukuru kunogona kusati kwaitika kwemakore akawanda.
Kakawanda, kunze kwezvimwe zviduku zvataurwa pamusoro apa, njodzi yekuvhenekera uye yemigumisiro yemigumisiro yakafanana zvakafanana nezvose zvingasarudzwa. Izvi zvinotitungamirira kukutarisa mushonga wehutano, izvo zvinopesana zvichienderana nechirwere chekenza chirwere. Muvarume vanobvumirwa nehutachiona, zvikamu zviviri zvakadzika zvekenza yeprostate zvakatsanangurwa, "huwandu hwehutano uye" pakati-panjodzi. "
Radiation for High-Risk Cancer Prostate
Sezvo zvidzidzo zviri nani zviripo kune ngozi yakawanda, kusarudzwa kwekurapa hakusi kukakavadzana kudarika kwepakati-panjodzi. Varume vane ngozi yakawanda vanozivikanwa nezvimwechete zvinotevera:
• Girasi yeGleason ye8 kana kupfuura
• PSA ropa iri kupfuura 20
• Chirwere chemadhini chechidimbu chinoratidza chirwere chikuru kana kenza kunze kweprostate
Nechirwere chakaipa kwazvo, nyanzvi dzinokurudzira "zvose kunze" nzira yekurapa. Sezvakataurwa pamusoro apa, mbeu yehutachiona inopa mizinga yakakura yemirairo kana ichienzaniswa nezvimwe zvinosarudzwa. Chirwere chepamusoro chinowedzera mushonga wehutano. Chidzidzo chikuru chinonzi ASCENDE-RT chirwere chechipatara chinogutsa izvi. Chidzidzo ichi chakabudirira chichienzanisa IMRT chete ne IMRT pamwe nembeu inogadziriswa. Kubatanidzwa kwembeu pamwe ne-IMRT kwakaguma ne 20% yemapurisa yepamusoro kuenzanisa nekurapa ne IMRT chete. Sezvo zvakadaro, kubvumirana ndeyokuti mbeu yemirasi inosanganiswa ne IMRT ndiyo yakanakisisa yehudhi yevarume vane hutachiwana hwehutachiona.
Sezvo pane kuenzana kwakawanda pakati pemazuva ano emproton therapy (IMPT) uye IMRT, zvinonzwisisika kuti inotsiva IMPT (pamwe nembeu) ye IMRT pamwe nembeu yevarume vane chirwere chakanyanya ngozi. Zvisinei, kushandurana kwakadaro hakuna kumbobvumirwa mukurongwa kwekliniki. Zvichida kukanganisa uku kunokanganisa zvimwe zvinobatsira zvenyama zvinozivikanwa kuti zvinosanganiswa nema proton akaenzaniswa nehoton. Anticancer energy inotumirwa kuburikidza neproton bhitamu inomira pa prostate, ichidzikisa kupisa kwemazivi kune zvisikwa zvakasarudzwa kune rumwe rutivi rweglandu.
Kusiyana neizvi, photon rayation inopfuura yakananga mumuviri, ichiratidza huwandu huzhinji hwomuviri kuhuwandu hwemhepo. Nharo huru yekushandiswa kwema proton panzvimbo pekuita IMRT inobva pane izvi zvakagadziriswa, kuti pane kuderedzwa kwehuwandu hwemasvundu ehutachiona anowanikwa kune mazaisai.
Radiation yeCeal-Risk Prostate Cancer
Kune huwandu hwekugadzirisa hutano hwakasarudzwa nehupakati-hutachiwana chirwere. Migumisiro yakanaka yakave yakanyorwa nezvose zvingasarudzwa. Zvisinei, nyanzvi dzakawanda dzinotanga kuparadzanisa pakati-panjodzi muzvakanaka uye zvisina kunaka subtypes. Kushandisa urongwa uhwu, varume vane chikamu chakanaka chinofanira kusangana nezvose zvinotevera:
• Gleason 3 + 4 (pane Gleason 4 + 3)
• Ndeviri chete kana vatatu chete yebiopsy cores zvachose ine kenza
• PSA yepamusoro yehutachiwana inopfuura gumi
• Kana chiremba achinzwa mutsvuku, zvishoma uye zviripo
Nechinangwa chemukati-kati, zvose zvingasarudzwa-mbeu, SBRT, IMRT, uye proton (IMPT) mazaisai-angava anonzwisisika. Varume vane zvipembenene zvikuru zve prostate, vanopfuura 60 cc kusvika ku80 cc, somuenzaniso, kana varume vane chirwere chakawandisa chepreexisting urinary zviratidzo, vanotarisana nehuwandu hwehutano hwehutano hwekuvhenekera nemirairo uye inofanira kunge yakasarudza SBRT, IMRT kana IMPT . Kana SpaceOAR hydrogel inoshandiswa kuchengetedza kukanganisa kwemaitiro akadai, SBRT isarudzo inofadza pamusoro pe IMRT uye mazai eproton, sezvo nhamba yekutarisirwa kunoshandiswa kurapwa yakanyanya kudarika neSBRT yakaenzaniswa ne IMRT uye chirongwa cheproton.
Kusafarirwa pakati pepakati-panjodzi yekenza yekenza inochengetedza maitiro ehupakati-pangozi (Gleason 7, PSA kubva pa10 kusvika ku20 kana kuti kuenzanisira prostate nodule) asi inokundikana kugadzirisa zvirongwa zvakanyanya zvakataurwa pamusoro apa kuti zvive zvakanaka pakati pengozi. Mienzaniso ndeyekuti: Gleason 4 + 3, varume vane zvinopfuura imwechete-mungozi uye varume vane multiple biopsy cores vane kenza. Izvi zvinoratidza rudzi rwechirwere chingave chinotyisa. Nokudaro, kurapa kunofanira kuva kusanganiswa kweMMTT (kana IMPT) pamwe nembeu inogadziriswa. Iyi nzira inogona kuoneka yakafanana neyakakurudzirwa pamusoro apa nokuda kwezvirwere zvakanyanya. Pane, asi zvakadaro, kusiyana kukuru-nzira iyo hormonal therapy inoshandiswa.
Hormonal therapy inotarisirwa kuti varume vose vawane mazaisai kunze kwevarume vane mukana wepakati-kati. Kazhinji, muLupron kana mishonga inonzi Lupron inotanga mwedzi miviri isati yasvika uye inoenderera mberi panguva yemirairo. Varume vane dambudziko risina kunaka pakati pemazuva ano vanopfuurira hormonal therapy kwemwedzi mitanhatu. Varume vane ngozi yakawanda vanopfuurira kwenguva yakareba, vachimira shure kwemwedzi 18. Chidzidzo chakamanikidzirwa chakabudiswa muNew England Journal of Medicine chinoratidza zvakare kuti rudzi rwakasimba rwemishonga inonzi hormone inonzi Zytiga inofanira kuendeswa pamwe chete neLupron kune varume vane ngozi yakawanda.
Proton Therapy Makomborero uye Matambudziko
Proton radiation inogona kureva kuwedzera kwekuwedzera pane IMRT nekuda kwekuderedza kuderedzwa kwezvinhu zvakapoteredza mishonga yemuviri kusvika pamasana. Saka, mumamiriro ezvinhu akataurwa pamusoro apa iyo IMRT inowanzotaridzirwa, varume vangasarudza kusarudza proton miriyoni pamusoro pe IMRT. Izvo zvinonzi zvinobatsira zvema proton magetsi pamusoro pe IMRT zvinoramba zvidzidzo uye zvisingagoneki muchipatara. Hapana musoro kune zvidzidzo zvepamusoro kuenzanisa IMRT uye mazaisai eproton.
Kukanganiswa kunoitwa neproton radiation yakabatana nemari yakakwirira uye kuti iyo isiri iyo mapurogiramu epurashumo anofukidza proton rayation. Mukuwedzera, kune nzvimbo shomanana dzinoita proton radiation, saka kusagadzikana kwenyika kunogona kuve chinhu chikuru chichifunga kuti kushanyira kakawanda kunodiwa pane 5 kusvika 9-vhiki.
Varume vanoona kurapwa kwekenza yeprotate vanofanira kuita basa ravo rechikoro. Zvimwe zvinokonzerwa nemirasidzo zvinogona kusakanganiswa. Kusarudzwa kwehutano hwakanaka kunosiyana nemamiriro ekurapa. Zvinhu zvakawanda zvinoda kuongororwa apo mashizha anotsanangurwa.
> Sources:
> James, ND., Et al. "Abiraterone nokuda kwekenza yeprostate yakanga isati yabatwa nehomoni inorapa." New England Journal of Medicine (2017).
> Morris, JW, et al. "Androgen Kuchengeta Kunobatanidza Nekusarudza Nodal uye Dose Escalated Radiation Therapy (iyo ASCENDE-RT Yakaedzwa): Kuongorora kwekupedzisira kwekupedzisira kwekuenzanisa kwekuenzanisa kuenzaniswa kwechirwere chezinga-chechi brachytherapy kukusimudzira kukura kwechimbichimbi chekunze kwepamusoro-uye kenza yepamusoro-panjodzi yepabonde. " International Journal of Radiation Oncology * Biology * Physics 98.2 (2017): 275-285.
> Zelefsky, MJ., Et al. "Kubudirira kweSildenafil muromo muvarwere vane erectile dysfunction mushure me radiotherapy ye carcinoma ye prostate." Urology 53.4 (1999): 775-778.