I-proton imisebe yindlela ephuculweyo yokuphuphuma kwemisebe ekuthandweni kwonyango lomhlaza wesibeletho. Amadoda acingisisa ngemitha yeproton kufuneka adibanise kwaye ahluke ngayo kunye nezinye iindidi zemimiselo ukuze aqinisekise ukuba unyango lweproton luncedo kubo ngenxa yeemeko ezithile.
Ikhosi epheleleyo ye-proton idiza ifuna unyango lwezilwanyana ngeveki eziqhubekayo kwiiveki ezisibhozo okanye ezithoba ezilandelelanayo.
Ngethuba lokutyelela ngamnye, izigulane zimi phambi kwebala elingabonakaliyo leeprotoni ezijolise kwi-prostate gland.
IProton kunye nePoton Radiation
Iproton radiation ihluke kwezinye iindidi zemisebe, ezithembele kwi-photons. I-radion ye-Photon ivela kwiintlobo ezintathu: i-radiation moderation (radiation radiation), i-brachytherapy, kunye ne-stereotactic radiation body (SBRT). Ngamanye amaxesha udibaniso lwe-brachytherapy ngokubambisana nenye yezinye iintlobo zeemitha zethambile zisetyenziswa.
Zonke iindidi zemizila ye-radiation zisebenza kakuhle, ezibangelwa ukufa kweeseli zomhlaza. Zonke zinokubangela iziphumo zecala, ukuba i-radiation ichukumisa izitho eziqhelekileyo ezinje, njenge-bladder, rectum, kunye ne-urethra.
Ingozi ye-Erectile Dysfunction
Okwamanje iingcali azikwazi ukuvuma ukuba uhlobo oluthile lweemitha-mpahla luhlala lugqithisa bonke abanye. Nangona kunjalo, kuxhomekeka kwiintlobo ezahlukeneyo zeemeko ezijongene nezigulane, olunye uhlobo lweyeza lunokuba luncedo ngaphezu kwabanye.
Zonke iinketho, xa zithunyelwa ngamagqirha anamava, ukufezekiswa kwamazinga okunyanga okulungileyo kwaye zinemivuzo embalwa engapheliyo-ngaphandle ko mngcipheko we- erectile dysfunction (ED).
Umngcipheko we-ED ochazwe njenge-ED awuphendulanga kwi-Viagra okanye iziyobisi ezifanayo-malunga neepesenti ezingama-50 kunye nazo zonke iintlobo zemitha.
Umngcipheko uphakamileyo kumadoda amadala kunye namadoda anesifo sengqondo sokuziphatha ngokwesini. Umngcipheko ungaphantsi kumadoda amancinci kwaye xa umsebenzi wezesondo uhamba kakuhle. Utyando lwe-ED eyenziwe nge-radiation lusebenza kakuhle kodwa aluveli, kwaye lufuna ukuba injola ye-prostaglandin ibe yipenis okanye ukufakelwa kwe-prosthetic surgically-placed.
Eyona nto, nangona i-ED emva kwemisebe iqhelekileyo, ayithathwa njengento ebalulekileyo ekukhethweni kolunye uhlobo lwemibala emzimbeni kwenye. Oku kungenxa yokuba umngcipheko we-ED unye kunye nazo zonke iintlobo zemitha. Ukuqhathaniswa nokukhethwa kwee-radiation, ngoko, kuxhomekeka kwezinye iimeko ezifana neerhafu zonyango kunye neziganeko zeengxaki zesantya okanye iingxaki.
Umngcipheko weBurnal Burns
Ngokomlando, ukusebenzisa iteknoloji ye-radiation endala, ukutshiswa kwamaritha okuvela emisebeni yinto eqhelekileyo kwaye inokuba yingozi. Ngoku kule nkwenkwezi yanamhla, ngenxa yeendlela ezibhetele zokujolisa, ukutshiswa komlilo okuqhelekileyo kuye kwavakala kakhulu. Okwangoku, zonke iindidi ezine ze-radiation (i-proton rayation, i-IMRT, i-brachytherapy kunye ne-SBRT) inomlinganiselo ofanayo (1 ukuya ku-2 ekhulwini) ingozi yeengxaki zamaritha ezide.
Kukho imibini emibini kulo mbandela. Okokuqala, ezinye iingazi zifundo ze-SBRT zibonisa ukuba kunokuba nomngcipheko ophezulu wokutshisa emzimbeni kunokuba kukho ezinye iindlela ezintathu, umngcipheko kwi-3% ukuya kwi-4 yeepesenti.
Ukwahlula okwesibini "imitha yasendulo" imitha yeproton. Isixhobo seproton esidala sikhululela umbhobho omkhulu wombane, okhangela kakhulu umbane othi "overspray" kwi-rectum. I-proton rayation yamanje, ebizwa ngokuba yi-proton ye-proton yonyango (IMPT) ihanjiswa ngokusebenzisa iipelisi ezincinci, ezifana nezobuchwephesha ezisetyenziselwa ukuhanjiswa kwe-IMRT. Zombili ii-IMPT kunye ne-IMRT zingenza insimu ye-radiation "ephihliweyo" engayilwa ukuze ilandelelene ngokusondeleyo kwimida engumda we-prostate gland. Oku kubangela ukuba kubekho i-radiation overspray engaphantsi kwaye ngoko ke umngcipheko ophantsi wokulimala komzi.
I-Gel Ukukhusela Ukushisa Okubalulekileyo
Ukutshiswa komhlaba wonke kungabonakali, kodwa kunokuba kunzima kakhulu, okubangelwa intlungu, ukuphuma kwegazi kunye nokulahleka kolawulo lwama-rectal. Ubuchwepheshe bobuchwepheshe obubizwa ngokuba yi-SpaceOAR buyanciphisa kakhulu umngcipheko wokutshisa okukhulu kwi-rectum. I-SpaceOAR hydrogel ifakwe phakathi kweprotate gland kunye nodongeni lwamabala kunye kwaye ihlala kwindawo yonke kwimizuzu. I-hydrogel ishukumisela udonga oluxakile kude ne-prostate gland kunye nommandla we-radiation. Ngaloo ndlela, umngcipheko wokutshiswa komlilo kwi-rectum usuphelile.
Umngcipheko we-Radiation-Yenza iingxaki ze-Urinary
Iingxaki ze-Urinary emva kokuba i-radiation ziquka intlungu ngexesha lokuchama, ukuphuthuma kwamanzi okuvuthwa, nokuvuswa ebusuku ngokukhawuleza ukuza. Umngcipheko weempawu emva kokuba i-radiation yanda kumadoda aneengxaki zokungena emanzini kunye namadoda anesifo esithile esikhulu se-prostate.
Umngcipheko weengxaki ze-urinary zandisiwe xa kusetyenziswa izilwanyana. Oku kungenxa yokuba i-dose epheleleyo yemirhumo ehanjiswa yimbewu iphezulu. I-urethra, ibhokisi lokuvuthwa elithwala umchamo kwi-bladder yangaphandle nge penis, ihamba ngqo phakathi kweprotrate. Ngoko ke, ukucaphukisa okwethutyana ngexesha le-radiation kunye nangoko emva kwemisebe kuqhelekileyo phakathi kwazo zonke iindlela.
Iimpawu ze-urinary ezide zenzeke kwipesenti ezili-10 okanye ngoko amadoda aphethe izilwanyana zembewu. Iimpawu zexesha lokuhlala emininzi ziyakwenzeka kunye nezinye iindlela, kodwa zingaphantsi kwama-5 eepesenti zezigulane, becinga ukuba azinayo iingqungquthela ezinkulu okanye iqondo eliphawulekayo leengxaki zokuvuthwa. Amachiza okuchasene nale mpawu yexesha elide i-urinary ayisebenzisayo kuphela. Kukho ukuthambekela kweempawu zexesha elide ukuphucula ngokukhawuleza, nangona ukuphuculwa okubalulekileyo kungenakwenzeka kwiminyaka emininzi.
Ngokubanzi, ngaphandle kwemibandela encinci echazwe ngasentla, umngcipheko weempembelelo ze-urinary kunye neeriteli zifana nezo zonke iinketho. Oku kusikhokelela ekujonganeni nemilinganiselo yokunyanga, eyahluka ngokuxhomekeka kwisigaba somhlaza wesigulane. Kwimadoda abaviwa be-radiation, izigaba ezibini zomhlaza wesi-prostate ziye zachazwa, "ingozi enkulu kunye" nomngcipheko ophakathi. "
I-Radiation ye-Can-Risk Prostate Cancer
Ekubeni uphando olungcono lukhona ngenxa yengozi enkulu, ukhetho lwezokwelapha aluphikisana kakhulu kunokuba lube ngumngcipheko ophakathi. Amadoda anomngcipheko ophezulu abonakaliswe ubuncinane ngenye yezi zinto zilandelayo:
• Ibakala le-Gleason eli-8 okanye ngaphezulu
• Igalelo legazi lePSA elingaphezu kwama-20
• Uvavanyo lwe-digital rectal olubonisa i-tumor enkulu okanye umdlavuza ngaphandle kweprotate
Ngenxa yezifo ezinobungozi obuphezulu, iingcali zincoma indlela "yokuphuma" indlela yokwelapha. Njengoko kuphawuliwe ngasentla, imirhumo yeembewu ihambisa umlinganiselo ophezulu wemitha ngokuthelekiswa nezinye iindlela. Inqanaba eliphezulu liphucula amazinga okunyanga. Ucwaningo olukhulu olubizwa ngokuba luvavanyo lwe-ASCENDE-RT lonyango luqinisekisa le nto. Uphononongo luye lwafanisa i-IMRT yodwa kunye ne-IMRT kunye ne-implant implantation. Ukudibaniswa kwembewu kunye ne-IMRT kubangele i-20% yezinga lokuphilisa eliphezulu xa kuthelekiswa nophathwe ne-IMRT yodwa. Ngaloo ndlela, ukuvumelanisa kukuba imbewu yemitha edibaniseneyo ne-IMRT yindlela efanelekileyo kakhulu ye-radiation yamadoda anesifo esiphezulu.
Ekubeni kukho ukufana okuninzi phakathi kweyonyango ye-proton (i-IMPT) kunye ne-IMRT, mhlawumbi kunengqiqo ukufaka indawo ye-IMPT (kunye nembewu) ye-IMRT kunye nembewu kumadoda anesifo esiphezulu. Nangona kunjalo, ukutshintshana okunjalo akuzange kuqinisekiswe kwilingo leklinikhi. Mhlawumbi le mpazamo iyancitshiswa ngezinye izinto ezibonakalayo ezinokuthi zidibaniswe neeponons ezifaniswe neephotons. Amandla anticancer athunyelwa nge-proton beam ishiya kwiprotate, ukunciphisa ukukhanya kweemitha kwiimpawu eziqhelekileyo kwicala elide.
Ngokwahlukileyo, imisebe ye-photon idlula ngqo emzimbeni, ibonisa inani elikhulu lomzimba kwimisebe. Ingxabano ephambili yokusebenzisa imisebe yeproton kunokuba i-IMRT isekelwe kulo mqathango, ukuba kuncitshiswe inani lezinto eziqhelekileyo zomzimba ezichazwe kumbane.
I-Radiation for Cancer Prostate Cancer
Kukho ukulungelelanisa okukhethileyo kunye nesifo esingasemngciphekweni. Iziphumo ezilungileyo zibhalwe kunye nazo zonke iinketho. Nangona kunjalo, iingcali ezininzi ziqala ukwahlula umngcipheko ophakathi kwinqanaba elincomekayo nelingathandekiyo. Ukusebenzisa le nkqubo, amadoda ane-subtype evumelekileyo kufuneka ahlangabezane nazo zonke ezi zilandelayo:
• iGleason 3 + 4 (esikhundleni seGleason 4 + 3)
• Kuphela ezimbini okanye ezintathu ze-biopsy cores ezipheleleyo eziqulethwe ngumhlaza
• Inqanaba legazi lePSA elingaphantsi kwelishumi
• Ukuba ugqirha uvakalelwa isigxina, sincinci kwaye siqulethwe
Ngomngcipheko ophakathi, zonke iinketho-imbewu, i-SBRT, i-IMRT kunye neproton (IMPT) i-radiation-iya kuba nengqiqo. Amadoda aneengqungquthela ezinkulu ze-prostate, ngaphezu kwama-60 cc ukuya ku-80 cc, umzekelo, okanye amadoda anesimo esiphezulu sokubonakalisa iimpawu zomchamo, abhekana nomngcipheko ophezulu weengxaki zokuvuthwa kwexesha elide kunye nombane kwaye kufuneka mhlawumbi ukhethe i-SBRT, IMRT okanye i-IMPT . Ukuba i-SpaceOAR i-hydrogel isetyenziselwa ukukhusela ingozi yomonakalo we-RC, i-SBRT iyona khetho ekhangayo ngaphezu kwe-IMRT kunye ne-proton imisebe, kuba inani lokutyelela unyango olufunekayo lingaphantsi kwe-SBRT xa kuthelekiswa ne-IMRT kunye neyeza-proton.
Umdlavuza ongenakunqwenela phakathi komhlaza wesifo seprotate ugcina iimpawu zomngcipheko ophakathi (iGleason 7, PSA ukususela kwi-10 ukuya kwe-20 okanye i-nodule ehambelana ne-prostate nodule) kodwa ehluleka ukuhlangabezana nemigqaliselo enemigangatho echazwe ngasentla ukuze ibe yingozi emngciphekweni ophakathi. Imizekelo yile: Gleason 4 + 3, amadoda anengxaki engaphezulu komnye kunye nabesilisa abanamaqabunga amaninzi e-biopsy anomdlavuza. Ezi zinto zibonisa uhlobo lwesifo esingaba nobudlova. Ngoko ke, unyango kufuneka ludibaniselwano lwe-IMRT (okanye i-IMPT) kunye ne-implant implantation. Le ndlela ingabonakala ifana nento ephakanyiswe ngasentla ngenxa yezifo ezinobungozi obuphezulu. Noko ke, kukho umlinganiselo omkhulu-indlela yokwelapha i-hormonal usetyenziso.
I-hormonal therapy iyadingeka ukuba bonke abantu bathole imisebe ngaphandle kwemadoda enobungozi obuphakathi. Ngokuqhelekileyo, i-Lupron okanye imithi efana ne-Lupron iqaliswe iinyanga ezimbini ngaphambi kokuba imisebe iqhutywe kwaye iqhubeke ngexesha lemitha. Amadoda anomngcipheko ongekho emgangathweni aqhubekeka unyango lwe-hormonal kwiinyanga ezili-6. Amadoda anomngcipheko oqhubekayo athatha ixesha elide, ema emva kweenyanga ezili-18. Ucwaningo olunyanzelisayo olupapashwe kwiNew England Journal of Medicine lubonisa ukuba uhlobo olomeleleyo lwamayeza e-hormone olubizwa ngokuba yiZytiga kufuneka lulawulwe ngokubambisana neLupron kumadoda anengozini enkulu.
Iproton yeTransfer Benefits and Disadvantages
I-proton imiseli ingabonisa ukuphuculwa kokwandiswa kwe-IMRT ngenxa yokunyanzeliswa okuncitshisiweyo kwezicubu zomzimba eziqhelekileyo ukuya kumbane. Ngoko ke, kwiimeko ezichazwe ngentla apho i-IMRT iza kuqwalaselwa ngokuqhelekileyo, amadoda angakhetha ukukhetha imisebe yeproton kwi-IMRT. Iimpawu ezixeliweyo ze-proton imisebe ngaphezu kwe-IMRT zihlala ziyingcali kwaye i-clinically isprovened. Akukho ntloko ukuya kwizifundo zentloko ngokuthelekiswa kwe-IMRT kunye ne-proton imisebe.
Iingxaki ezinxulumene nemitha yeproton zidibene neendleko zayo eziphezulu kunye nokuba zonke iinkqubo ze-inshorensi zibandakanya umbane weproton. Ukongezelela, kukho amaziko amancinci enza i-proton imisebe, ngoko ukuphazamiseka kweendawo ezinokuba yinto enokubangela ukuba uhambo oluninzi lufunekayo kwixesha leveki ezi-5 ukuya kwe-9.
Amadoda acinga unyango lwe-prostate umdlavuza kufuneka enze umsebenzi wesikolo. Imiphumo emibi evela kumisebe yombane ingenakuguquka. Ukukhethwa kwe-radiation ephezulu kufana nezimo zesigulane. Zininzi izinto ezifuneka ziqwalaselwe xa i-radiation icacisiwe.
> Imithombo:
> James, ND., Et al. "I-Abiraterone ngenxa yomhlaza wesifo somhlaza ongaphendulwanga ngaphambili nge-hormone unyango." I-New England Journal of Medicine (2017).
> Morris, JW, et al. "Ukunciphisa i-Androgen kunye ne-Elective Nodal kunye ne-Dose Ukuphulukiswa kwamayeza omzimba (i-ASCENDE-RT Trial): Uhlalutyo lwamaphulo okuphila olulinganisela ukulinganisa ukunyuka kwe-brachytherapy kwinqanaba elingaphantsi kwe-dose-escalated beam boost Umhlaza womhlaza wesifo seprotate. " I-International Journal ye-Radiation Oncology * I-Biology * I-Physics 98.2 (2017): 275-285.
> Zelefsky, MJ., Et al. "Ukusebenza kwe-sildenafil yomlomo kwizigulane ezinobungozi obungasebenzi emva kwe-radiotherapy ye-carcinoma ye-prostate." Urology 53.4 (1999): 775-778.