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2016 | 14 | 4 | 222–230
Article title

Możliwości zastosowania radioterapii w leczeniu nawrotu w pochwie u chorych z nowotworami narządu rodnego

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Title variants
EN
Possibilities of using radiotherapy in the treatment of vaginal recurrence in patients with uterine cancers
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EN PL
Abstracts
EN
A major problem in cancer treatment is disease recurrence, i.e. a situation in which the standard procedures turned out to be ineffective and the previously used therapy significantly limits its next use. Vaginal recurrence is found in 2.4–15% of patients with uterine cancer. For large recurrent tumors radical treatment involves surgical pelvic exenteration. However, indications for this procedure are significantly limited; in addition, it is associated with a high risk of complications and a significantly compromised quality of life. For this reason, brachytherapy and/or another course of radiotherapy are administered, which until recently were used as a further-line treatment option or as palliative care. Over the last few years extension of indications for radiotherapy and brachytherapy has been noted due to the dynamic development of new techniques for planning and conducting treatment. These allow for the irradiation of the target volume which causes radiation-related reactions that are acceptable for the patient while protecting critical organs. The introduction of new therapeutic devices allowed for the use of different treatment techniques, including intensity-modulated radiation therapy, image-guided radiotherapy, RapidArc, tomotherapy, intraoperative radiotherapy and stereotactic body radiotherapy, which contributed to a significant increase in the role of repeat radiotherapy. One needs to remember about the possibilities of systemic treatment, although it is usually palliative in nature. Brachytherapy may be considered for the treatment of recurrent disease if the lesions are located in the region of the vagina or vaginal stump or if infiltration is found in the parametria; in other situations treatment combined with external beam radiotherapy should always be considered. The choice of brachytherapy method depends on the location of the lesion and the extent of infiltration. If the infiltration is up to 5 mm deep, intracavitary brachytherapy is performed. If the infiltration is deeper, the use of interstitial brachytherapy is indicated.
PL
Jednym z poważnych problemów w leczeniu onkologicznym są nawroty choroby, czyli przypadki, w których standardowe procedury okazały się nieskuteczne, a uprzednio przeprowadzona terapia znacznie ograniczyła możliwość jej ponownego wykorzystania. Nawrót w pochwie stwierdza się u 2,4–15% chorych na nowotwory narządu rodnego. W przypadku dużych nawrotowych guzów leczenie o założeniu radykalnym jest chirurgiczne i wiąże się z wytrzewieniem miednicy. Wskazania do tego zabiegu są jednak istotnie ograniczone, a ponadto jest on obarczony wysokim ryzykiem powikłań i znacznego pogorszenia jakości życia. Dlatego wykorzystuje się brachyterapię i/lub powtórną radioterapię, do niedawna jako leczenie kolejnego rzutu albo leczenie paliatywne. W  ostatnich latach obserwuje  się poszerzenie wskazań do radioterapii i brachyterapii – ze względu na dynamiczny rozwój nowych technik planowania i realizacji leczenia, które pozwoliły na napromienianie obszarów tarczowych przy akceptowanym przez pacjenta poziomie odczynów popromiennych, a jednocześnie umożliwiły ochronę narządów krytycznych. Wprowadzenie nowych aparatów terapeutycznych pozwoliło na stosowanie różnych technik leczenia, m.in. radioterapii z modulacją intensywności wiązki, radioterapii sterowanej obrazem, RapidArc, tomoterapii, radioterapii śródoperacyjnej i radioterapii stereotaktycznej, co wpłynęło na znaczący wzrost roli powtórnej radioterapii. Należy pamiętać o możliwościach leczenia systemowego, choć na ogół ma ono charakter paliatywny. O wykorzystaniu brachyterapii w leczeniu nawrotu można pomyśleć, gdy zmiany są zlokalizowane w okolicy pochwy lub jej kikuta albo gdy naciek obejmuje przymacicza; w innych sytuacjach zawsze należy rozważyć leczenie skojarzone z radioterapią wiązką zewnętrzną. Wybór metody brachyterapii zależy od lokalizacji zmiany i wielkości nacieku. Gdy grubość nacieku wynosi do 5 mm włącznie, przeprowadza się brachyterapię dojamową; gdy naciek tę grubość przekracza, wskazane jest zastosowanie brachyterapii śródtkankowej.
Discipline
Publisher

Year
Volume
14
Issue
4
Pages
222–230
Physical description
Contributors
author
  • Katedra Onkologii iKlinika Brachyterapii, Uniwersytet Mikołaja Kopernika w Toruniu, Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy, Bydgoszcz, Polska; Zakład Radioterapii, Centrum Onkologii w Bydgoszczy, Bydgoszcz, Polska, martabiedka@tlen.pl
  • Zakład Radioterapii, Centrum Onkologii w Bydgoszczy, Bydgoszcz, Polska
  • Katedra iKlinika Ginekologii Onkologicznej iPielęgniarstwa Ginekologicznego, Uniwersytet Mikołaja Kopernika wToruniu, Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy, Bydgoszcz, Polska
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Document Type
article
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bwmeta1.element.psjd-4854a7f1-612f-4763-869d-237677fa4bc9
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