Proton radiation wani nau'i ne na ingantaccen radiation wanda ya samu a cikin shahararrun maganin cutar ta prostate. Maza maza da ke kallon radiation proton ya kamata su kwatanta shi tare da sauran nau'in radiation don tantance idan farfadowar proton ya fi dacewa a gare su saboda yanayin da suka dace.
Hanyoyin rashawa na proton yana buƙatar samun magani guda biyar a mako guda domin takwas ko tara a cikin makonni masu jimawa.
A lokacin ziyarar kowace shekara, marasa lafiya suna matsayi a gaban wani katako na protons wanda ke sa ido kan glandan prostate.
Proton vs. Photon Radiation
Proton radiation ya bambanta da sauran nau'in radiation , wanda ya dogara da photons. Faɗakarwar Photon ta zo ne a cikin nau'i uku: ƙarfin gyaran radiation mai tsanani (IMRT), radiation radiation radiation (brachyrapy), da kuma maganin radiation radiation (SBRT). Wani lokaci ana haɗuwa da haɗin gwiwar juna tare da ɗaya daga cikin sauran nau'in radiyon hasken.
Daban kowane radiation yana da tasiri, sakamakon mutuwar ciwon daji. Dukkanin zai iya haifar da sakamako mai lalacewa, idan radiation ta kusa kusa da gabobin al'ada, kamar mafitsara, rectum, da urethra.
Rashin Hadin Kayan Erectile Dysfunction
Ya zuwa yanzu masana basu iya yarda da cewa irin wannan radiation ya kasance cikakke ba duk sauran. Duk da haka, dangane da nau'o'in yanayin da marasa lafiya ke fuskanta, wani nau'i na farfadowa na iya samun kwarewa akan wasu.
Dukan zaɓuɓɓuka, lokacin da masu kwantar da hankalinsu suka samu, sun sami magani mai kyau kuma suna da ƙananan cututtuka na ƙarshe - sai dai hadarin dysfunction ta hanyar (ED).
Hasarin dindindin dindindin ED wanda aka ƙayyade kamar yadda ED bai amsa zuwa Viagra ko kwayoyi masu kama da juna ba - yana da kimanin kashi 50 cikin kowane irin radiation.
Rashin haɗari ya fi girma a cikin tsofaffi maza da maza waɗanda ke da halayen jima'i. Haɗarin yana da ƙananan ƙananan yara kuma lokacin da aikin jima'i na da kyau. Jiyya ga gyaran-gyaren ED yana da tasiri amma ƙari, kuma yana buƙatar kogin allurar prostaglandin a cikin azzakari ko kuma wani abu da aka sanya a cikin ƙuƙwalwa.
Rashin layi, ko da yake ED bayan radiyo ne na kowa, ba a la'akari da factor factor in selection of daya irin radiation a kan wani. Wannan shi ne saboda hadarin ED yana daidai da kowane irin radiation. Yin kwatankwacin zaɓuɓɓukan radiyo, sabili da haka, ya dogara da wasu dalilai kamar maganin magani da kuma tasirin matsalar mafitsara ko matsaloli na rectal.
Hadarin wutar konewa
A tarihi, ta hanyar amfani da fasahar radiation tsofaffin ƙwayoyi, madaidaicin wuta daga wutar lantarki ya kasance na kowa kuma yana da mummuna. Yanzu a cikin wannan zamanin zamani, saboda hanyoyin da suka fi dacewa da niyya, ƙananan ƙaddarar sunadarai sun zama abin ban mamaki. A halin yanzu, dukkan nau'ukan radiation guda hudu (proton radiation, IMRT, brachytherapy da SBRT) suna da hadarin (1 zuwa 2 bisa dari) na hadarin matsaloli na tsawon lokaci.
Akwai hanyoyi biyu ga wannan furta. Na farko, wasu amma ba duk wani nazarin SBRT ba yana cewa zai iya samun ƙananan haɗari na ƙonawa fiye da sauran nau'i uku, haɗari a cikin kashi 3 zuwa kashi 4 cikin dari.
Kashi na biyu shi ne "tsofaffi". Abubuwan tsofaffi na tsofaffin kayan aiki suna ba da haske mai zurfi, wanda zai iya haifar da radiation "overspray" a cikin dubun. Anyi amfani da radiation na zamani, wanda ake kira ƙarfin gyare-gyare mai rikitarwa (IMPT), ta hanyar amfani da ƙananan ƙananan fensir, mai kama da irin fasaha da aka yi amfani da su wajen aika IMRT. Dukansu IMPT da IMRT zasu iya ƙirƙirar filin radiyon "mai lankwasa" wanda za a iya tsara shi don biyan iyakokin gaɓar iyakokin glandan prostate. Wannan yana haifar da ƙananan rashawa saboda haka ƙananan haɗari na lalacewa.
Gel don hana ƙonewa ta wuta
Rashin ƙididdigar tsawon rai yana da wuya, amma zai iya zama mai haɗari, yana haifar da ciwo, zub da jini, da kuma hasara na gyare-gyare. Fasahar juyin juya halin da ake kira SpaceOAR ya rage haɗari mai tsanani a cikin dubun. SpaceOAR hydrogel an injected tsakanin gishiri prostate da gindin gyara kuma ya kasance cikin wuri a cikin tsawon radiation. Jirgin hydrogel yana motsa ginin ta tsakiya daga glandan prostate kuma daga cikin filin radiation. Saboda haka, an kusan kawar da haɗarin radiation a cikin dubun.
Rashin Hanyoyin Cutar Guda-Ra'ayin Matsalar Urinary
Matsalar urinary bayan radiation sun hada da ciwo a lokacin urination, gaggawa na gaggawa, da farkawa a dare akai-akai zuwa urinate. Haɗarin bayyanar cututtuka bayan radiation ya karu a cikin maza tare da matsalolin urinary ciki da kuma maza waɗanda ke da ƙananan ƙwayar prostate.
Ana haɗarin hadarin matsalolin urinarya yayin da ake amfani da iri iri. Wannan shi ne saboda yawan jimlar radiation da tsaba ke bayarwa ya fi girma. Urethra, urinary nassi wanda ke dauke da fitsari daga cikin mafitsara zuwa waje ta hanyar azzakari, yana tafiya ta mike ta hanyar tsakiyar prostate. Sabili da haka, wucin gadi a lokacin radiation kuma nan da nan bayan radiation na kowa daga dukan zaɓuɓɓuka.
Dogon lokaci urinaryar cututtuka na faruwa a kashi 10 cikin dari ko na maza da ke da nau'in jini. Tsayawa mai tsawo urinaryar cututtuka na iya faruwa tare da sauran zaɓuɓɓuka, amma a cikin ƙasa da kashi 5 cikin dari na marasa lafiya, suna zaton basu da matsananciyar ƙuƙwalwa ko ƙananan digiri na matsalolin urinary ciki. Magunguna don magance wannan lokaci mai tsawo urinaryar cututtuka ba su da tasiri kawai. Akwai wani hali na tsawon lokaci bayyanar cututtuka don sannu a hankali inganta, ko da yake ci gaba mai mahimmanci ba zai faru ba har tsawon shekaru.
Bugu da ƙari, ban da ƙananan ƙananan hanyoyi da aka ambata a sama, hadarin urinary da rectal effects sakamako daidai ne da dukan zažužžukan. Wannan yana haifar da mu maganin maganin magani, wanda ya bambanta dangane da yanayin ciwon daji. A cikin 'yan takara na radiation, an bayyana matakai biyu na ciwon daji na prostate, "babban haɗari da" matsanancin haɗari. "
Radiation ga Ciwon ƙwayar Ciwon Magunguna
Tun bayan karatu mafi kyau ya zama babban haɗari, zaɓi na magani ba shi da wata rikitacciya fiye da shi don matsakaici-hadarin. Mutanen da ke dauke da haɗari suna nuna akalla daya daga cikin wadannan:
• Girman Gleason na 8 ko mafi girma
• Matsayin jini na PSA a kan 20
• Gwajin gwaji na dubban da ke nuna babban ciwon ko ciwon daji a waje da prostate
Tare da cututtukan ƙwayar cuta, masana sun bayar da shawarar "matsala" mai mahimmanci. Kamar yadda muka gani a baya, radiation iri yana samar da mafi girma daga radiation idan aka kwatanta da sauran zaɓuɓɓuka. Kyakkyawar matakin inganta maganin magani. Babban binciken da ake kira jarrabawar ASCENDE-RT yana tabbatar da wannan shirin. Binciken da aka yi idan aka kwatanta da IMRT kadai tare da IMRT tare da nau'in implant. Haɗuwa da tsaba tare da IMRT sun haifar da kashi 20 bisa dari idan aka kwatanta da magani tare da IMRT kadai. Saboda haka, yarjejeniya ita ce radiation iri tare da IMRT ita ce mafi kyawun radiation ga mutanen da ke fama da cutar mai tsanani.
Tun da akwai alamance tsakanin daidaituwa na zamani na zamani (IMPT) da IMRT, yana yiwuwa ya dace a maye gurbin IMPT (karin tsaba) don IMRT da tsaba a cikin maza da ke dauke da cutar mai tsanani. Duk da haka, irin wannan musanyawar ba a taɓa tabbatar da shi ba a gwaji. Wataƙila wannan kuskure yana ɓatar da wasu daga wasu kwarewar jiki da aka sani da za a haɗa su da protons idan aka kwatanta da photons. Ƙarfin anticancer da aka kawo ta hanyar katako mai tsutsawa a dakatar da prostate, rage ragewar radiation zuwa nama na al'ada a gefen gefen gland.
Ya bambanta, radiation radiation ya mike tsaye ta jiki, yana nuna yawan adadin jiki zuwa radiation. Babban hujja akan amfani da radiation na proton maimakon IMRT dogara ne akan wannan shirin, cewa akwai raguwa a yawan adadin kayan jikin da aka fallasa zuwa radiation.
Radiation ga Cibiyar Tsakanin Tsakanin Matsakaici na Tsakanin Matsakaici
Akwai mafi sauƙin sassaucin zabi tare da cututtukan ƙwayar cuta. An samo kyakkyawan sakamako tare da dukan zaɓuɓɓuka. Duk da haka, yawancin masana sun fara raba ragowar matsakaici cikin raƙuman tsari da maras kyau. Amfani da wannan tsarin, maza da mahimmanci masu kyau sun dace da duk waɗannan ka'idoji:
• Gleason 3 + 4 (maimakon Gleason 4 + 3)
• Kashi biyu ko uku na adadin kwayoyin halittu dake dauke da ciwon daji
• Matsayin jini PSA na kasa da goma
• Idan likita ta ji nau'in nodule, ƙananan ya ƙunshi
Tare da haɗarin tsaka-tsaki mai kyau, duk zaɓuɓɓukan-tsaba, SBRT, IMRT, da radiation na proton (IMPT) - zai zama m. Maza masu fama da karuwanci masu yawa, fiye da 60 cc zuwa 80 cc misali, ko maza da ke da matsananciyar magungunan urinaryar rigakafi, suna fuskantar babban haɗari na tsawon lokaci matsalolin urinary tare da radiation iri kuma zai yiwu ya fita don SBRT, IMRT ko IMPT . Idan ana amfani da SpaceOAR hydrogel don kare lalacewa ta ruɗuwa, SBRT wani zaɓi ne mai kyau a kan IMRT da proton radiation, tun da yawan adadin kulawa da ake buƙatar da ake bukata ba tare da SBRT ba idan aka kwatanta da IMRT da proton far.
Maganin rashin ciwon gurbataccen ƙwayar cuta mai rikitarwa yana ɗauke da halaye na haɗari na tsaka-tsaki (Gleason 7, PSA daga 10 zuwa 20 ko ƙwayar prostate matsakaici) amma ya kasa cika ka'idodin ka'ida da aka tsara a sama don haɗarin tsaka-tsaki mai kyau. Misalan sune: Gleason 4 + 3, maza da fiye da ɗaya matsanancin haɗari da kuma maza da ƙananan kwakwalwan halittun dake dauke da ciwon daji. Wadannan dalilai suna nuna irin cutar da ke da mawuyacin hali. Saboda haka, magani ya kamata hade na IMRT (ko IMPT) tare da wani nau'in implant. Wannan tsari na iya zama alama ga abin da aka bada shawara a sama don cutar mai tsanani. Akwai, duk da haka, babban bambanci-yadda ake amfani da maganin hormonal.
Ana buƙatar maganin gaggawa don dukan rayukan mutane ba tare da jin dadi ba sai dai ga maza da matsanancin haɗari. Yawanci, an fara amfani da Lupron ko maganin Lupron watanni biyu kafin radiation kuma ya ci gaba yayin radiation. Maza masu fama da mummunar haɗari suna ci gaba da farfadowa na hormonal na tsawon watanni 6. Mutanen da ke dauke da haɗari suna ci gaba da wucewa, suna tsayawa bayan watanni 18. Wani binciken da ya tilasta da aka buga a cikin New England Journal of Medicine ya nuna cewa dole ne a yi amfani da wani nau'in tsarin maganin hormone da ake kira Zytiga tare da Lupron ga maza da babban haɗari.
Proton Far farfãni da rashin amfani
Proton radiation na iya wakiltar ingantaccen gyare-gyare a kan IMRT saboda rageccen ɗaukar hoto na jikin kyallen takarda ta jiki zuwa radiation. Saboda haka, a cikin yanayi da aka kwatanta akan inda IMRT za a yi la'akari akai akai, mutane za su fi son zaɓar radiation ta proton akan IMRT. Abubuwan da aka ambata daga proton radiation a kan IMRT sun kasance masu ilimin lissafi kuma marasa lafiya. Babu wani shugaban da ya fara nazarin nazarin IMRT da radiation na proton.
Abubuwan da ba su da amfani da haɓaka da proton radiation suna da alaƙa da kudaden kudade da kuma gaskiyar cewa ba dukan dukiyoyin haɗari sun rufe fadin proton ba. Bugu da ƙari, akwai ƙananan cibiyoyin da ke yin radiyo, don haka yanayin rashin tausayi na iya zama babban mahimmanci idan an la'akari da yawancin ziyara ana buƙatar a tsawon makonni biyar zuwa 9.
Maza suna lura da maganin cutar kanjamau don buƙatar su. Hanyoyin da za a iya haifar daga radiation na iya zama wanda ba za a iya ba. Zaɓin zaɓi na radiation mafi kyau ya bambanta da yanayin haƙuri. Ya kamata a yi la'akari da dalilai masu yawa idan an kwatanta radiyo.
> Sources:
> James, ND, et al. "Abyerone don ciwon daji wanda ba a taɓa magance shi ba tare da maganin hormone." New England Journal of Medicine (2017).
> Morris, JW, et al. "Maganar ciwon haɗi da aka haɗa da Nodal na Elective da Tsarin Farfadowa da Lafiya (ASCENDE-RT Trial): Bincike game da maganganu na rayuwa don gwaji da aka kwatanta da ƙananan kashi-kashi na karfin zuciya ya bunkasa wani ƙarfin ƙirar ƙirar waje don ƙananan ciwon kwakwalwa na karuwanci na matsakaici. " Littafin Labaran Labaran Lafiya na Duniya * Biology * Kwayoyin Kimiyya 98.2 (2017): 275-285.
> Zelefsky, MJ., Et al. "Ƙarfafawa na maganin sildenafil na maganin marasa lafiya tare da ciwon daji na baya bayan radiotherapy na carcinoma na prostate." Ilimin kimiyya 53.4 (1999): 775-778.