{"id":12305,"date":"2021-07-12T09:37:47","date_gmt":"2021-07-12T09:37:47","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=12305"},"modified":"2021-07-12T09:37:47","modified_gmt":"2021-07-12T09:37:47","slug":"radioterapia-in-cancerele-uterine","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/radioterapia-in-cancerele-uterine\/","title":{"rendered":"Radioterapia \u00een cancerele uterine"},"content":{"rendered":"
\"\"<\/a>
Dr. Liviu Stoleru, medic primar Radioterapie, Centrul Medical Neolife Bucure\u0219ti<\/em><\/figcaption><\/figure>\n

Radioterapia este o metod\u0103 de tratament prin care se administreaz\u0103 \u00een mod precis o doz\u0103 controlat\u0103 de iradiere \u00een scopul distrugerii unei tumori, protej\u00e2nd la maxim organele s\u0103n\u0103toase din vecin\u0103tate. Este o component\u0103 de baz\u0103 a tratamentului multidisciplinar al cancerului, al\u0103turi de chirurgie \u0219i chimioterapie (tratament citostatic).<\/p>\n

In cancerele uterine (de col uterin sau corp uterin \u2013 endometriale), radioterapia se utilizeaz\u0103 at\u00e2t \u00een scop curativ \u2013 c\u00e2nd se urm\u0103re\u0219te vindecarea sau controlul bolii pe termen lung, c\u00e2t \u0219i \u00een scop paliativ, \u00een formele de boal\u0103 avansat\u0103, pentru controlul simptomelor (s\u00e2ngerare, durere).<\/p>\n

Exist\u0103 2 metode de radioterapie pentru cancerele uterine: radioterapia extern\u0103 (pelvin\u0103<\/em>) \u0219i intern\u0103 (brahiterapie<\/em>). In func\u021bie de localizarea bolii (col uterin sau corp uterin), stadiul bolii \u0219i asocierea cu chirurgia sau chimioterapia, aceste metode pot fi utilizate individual sau asociate.<\/p>\n

Radioterapia extern\u0103<\/strong> utilizeaz\u0103 fascicule de iradiere produse de dispozitive aflate \u00een afara corpului, care se numesc acceleratoare liniare. Cu ajutorul lor se pot trata at\u00e2t tumora c\u00e2t \u0219i ganglionii limfatici de vecin\u0103tate, unde celulele tumorale ar putea s\u0103 se r\u0103sp\u00e2ndeasc\u0103.<\/p>\n

Durata radioterapiei externe este \u00eentre 4,5-6 s\u0103pt\u0103m\u00e2ni (23-30 \u0219edin\u021be), tratamentele efectu\u00e2ndu-se zilnic, de luni p\u00e2n\u0103 vineri, iar durata unei \u0219edin\u021be este de c\u00e2teva minute.<\/p>\n

Prima etap\u0103 a radioterapiei externe const\u0103 \u00een efectuarea unei tomografii computerizate pentru planul de tratament (CT de simulare). Aceasta se face cu pacienta \u00een pozi\u021bia \u00een care va fi tratat\u0103 ulterior; se vor face marcaje minime pe piele, care sunt necesare pentru pozi\u021bionarea corect\u0103 \u00een vederea tratamentului.<\/p>\n

Imaginile 3D ob\u021binute la CT-ul de simulare sunt utilizate pentru delimitarea precis\u0103 de c\u0103tre medicul terapeut a \u021bintelor tumorale care trebuie iradiate \u0219i a organelor s\u0103n\u0103toase din vecin\u0103tate care trebuie protejate la maxim.<\/p>\n

Fizicianul medical stabile\u0219te apoi parametrii specifici ai iradierii (num\u0103r de fascicule de iradiere, orientarea acestora, tehnic\u0103 de administrare a iradierii), \u00een a\u0219a fel inc\u00e2t obiectivele stabilite de medicul radioterapeut s\u0103 fie realizate.<\/p>\n

Radioterapia extern\u0103 \u00eencepe, \u00een general, \u00een interval de 2 s\u0103pt\u0103m\u00e2ni de la CT-ul de simulare, iar pe durata acesteia, corectitudinea pozi\u021bion\u0103rii pacientei este verificat\u0103 prin imagistic\u0103 efectuat\u0103 la aparatul de iradiere (radioterapie ghidat\u0103 imagistic -IGRT).<\/p>\n

Brahiterapia<\/strong> se utilizeaz\u0103 pentru tratarea unor suprafe\u021be restr\u00e2nse. Sursa de iradiere este plasat\u0103 \u00een interiorul corpului, \u00een regiunea de interes (uter, vagin) cu ajutorul unor dispozitive numite aplicatori \u0219i este retras\u0103 dup\u0103 administrarea iradierii.<\/p>\n

C\u00e2nd este necesar\u0103 asocierea cu radioterapia extern\u0103, brahiterapia se efectueaz\u0103 dup\u0103 finalizarea acesteia.<\/p>\n

Num\u0103rul \u0219edin\u021belor de brahiterapie este \u00eentre 2 \u0219i 5, cu 1-2 \u0219edin\u021be pe s\u0103pt\u0103m\u00e2n\u0103.<\/p>\n

Pacientele \u00een tratament cu radioterapie extern\u0103 sau brahiterapie pentru cancerele uterine nu sunt radioactive sau periculoase pentru cei din jur, inclusiv copii \u0219i gravide.<\/p>\n

Medicul radioterapeut urm\u0103re\u0219te r\u0103spunsul tumorii \u0219i reac\u021biile adverse produse de iradiere prin controale clinic \u0219i prin analize de laborator care se fac dup\u0103 un protocol care este comunicat pacientei \u00eenainte de \u00eenceperea radioterapiei.<\/p>\n

Efectele adverse<\/strong> ale iradierii pot ap\u0103rea \u0219i se pot accentua pe durata acesteia, \u00een zilele sau s\u0103pt\u0103m\u00e2nile de dup\u0103 finalizarea acesteia (reac\u021bii acute<\/strong>) sau dup\u0103 luni, ani de la terminarea radioterapiei (reac\u021bii tardive<\/strong>).<\/p>\n

\"\"<\/a>Reac\u021biile acute<\/strong> produse ca urmare a iradierii intestinului, rectului \u0219i vezicii urinare, se pot manifesta sub form\u0103 de diaree, balonare, dureri abdominale, s\u00e2nger\u0103ri la nivelul anusului, urin\u0103ri mai frecvente \u00eenso\u021bite de usturime, senza\u021bie de arsur\u0103 sau dificultate de a men\u021bine urina (incontinen\u021b\u0103 urinar\u0103).<\/p>\n

Oboseala, \u00een grade variabile p\u00e2n\u0103 la senza\u021bie de epuizare, este o reac\u021bie acut\u0103 care apare frecvent \u0219i este mai accentuat\u0103 c\u00e2nd se iradiaz\u0103 suprafe\u021be mari ale corpului; \u00een plus, radioterapia extern\u0103 pelvin\u0103 poate produce anemie, din cauza efectului asupra m\u0103duvei osoase, care accentueaz\u0103 oboseala.<\/p>\n

Sc\u0103dere apetituluui, grea\u021ba \u0219i v\u0103rs\u0103turile, apar mai frecvent \u00een cazurile \u00een care la iradierea exten\u0103 pelvin\u0103 se asociaz\u0103 \u0219i iradierea ganglionilor limfatici abdominali sau chimioterapia concomitent\u0103.<\/p>\n

Pielea se poate \u00eenro\u0219i, eventual cu senza\u021bie de usturime asociat\u0103, la nivelul zonei care este iradiat\u0103.<\/p>\n

Intensitatea reac\u021biilor adverse acute variaz\u0103 mult de la o persoan\u0103 la alta, dar, \u00een general se amelioreaz\u0103 semnificativ \u0219i dispar \u00een interval de 4-6 s\u0103pt\u0103m\u00e2ni de la terminarea radioterapiei. Pentru prevenirea \u0219i limitarea acestora, este necesar un stil de via\u021b\u0103 sanatos. \u00cen alimenta\u021bie trebuie s\u0103 se evite alimentele care fermenteaz\u0103, dulciurile concentrate, b\u0103uturile carbogazoase dulci, condimentele \u0219i se recomand\u0103 un consum adecvat de lichide (minim 2-2,5 litri pe zi). Exerci\u021biile fizice u\u0219oare, mersul pe jos \u0219i plimb\u0103rile \u00een aer liber, pot ameliora senza\u021bia de oboseal\u0103.<\/p>\n

Reac\u021biile tardive<\/strong> ale iradierii se pot manifesta prin afectarea fertilit\u0103\u021bii, inducerea menopauzei, inflama\u021bii cronice la nivelul vezicii urinare, intestinului \u0219i rectului, care pot asocia diaree sau constipa\u021bie, crampe abdominale, s\u00e2nger\u0103ri. In foarte rare cazuri (1\/1000) poate ap\u0103rea, la interval de ani, un al doilea cancer \u00een regiunea tratat\u0103.<\/p>\n

Tehnicile moderne de radioterapie (3D conforma\u021bional\u0103 \u2013 3D CRT, cu intensitate modulat\u0103 \u2013 IMRT\/VMAT) au sc\u0103zut mult riscul de apari\u021bie \u0219i gravitatea reac\u021biilor adverse.<\/p>\n

Progresele tehnologice \u00een planul de tratament, bazat pe imagistic\u0103 CT \u0219i tehnicile moderne, conforma\u021bionale de radioterapie, al\u0103turi de o bun\u0103 comunicare medic radioterapeut \u2013 pacient, asigur\u0103 rezultate optime pentru controlul bolii \u0219i calitatea vie\u021bii pacientelor cu cancere uterine.<\/p>\n","protected":false},"excerpt":{"rendered":"

Radioterapia este o metod\u0103 de tratament prin care se administreaz\u0103 \u00een mod precis o doz\u0103 controlat\u0103 de iradiere \u00een scopul distrugerii unei tumori, protej\u00e2nd la maxim organele s\u0103n\u0103toase din vecin\u0103tate. […]<\/p>\n","protected":false},"author":4,"featured_media":12309,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[429],"tags":[],"class_list":["post-12305","post","type-post","status-publish","format-standard","has-post-thumbnail","category-ginecologie"],"yoast_head":"\nRadioterapia \u00een cancerele uterine - Jurmed - Medici<\/title>\n<meta name=\"description\" content=\"Radioterapia este o metod\u0103 de tratament prin care se administreaz\u0103 \u00een mod precis o doz\u0103 controlat\u0103 de iradiere \u00een scopul distrugerii unei tumori.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/medici\/radioterapia-in-cancerele-uterine\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Radioterapia \u00een cancerele uterine - 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