{"id":5780,"date":"2016-06-07T13:50:11","date_gmt":"2016-06-07T13:50:11","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=5780"},"modified":"2016-06-07T13:50:11","modified_gmt":"2016-06-07T13:50:11","slug":"imrt-vmat-intr-un-caz-de-neoplasm-al-orofaringelui-dr-ruxandra-ortansa-mitulescu-medic-primar-radioterapie","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/imrt-vmat-intr-un-caz-de-neoplasm-al-orofaringelui-dr-ruxandra-ortansa-mitulescu-medic-primar-radioterapie\/","title":{"rendered":"IMRT-VMAT intr-un caz de neoplasm al orofaringelui"},"content":{"rendered":"<p style=\"text-align: justify\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-5791\" src=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/Dr-Ruxandra-Mitulescu-radioterapeut-1-200x300.jpg\" alt=\"Dr-Ruxandra-Mitulescu-radioterapeut-1\" width=\"200\" height=\"300\" srcset=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/Dr-Ruxandra-Mitulescu-radioterapeut-1-200x300.jpg 200w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/Dr-Ruxandra-Mitulescu-radioterapeut-1.jpg 300w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/>Dr. Ruxandra Ortansa Mitulescu<\/p>\n<p style=\"text-align: justify\">Medic primar radioterapie<\/p>\n<p style=\"text-align: justify\">Cancerul reprezint\u0103 o problem\u0103 social\u0103 de s\u0103n\u0103tate din cauza frecven\u0163ei ridicate \u00een r\u00e2ndul popula\u0163iei, afectarea persoanelor de toate v\u00e2rstele \u0219i a consecin\u0163elor negative cu rasunet \u00een plan social \u015fi economic<\/p>\n<p style=\"text-align: justify\">Cancerele de la nivelul capului \u015fi al g\u00e2tului reprezint\u0103 aproximativ 4% din localiz\u0103rile neoplazice \u015fi cuprind o varietate de neoplasme cu evolu\u021bii naturale diferite.<\/p>\n<p style=\"text-align: justify\">Managementul pacientului neoplazic cu aceast\u0103 localizare este complex \u015fi presupune o colaborare multidisciplinar\u0103 eficient\u0103 \u00eentre chirurg, oncolog medical, radioterapeut, anatomopatolog, chirurg plastician, tehnicieni radiologi, asistente medicale, logopezi, nutri\u021bioni\u0219ti, to\u0163i implica\u021bi \u00een diferite etape de tratament ce au drept scop vindecarea \u0219i reintegrarea social\u0103 a pacientului.<\/p>\n<p style=\"text-align: justify\"><strong>Epidemiologia cancerelor de cap \u0219i g\u00e2t.<\/strong><\/p>\n<p style=\"text-align: justify\"><strong>\u00a0<\/strong>Conform datelor Globocan 2012, la nivel global pentru ambele sexe la 100000 de locuitori, inciden\u021ba a fost de 6,9, mortalitatea de 5,1 iar prevalen\u021ba a fost de 9<a name=\"_Toc406656770\"><\/a>.<\/p>\n<p style=\"text-align: justify\"><strong>Principii de tratament \u00een cancerele de orofaringe<\/strong><\/p>\n<p style=\"text-align: justify\">Tratamentul pacien\u021bilor cu neoplasm situat la nivelul capului \u015fi g\u00e2tului reprezint\u0103 o adev\u0103rat\u0103 provocare pentru medicul practician \u015fi se realizeaz\u0103 \u00een echipa oncologic\u0103 conform stadiului de boal\u0103 \u015fi ghidurilor terapeutice existente.<\/p>\n<p style=\"text-align: justify\">Trecerea de la iradierea clasic\u0103 2D, la radioterapia modern\u0103 conforma\u0163ional\u0103, a avut un beneficiu real pentru pacien\u021bi. Astfel, s-a putut administra doze mari de iradiere la nivelul volumelor de interes, \u00een acela\u015fi timp cu protec\u0163ia \u0163esuturilor s\u0103n\u0103toase. Acest lucru a semnificat pentru pacient ob\u021binerea unor rezultate terapeutice mai bune \u015fi efecte secundare mai mici, respectiv costuri medicale mai reduse, integrare socio-profesional\u0103 mai rapid\u0103 \u015fi o calitate a vie\u021bii mai bun\u0103.<\/p>\n<ul style=\"text-align: justify\">\n<li>Tratamentul chirurgical sau radioterapia se recomand\u0103 ca unic\u0103 metod\u0103 terapeutic\u0103 \u00een stadiile incipiente (I \u015fi II) de cancer al orofaringelui.<\/li>\n<li>\u00cen stadiile III \u015fi IV, tratamentul chirurgical radical este urmat de radioterapie sau de radiochimioterapie \u00een adjuvan\u021b\u0103, \u00een func\u0163ie de factorii histopatologici de prognostic, care au importan\u021b\u0103 major\u0103 \u00een indica\u021bia terapeutic\u0103. \u00cen cazurile avansate loco-regional se indic\u0103 chimioradioterapia definitiv\u0103 sau neo-adjuvant\u0103 cu scopul de conversie la rezecabilitate.<\/li>\n<li>Tehnicile moderne de radioterapie conforma\u021bional\u0103 3D \u015fi IMRT sunt de preferat pentru iradierea neoplasmelor cu aceast\u0103 localizare, deoarece realizeaz\u0103 o conformare mai bun\u0103 a dozei \u015fi o protec\u021bie mai bun\u0103 a organelor critice cu toxicit\u0103\u0163i mai mici.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>IMRT-VMAT intr-un caz de neoplasm al orofaringelui \u2013 CAZ CLINIC<\/strong><\/p>\n<p style=\"text-align: justify\"><strong>\u00a0<\/strong>Pacientul B.A , sex masculin, in varsta de 47 ani.<\/p>\n<p style=\"text-align: justify\">Simptomatologie: odinofagie, senzatie de corp strain de aproximativ 3 luni pentru care se indica initial antibioterapie. Simptomatologia nu se remite si pacientul seprezinta la medicul O.R.L unde se efectueaza biopsie din formatiunea localizata la nivelul amigdalei palatine stangi si a valului palatin, rezultatul histopatologic fiind de carcinom epidermoid spinocelular cheratinizant invaziv, G1.<\/p>\n<p style=\"text-align: justify\"><strong>Bilant preterapeutic<\/strong><\/p>\n<p style=\"text-align: justify\">Evaluarea complet\u0103 a pacientului implic\u0103 status-ul dentar \u015fi nutri\u021bional, aprecierea tulbur\u0103rilor de degluti\u021bie, posibilitatea de a asigura nutri\u021bia corespunz\u0103toare a pacientului pe parcursul tratamentului prin efectuarea unei gastrostome\/jejunostome \u00eenaintea \u00eenceperii tratamentului multimodal (radioterapie sau radiochimioterapie), \u0219tiindu-se c\u0103 pot ap\u0103rea toxicit\u0103\u0163i ce afecteaz\u0103 suplimentar status-ul, \u015fi a\u0219a precar al pacientului.<\/p>\n<p style=\"text-align: justify\">In cadrul bilantului preterapeutic se coroboreaza datele clinice si paraclinice, scopul fiind\u00a0 stadializarea bolii si indicatia terapeutica.<\/p>\n<p style=\"text-align: justify\">S-au efectuat urmatoarele investigatii:<\/p>\n<p style=\"text-align: justify\"><strong>\u00a0<\/strong>Examen O.R.L: Formatiune tumorala amigdala stanga cu aspect papilomatos extinsa la valului palatin si pilierului amigdalian posterior. Cavum liber, hipofaringe de aspect normal.<\/p>\n<ul style=\"text-align: justify\">\n<li>CT cap si gat cu substanta de contrast : Amigdala palatina stanga marita in volum 27\/17 mm; poliadenopatii laterocervicale superioare bilaterale mai numeroase de partea stanga cu dimensiuni maxime de 14\/17 mm.<\/li>\n<li>CT torace cu substanta de contrast: Fara determinari secundare pleuro-pulmonare.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">APP: Ulcer perforat operat ( 1999).<\/p>\n<p style=\"text-align: justify\"><strong>Diagnostic stadial<\/strong>: Carcinom epidermoid spinocelular cheratinizant invaziv al \u00a0amigdalei stangi\u00a0 cT3 cN2b M0, stadiul IV A, G1.<\/p>\n<p style=\"text-align: justify\"><strong>Decizie de tratament in cadrul comisiei oncologice a clinicii Amethyst:<\/strong><\/p>\n<p style=\"text-align: justify\">Radioterapie curativa si chimioterapie de radiosensibilizare saptamanala cu Cisplatin.<\/p>\n<p style=\"text-align: justify\">Gastrostoma inainte de inceperea tratamentului; din pacate pacientul refuza montarea gastrostomei.<\/p>\n<p style=\"text-align: justify\"><strong><u>Etapele planului de tratament<\/u><\/strong><\/p>\n<p style=\"text-align: justify\"><strong><u>I.Efectuarea CT \u2013 SIM.<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">\u00cen aceast\u0103 prim\u0103 etap\u0103 se efectueaz\u0103 un examen CT cu pacientul imobilizat \u00een pozi\u021bie de tratament. Se scaneaz\u0103 regiunea de interes la 2 mm distan\u0163\u0103 .<a name=\"_Toc406656772\"><\/a><\/p>\n<p style=\"text-align: justify\"><strong>Imobilizarea pacientului<\/strong> se efectueaz\u0103 cu m\u0103\u015fti termoplastice ce imobilizeaz\u0103 capul \u015fi umerii ( care vor fii trasi in jos cu ajutorul unor chingi) ,care se prind \u00een cinci puncte la masa de tratament. Se pun repere metalice aleatorii pe masca de conten\u0163ie la nivelul laserelor central \u015fi laterale pentru efectuarea ulterioara a pozitionarii la prima sedinta de radioterapie.<\/p>\n<p style=\"text-align: justify\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-5781 size-medium\" src=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/Fig.1-Imagine-de-imobilizare-cu-masca-de-contentie-300x221.jpg\" alt=\"Fig.1 Imagine de imobilizare cu masca de contentie\" width=\"300\" height=\"221\" srcset=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/Fig.1-Imagine-de-imobilizare-cu-masca-de-contentie-300x221.jpg 300w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/Fig.1-Imagine-de-imobilizare-cu-masca-de-contentie.jpg 665w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p style=\"text-align: justify\">Fig.1 Imagine de imobilizare cu masca de contentie.<\/p>\n<p style=\"text-align: justify\"><strong><u>II.Etapa de contouring.<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Exist\u0103 ghiduri publicate (RTOG, DAHANCA, EORTC) pentru contouring-ul CTV ganglionar \u00een cazul ariilor ganglionare neinvadate (Gregoire 2003), \u00een prezen\u021ba adenopatiilor \u0219i postoperator (Gregoire 2006 \u0219i 2013).Astfel, extrapol\u00e2nd experienta chirurgical\u0103 la nivelul ganglionar cervical s-au definit ariile ganglionare regionale pentru cancerul de cap si gat. Se definesc cu ajutorul structurilor anatomice u\u0219or de identificat pe imaginile CT nivele ganglionare cervicale.Scopul introducerii acestor protocoale de contouring pentru ariile limfatice a fost de a minimaliza diferen\u021bele dintre diferite centre medicale \u0219i de a \u00eembun\u0103t\u0103\u021bi practica medical\u0103.Clasificarea din anul 2013 propus\u0103 de Gregoire et al. cuprinde zece nivele ganglionare.Conceptul de radioterapie electiv\u0103 \u00een neoplasmele de cap \u0219i g\u00e2t are la baz\u0103 modalitatea predictibil\u0103 de drenaj limfatic dovedit\u0103 \u00een localiz\u0103rile de la nivelul cavit\u0103\u021bii bucale, laringelui \u0219i faringelui.<\/p>\n<p style=\"text-align: justify\">Drenajul limfatic primar pentru neoplasmele de orofaringe este reprezentat de ganglionii jugulodigastrici superiori, ganglionii retrofaringieni si ganglionii parafaringieni.<\/p>\n<p style=\"text-align: justify\">Delimitarea volumelor de interes oncologic necesit\u0103 cunoa\u0219terea c\u0103ilor de diseminare limfatic\u0103 loco-regionale, no\u021biunilor de anatomie radiologic\u0103, procedurilor chirurgicale practicate \u0219i, nu \u00een ultimul r\u00e2nd,\u00a0 experien\u021b\u0103 din partea medicului radioterapeut.<\/p>\n<p style=\"text-align: justify\">Aceast\u0103 etap\u0103 presupune achizi\u021bia imaginilor CT, \u00een sistemul de planning al aparatului ( in Centrul Amethyst-sistem de planning Pinnacle)si efectuarea conturajului de catre medicul radioterapeut. Se contureaza volumele de interes definite ca GTV, CTV si PTV si OAR ( Organs at risk- organe critice: structuri sanatoase prezente in interiorul volumelor de iradiat care limiteaza doza de iradiere).<\/p>\n<p style=\"text-align: justify\">GTV= Gross tumor volume ( volum macroscopic tumoral prezent pe investigatiile imagistice )<\/p>\n<p style=\"text-align: justify\">Se definesc GTV-T ( tumoral) si GTV-N ( ganglionar).<\/p>\n<p style=\"text-align: justify\">Fig 2. GTV-T<\/p>\n<p style=\"text-align: justify\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-5783 size-medium\" src=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/3-300x276.jpg\" alt=\"3\" width=\"300\" height=\"276\" srcset=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/3-300x276.jpg 300w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/3.jpg 666w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p style=\"text-align: justify\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-5783 size-medium\" src=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/3-300x276.jpg\" alt=\"3\" width=\"300\" height=\"276\" srcset=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/3-300x276.jpg 300w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/3.jpg 666w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p style=\"text-align: justify\">Fig 3. GTV-T ( culoare rosie) si GTV-N ( culoare cian).<\/p>\n<p style=\"text-align: justify\">CTV= Clinical target volume (reprezinta zonele cu risc de diseminare tumorala la nivel microscopic).<\/p>\n<p style=\"text-align: justify\">Se vor defini:<\/p>\n<p style=\"text-align: justify\"><strong>CTV 70 ( High risk<\/strong>)- se obtine prin extindere GTV cu 0,5-1 cm in functie de situatia clinica ( in cazul prezentat 0,5 cm) urmata de editare ( evitare bariere naturale: os, muschi).<\/p>\n<p style=\"text-align: justify\"><strong>GTV<\/strong> se delimiteaz\u0103 utiliz\u00e2nd sistemul de planning de tratament \u00een fereastra pentru \u021besuturi moi; se vor defini GTV-T \u015fi GTV-N (ganglioni limfatici cu dimensiuni mai mari de 10 mm sau cu dimensiuni mai mici, dar rotunzi sau cu centru necrotic).<\/p>\n<p style=\"text-align: justify\"><strong>CTV 60<\/strong> ( <strong>Intermediar risk<\/strong>): reprezentat de ariile limfatice cu risc.<\/p>\n<p style=\"text-align: justify\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-5784\" src=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/4-294x300.jpg\" alt=\"4\" width=\"294\" height=\"300\" srcset=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/4-294x300.jpg 294w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/4-67x67.jpg 67w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/4.jpg 600w\" sizes=\"auto, (max-width: 294px) 100vw, 294px\" \/><\/p>\n<p style=\"text-align: justify\">Fig. 4 . CTV 60<\/p>\n<p style=\"text-align: justify\"><strong>CTV60 (Intermediar risk)<\/strong>: definirea acestui volum necesit\u0103 coroborarea datelor clinice cu cele anatomopatologice. Exist\u0103 anumite situa\u021bii care pot interfera cu delimitarea precis\u0103 a acestui volum, \u015fi anume, mucoasa cavit\u0103\u0163ii bucale nu poate fi definit\u0103 foarte precis prin evaluare imagistic\u0103 CT deoarece pe imaginile CT pot exista artefacte, de exemplu, protezele dentare sau, \u00een cazul \u00een care s-a efectuat reconstruc\u021bie, grefele pot fi confundate cu structuri anatomice normale.<\/p>\n<p style=\"text-align: justify\">\u00cen cazul \u00een care s-a efectuat reconstruc\u0163ie, nu trebuie inclus\u0103 \u00eentreaga zon\u0103, ci se va include \u00een CTV 60, doar zona unde a fost forma\u021biunea tumoral\u0103, cu o margine de siguran\u0163\u0103 de 10 mm pentru excluderea eventualelor micrometaze<\/p>\n<p style=\"text-align: justify\"><strong>CTV 50 ( Low risk):<\/strong> reprezinta nivelele ganglionare locoregionale (in cazul prezentat IB-V ipsilateral si II \u2013 IV controlateral).<\/p>\n<p style=\"text-align: justify\"><strong>PTV<\/strong> \u2013 se define\u0219te prin ad\u0103ugarea unei margini de siguran\u0163\u0103 in jurul CTV (aproximativ 3-5 mm, diferit\u0103 \u00een fiecare departament, calculat\u0103 \u00een func\u021bie de valoarea m\u0103surat\u0103 a erorilor randomizate \u015fi sistematizate). In situatia clinica prezentata marginea de siguranta a fost de 3 mm.<\/p>\n<p style=\"text-align: justify\">Medicul radioterapeut prescrie doza de iradiere finala, fractionarea si etalarea\u00a0 tratamentului.<\/p>\n<p style=\"text-align: justify\">In situatia clinica prezentatadoza finala este de 70 Gy, doza pe fractie (d=200 cGy), in 35 de \u00a0sedinte de radioterapie.<\/p>\n<p style=\"text-align: justify\"><strong><u>III. Etapa de dozimetrie<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Dozimetria este realizat\u0103 de fizicianul medical care utilizeaz\u0103 \u00een acest scop aceea\u0219i platform\u0103 a sistemului Pinnacle de plan de tratament,bazindu-se pe conceptul de realizare si optimizare a planului \u201eInverse treatment planning\u201d. Este o etapa consumatoare de timp in care fizicianul medical realizeaza in mai multi pasi dezideratele propuse pana la obtinerea celei mai bune variante pentru iradierea pacientului.<\/p>\n<p style=\"text-align: justify\"><strong><u>IV.Etapa de verificare \u015fi aprobare<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">\u00cen aceast\u0103 etap\u0103, medicul radioterapeut verific\u0103 dozimetria realizat\u0103 \u00een etapa anterioar\u0103 de c\u0103<a name=\"_Toc406656755\"><\/a>tre fizicianul medical si in cazul in care sunt respectate constrangerile de doza impuse, planul este acceptat.<\/p>\n<p style=\"text-align: justify\"><strong>Fig. 5: Evaluare DVH ( Dose Volume Histogram)<\/strong><\/p>\n<p style=\"text-align: justify\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-5785\" src=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/5-300x290.jpg\" alt=\"5\" width=\"300\" height=\"290\" srcset=\"https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/5-300x290.jpg 300w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/5-768x741.jpg 768w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/5-52x50.jpg 52w, https:\/\/jurmed.ro\/medici\/wp-content\/uploads\/sites\/2\/2016\/06\/5.jpg 1012w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p style=\"text-align: justify\">Sunt evaluate dozele pentruvolumele tinta (PTV) si organele critice (OAR).<\/p>\n<p style=\"text-align: justify\">In aceasta situatie 99,5 % din PTV 70 a primit 95 % din doza prescrisa iar parotida dreapta a primit o doza mediana sub 27 Gy. In consecinta exista un risc redus de xerostomie, implicand cresterea calitatii vietii pacientului, fara a compromite efectul terapeutic.<\/p>\n<p style=\"text-align: justify\">In cadrul centrului AMETHYST se utilizeaza tehnica de radioterapie cu modularea intensitatii (IMRT), arcterapie modulata volumetric (VMAT).<\/p>\n<p style=\"text-align: justify\">Avantajul IMRT \u2013VMAT il reprezinta distribuirea cu precizie a dozei prin rotatia cu 360\u2070 a capului de iradiere in timpul livrarii tratamentului. Spre deosebire de tehnica IMRT conventionala, in care aparatul porneste si se opreste de mai multe ori, pentru a trimite fascicule din unghiuri multiple. Timpul de tratament prin VMAT este redus la maximum 2 minute.<\/p>\n<p style=\"text-align: justify\"><strong><u>V.Dozimetria pe fantom:<\/u><\/strong><\/p>\n<p style=\"text-align: justify\">Inainte de inceperea iradierii efective a pacientului, fizicianul medical verifica prin masurare pe <strong>fantom<\/strong>(<strong>dispozitiv tip pacient virtual)<\/strong>corespondenta dintre doza de iradiere afisata si cea administrata de aparat. Daca rezultatele se incadreaza in parametrii de acceptanta se poate incepe iradierea clinica a pacientului.<\/p>\n<ol style=\"text-align: justify\">\n<li><strong><u> Etapa de implementare a tratamentului la aparat<\/u><\/strong><strong><u>.<\/u><\/strong><\/li>\n<\/ol>\n<p style=\"text-align: justify\">\u00cen aceast\u0103 etap\u0103, la prima sedin\u0163\u0103 de tratament, se realizeaz\u0103 pozi\u021bionarea pacientului utilizandu-se reperele metalice aleatorii de la nivelul mastii de contentie puse in etapa de simulare. Se executa miscari ale mesei de tratament in coordonate de x, y si z specificate de fizicianul medical pentru realizarea unei iradieri izocentrice.<\/p>\n<p style=\"text-align: justify\">Pacientul se prezinta zilnic la aparat pentru efectuarea sedintelor de tratament pana la incheierea tratamentului.<\/p>\n<p style=\"text-align: justify\">S-a efectuat saptamanal consult intraterapeutic ( clinic, hematologic si biochimic) pentru monitorizarea efectului terapeutic si a toxicitatilor. Pacientul a tolerat bine iradierea, prezentind radiodermita gradul I si mucozita gradul I. S-au administrat tratamente suportive si simptomatice.<\/p>\n<p style=\"text-align: justify\">La 4 saptamani postradioterapie nu se mai constata la examenul ORL tumora sau adenopatii. Subiectiv se mai constata xerostomie usoara (grad I).<\/p>\n<p style=\"text-align: justify\"><strong>CONCLUZII:<\/strong><\/p>\n<ul style=\"text-align: justify\">\n<li>Radioterapia cu modularea intensitatii este superioar\u0103 iradierii clasice 2D si a celei conformationale 3D, tratamentul fiind personalizat prin achizitia datelor bazate pe imagini CT, administrarea unei doze precis conformata realizandu-se cu protejarea optima a tesuturilor sanatoase.<\/li>\n<li>Aceast\u0103 metod\u0103 permite realizarea a dou\u0103 deziderate importante pentru medicul radioterapeut: administrarea unor doze crescute de iradiere la nivelul volumului planificat \u0219i protec\u021bia organelor critice, a c\u0103ror prezen\u0163\u0103 \u00een interiorul volumului de iradiat, condi\u0163ioneaz\u0103 limitarea dozei care se poate administra.<\/li>\n<li>Tehnica de tratament IMRT-VMAT efectuata in cadrul Centrului Amethyst permite modularea volumetrica a intensiatii dozei in interiorul volumului planificat, in conditiile unui timp redus al sedintei de tratament radioterapic asigurand obtinerea unor rezultate terapeutice superioare cu toxicitati reduse .<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Dr. Ruxandra Ortansa Mitulescu Medic primar radioterapie Cancerul reprezint\u0103 o problem\u0103 social\u0103 de s\u0103n\u0103tate din cauza frecven\u0163ei ridicate \u00een r\u00e2ndul popula\u0163iei, afectarea persoanelor de toate v\u00e2rstele \u0219i a consecin\u0163elor negative [&hellip;]<\/p>\n","protected":false},"author":5,"featured_media":5790,"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":[33,168,440],"tags":[170,476,553,105],"class_list":["post-5780","post","type-post","status-publish","format-standard","has-post-thumbnail","category-articole","category-oncologie","category-orl","tag-amethyst","tag-cancer","tag-neoplasm","tag-oncologie"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.0 - 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