Proton therapy in clinical use

Proton terapi (PT), 1970 yılından beri klinik kullanımda olup, Aralık 2008 tarihine kadar tüm dünyada toplam 61,122 hasta tedavi edilmiştir. PT'nin en önemli avantajlarından biri, “konvansiyonel foton” tedavisine göre normal dokuda daha az erken ve geç yan etkiye sebebiyet vermesidir. Bu avantajlar tedaviye ara verilme ihtimalinin azalmasına ve radyoterapi ile eş zamanlı kemoterapi kullanımına olanak sağlamakta dolayısıyla tedavi etkiliğinin artmasına olanak vermektedir. Ayrıca, olumsuz geç etkilerin azalması hasta hayat kalitesinde artma ile sonuçlanmaktadır. PT'nin dozimetrik avantajlarının direk olarak kliniğe en iyi yansıdığı hasta gurupları uveal melanomlar ve kafa tabanı (kordoma ve kondrosarkoma) tümörleridir. Uygulama alanı bulunan hemen tüm beyin, baş-boyun, meme, prostat, erken evre akciğer, osefagus, karaciğer tümörleri ile yumuşak doku/kemik sarkomlarında lokal kontrol ve sağ kalım oranlarının en azından fotona eşit olduğu, ancak PT ile yan etki profilinin çok daha iyi olduğu bildirilmektedir. PT kliniğinde en çok kullanılan yöntem pasif saçılmadır. Paul Scherrer Enstitüsü tarafından geliştirilen isosentrik gantry ile aktif tarama teknolojisi kullanılmaya başlanmış ve yoğunluk ayarlı PT'ye olanak vermesi, pasif saçılmaya göre daha az nötron saçılması sonucu azalan integral doz ile dünyadaki tüm merkezlerin ilgisinin bu tekniğe çevrilmesine sebep olmuştur. Dünyada PT'ye olan ilgi giderek artmakta olup varolan merkezlerin yanı sıra faaliyete geçmesi planlanan birçok merkez bulunmaktadır.

Klinik proton terapi uygulamaları

Proton therapy (PT) has been in clinical use since 1970, and 61,122 patients have been treated as of the end of the 2008 in the world. The major advantage of PT over conventional radiatiotherapy is reduced side effects in the neighboring critical tissues, which in turn results in less treatment interruption and therefore better integration of RT with systemic chemotherapy. Indirectly, reducing late effects permits the radiation oncologist to dose escalation to a tumor which may potentially translate into higher tumor control rates. Additionally, patients experience a relatively better quality of life during and after PT. Proton therapy has been most extensively studied in the treatment of uveal melanomas and chordoma and chondrosarcoma patients. Other common tumors successfully treated with PT include central nervous system, head and neck, breast, lung, esophagus, prostate and liver tumors, and soft tissue/bone sarcomas. Proton therapy was conventinally delivered by passive scattering. Active scanning (AS) was developed at Paul Scherrer Institute. In addition to reducing scattered dose, intensity modulation and inverse planning are possible advantages offered by AS, therefore, most of the proton facilities in the world have voiced their interest in moving towards an AS system. Interest is growing in proton technology and newer PT facilities are being added to currently active ones all over the world.

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