JİNEKOLOJİK TÜMÖRLERDE ÜÇ BOYUTLU KONFORMAL RADYOTERAPİ JİNEKOLOJİK TÜMÖRLERDE RADYOTERAPİ

Radyoterapi, jinekolojik tümörlerin gerek primer gerekse postoperatif adjuvant tedavi olarak küratif tedavinin önemli bir parçasıdır. Bu gaye ile uygulanacak radyoterapi volümü primer tümör veya tümör yatağı ile ilgili bölgesel lenf nodlarını kapsamalıdır. Tedavi başarısı açısından sağkalım ve toksisite kadar yaşam kalitesi de önemli bir kriterdir. Teknolojik gelişmelerin radyoterapi üzerine yansıması ve 3 boyutlu tedavilere geçiş ile arzulanan sonuçlara ulaşma oranları artmıştır. Yapılan birçok çalışma ile konvansiyonel yöntemlerde kemik referansların kullanılması ile gerekli tedavi alanlarının kapsanmadığı gösterilmiştir. Hedef hacmin daha iyi saptanması, daha uygun doz dağılımı, daha az erken ve geç yan etki, tümörde daha yüksek doza ulaşma, daha iyi lokal kontrol, daha iyi yaşam kalitesi ve sağkalım gereksinimleri 3 boyutlu konformal radyoterapinin güncel tedavi stratejisi olmasını zorunlu kılmıştır. İyi tasarlanmış bir simülasyon işlemi sonrasında hedef hacimler ve risk altındaki organlar titizlikle belirlenmelidir. Planlamada kullanılan hedef hacimler Uluslararası Radyasyon Birim ve Ölçümleri Komisyonu (International Commission on Radiation Units and Measurement-ICRU)’nun 50 ve 62 numaralı raporlarına göre düzenlenmektedir. Anatomik yapıları daha net ayırarak planlamaya yardımcı olması amacı ile tedavi pozisyonunda alınan dozimetrik magnetik rezonans (MR) görüntüleri rutin olarak kullanılmalıdır. Ayrıca gelecekte BT-MR görüntü birleştirme işleminin daha yaygın kullanılabilme imkânı olabileceği ümit edilmektedir. Sonrasında planlama sistemleri üzerinden tedavi alanlarının ve dozlarının belirlenmesi ile güvenilir bir biçimde radyoterapi uygulanabilmektedir. Sonuç olarak tüm gelişmiş ülkelerde ve ülkemizdeki büyük merkezde 3 boyutlu konformal tedavi standart olarak kullanılmaktadır. Ekip çalışması ile tüm aşamalar titizlikle yapılmalıdır ve her aşamanın denetimi ile tedavi kalitesinin arttırılacağı unutulmamalıdır

Anahtar Kelimeler:

Jinekolojik tümörler, radyoterapi, 3 boyutlu planlama

THREE DIMENSIONAL CONFORMAL RADIOTHERAPY AT GYNECOLOGICAL MALIGNANCIES

Radiotherapy is an important part of both primary and postoperative adjuvant treatments of gynecological tumors. With this goal radiotherapy volume should include the primary tumor or tumor bed and regional lymph nodes. Quality of life is also important criteria such as survival and toxicity for treatment success. The rate of desired results have increased with reflection of tecnological developments on radiotherapy and the passage of 3-dimensional treatments. Many studies have shown that the use of bone references in conventional methods are not covered the necessary treatment areas. Three-dimensional conformal radiotherapy became the current treatment strategy for a better determination of the target volume, more convenient dose distribution, less early and late side-effects, higher tumor dose ,better local control ,better quality of life and survival. After a well-designed simulation, target volumes and organs at risk should be determined carefully. International Commission on Radiation Units and Measurements’s 50 and 62 reports are used for arranged planning target volumes. The dosimetric magnetic resonance images in treatment position are routinely used to help planning by seperation the anatomical structures more clearly. After that, the radiotherapy can be applied in a reliable manner by the determination of treatment areas and doses at planning systems. As a result, three-dimensional conformal radiotherapy is used as standard treatment in all developed countries and the great centers of our country. All steps should be done carefully with teamwork and it should be noted that the quality of treatment will be increased with the control of each stages

Keywords:

Gynecological tumors, radiotherapy, three-dimensional planning.,

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