tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncowebtumors-173Research ArticleСтатьиСтереотаксическая лучевая терапия в лечении рецидивных опухолей прямой кишкиStereotactic radiation therapy in recurrent rectal cancer treatmentГлебовскаяВалерия ВладимировнаGLEBOVSKAYAV. V.

к. м.н., с. н.с.

Moscow

oncovalery@mail.ruТкачевСергей ИвановичTKACHEVS. I.

д. м.н., в. н.с.

Moscow

sitkachev@gmail.comНазаренкоАлексей ВитальевичNAZARENKOA. V.

к. м.н., зав.отд.

Moscow

llexoff@mail.ruТрофимоваОксана ПетровнаTROFIMOVAO. P.

д. м.н., в. н.с.

Moscow

dr.trofimova@mail.ruФГБУ РОНЦ им. Н. Н. Блохина» МЗ РФРоссияFSBSC «Russian Cancer Scientific Center named after N. N. Blokhin»Russian Federation20152111201504s28287Copyright © Глебовская В.В., Ткачев С.И., Назаренко А.В., Трофимова О.П., 20152015Глебовская В.В., Ткачев С.И., Назаренко А.В., Трофимова О.П.GLEBOVSKAYA V.V., TKACHEV S.I., NAZARENKO A.V., TROFIMOVA O.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/173

Анализ данных, получаемых за последние годы, свидетельствует о неуклонном росте заболеваемости колоректальным раком как в России, так и в других развитых странах.

В лечении рецидивов рака прямой кишки в настоящее время не существует единых стандартов. В последние годы в мире отмечается стремление к использованию многокомпонентных комплексных программ, включающих, помимо хирургического метода, лучевую и лекарственную терапию. Рецидивные опухоли считаются резистентными к лучевому лечению, а локальное воздействие высокими дозами лучевой терапии зачастую ограничено толерантностью близлежащих органов и дозой ранее проведенной лучевой терапии. Повторное лучевое воздействие несет в себе значительный риск из-за кумулятивного воздействия ионизирующего излучения на критические структуры и нормальные ткани. Высокоточные технологии конформной лучевой терапии (лучевая терапия с модуляцией интенсивности (IMRT), брахитерапия, интраоперационная лучевая терапия и стереотаксическая радиотерапия) применяемые с целью облучения рецидивных опухолей, способствуют снижению токсичности и более щадящему воздействию на нормальные ткани. Существуют исследования, показывающие эффективность современных технологий стереотаксической радиотерапии (SBRT), которые являются вариантом радиотерапевтического агрессивного лечения, обеспечивающего приемлемый локальный контроль при минимальной токсичности. Инновационным направлением применения лучевой терапии у данной категории больных является протонная терапия и терапия ионами углерода. Распределение энергии пучка протонов с практически нулевой выходной дозой открывает новые возможности, при повторном облучении, позволяет снизить дозу излучения в тканях за пределами опухолевой мишени, что важно у больных, которые при первичном облучении уже получили дозу, близкую к максимально допустимой.

Analysis of the last data shows that there is a steady rise in colorectal morbidity not only in Russian Federation, but also in other developed countries. In rectal cancer treatment there are no standarts by the moment. Last years all over the world there are tendencies to use multicomponent complex modalities of treatment wich include not only surgery, but also radiation therapy and chemotherapy.

Recurrent cancer is considered as radioresistent, and local treatment with high doses of radiation is frequently limited by normal tissues’ tolerance and by dose received in previous course. Reirradiation is always a risk because of cumulative radiation dose to organs at risk and normal tissues. Highly precise techniques of radiation therapy, such as IMRT, brachytherapy, IORT, stereotactic radiation therapy can be used in reccurent cancer treatment because of toxicity decrease and sparing of normal tissues.

Some data shows that usage of modern technologies is effective when using CyberKnife. Stereotactic radiation theapy (SBRT) is a variant of aggressive treatment which is able to provide good local control with minimal toxicity. Innovative approach in reirradiation for patients with recurrent cancer is proton therapy and carbon ion therapy. Dose distribution in proton therapy with its practically no exit dose clears the way to new abilities in reirradiation, leads to dose decrease in tissues outside irradiated volume, and it’s very important in patients who got virtually maximal dose while treating initial disease.

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The authors declare that there are no conflicts of interest present.