tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2017-3s1-35-40tumors-377Research ArticleСтатьиИнтраоперационная лучевая терапия: реальность и перспективаНовиковВ. А.vnovi17@zoho.comВасильевР. В.vnovi17@zoho.comЧойнзоновЕ. Л.vnovi17@zoho.comЛисинВ. А.vnovi17@zoho.comМусабаеваЛ. И.vnovi17@zoho.comГрибоваО. В.vnovi17@zoho.comСурковаП. В.vnovi17@zoho.comШтинВ. И.vnovi17@zoho.comРябоваА. И.vnovi17@zoho.comНИИ онкологии Томского Национального исследовательского медицинского центра РАНRussian Federation20171711201703s13540Copyright © Новиков В.А., Васильев Р.В., Чойнзонов Е.Л., Лисин В.А., Мусабаева Л.И., Грибова О.В., Суркова П.В., Штин В.И., Рябова А.И., 20172017Новиков В.А., Васильев Р.В., Чойнзонов Е.Л., Лисин В.А., Мусабаева Л.И., Грибова О.В., Суркова П.В., Штин В.И., Рябова А.И.Новиков В.А., Васильев Р.В., Чойнзонов Е.Л., Лисин В.А., Мусабаева Л.И., Грибова О.В., Суркова П.В., Штин В.И., Рябова А.И.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/377Резюме

Резюме: Комбинированное лечение с использованием ИОЛТ (интраоперационная лучевая терапия) предполагает максимально радикальное удаление основного опухолевого процесса, а возможные микрофокусы рака в прилежащих тканях, оставшиеся микрометастазы девитализировать с помощью интраоперационного облучения, основной точкой приложения которого является область большего онкологического риска. Помимо этого, использование ИОЛТ позволяет сократить время лечения и значительно снизить лучевую нагрузку на кожу и критические органы при сочетании с наружным облучением. Ключевым моментом при планировании ИОЛТ является правильный выбор однократной дозы, кроме того, при сочетании с ДГТ (дистанционная гамма-терапия) необходимо решить вопрос об изоэффективности их воздействия на нормальные ткани. Величина суммарной курсовой дозы смешанного облучения ИОЛТ и ДГТ не должна превышать 60–65 иГр, или в показателях фактора ВДФ 100–125 усл. ед. в очаге-мишени. В Томском НИИ онкологии разработана методика комбинированного лечения злокачественных опухолей полости носа и придаточных пазух с предоперационным курсом фотонной терапии в режиме среднего фракционирования дозы, последующим хирургическим вмешательством и ИОЛТ на ложе удаленной опухоли. Однократную дозу ИОЛТ определяли по формуле. Интраоперационная лучевая терапия проводилась на малогабаритном бетатроне МИБ-6Э с энергией 6 МэВ, разовая очаговая доза равнялась 10–12 Гр. Доказательства эффективности применения ИОЛТ получены при клинической апробации метода. Проведено лечение 115 больных раком полости носа Т3–4. Лечение удовлетворительно перенесли все больные. Анализ локализации рецидивов после комбинированного лечения с ИОЛТ и ДГТ показал, что дополнительное облучение зон «риска» в операционной полости позволяет снизить частоту рецидивов в этих зонах и существенно повлиять на показатели выживаемости больных. Показатели 5-летней безрецидивной выживаемости в основной и контрольной группах составили 66,2 ± 8,8 % и 40 ± 9,2 % соответственно. Накоплен собственный клинический опыт, осуществлена методологическая и методическая разработка проведения интраоперационного облучения. Проведенные исследования продемонстрировали безопасность доставки ИОЛТ при лечении пациентов с локально развитым раком головы и шеи в контексте агрессивной комбинированной терапии.

 

 

 

 

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