Toksičnost radioterapije kod pacijenata sa karcinomom prostate

Jelena Stanić; Vesna Stanković; Marina Nikitović

doi:10.5937/mp72-32377

Jelena Stanić Specijalista radijacioni onkolog
Vesna Stanković NS dr sc. med prim.
Marina Nikitović Prof. dr

DOI: https://doi.org/10.5937/mp72-32377

Ključne reči: karcinom prostate; radioterapija; radijaciona toksičnost

Sažetak

Sažetak

Karcinom prostate je najčešći tumor u muškoj populaciji, čineći približno trećinu svih karcinoma. Budući da je preživljavanje često dugogodišnje bez obzira na primenjenu terapiju, odluke o lečenju mogu zavisiti od potencijalnih komplikacija specifičnih za terapiju. Većina pacijenata kojima je dijagnostikovan lokalizovani rak prostate na kraju umire sa, a ne zbog svoje bolesti. Kao rezultat, pacijenti kojima je dijagnostikovan rak prostate živeće mnogo godina sa posledicama svog specifičnog onkološkog lečenja.

Glavne terapijske strategije uključuju radikalnu prostatektomiju ili transkutanu radioterapiju. Radioterapija je jedna od opcija kurativnog lečenja. Odnos doze zračenja i tumorskog odgovora na terapiju je široko i detaljno proučavan i prihvaćen. Zapravo, nezadovoljavajuća lokalna kontrola bolesti sa dozama <70Gy dovela je do studija eskalacije doze i primenu visoko preciznih radioterapijskih tehnika kao što su trodimenzionalna konformalna radioterapija i intenzitetom modulisana radioterapija omogućavajući aplikovanje visokih doza zračenja na prostatu od 74-78 Gy.

Toksičnost tankog creva, rektuma i urinarna toksičnost su glavni ograničavajući faktori u isporuci visoke radioterapijske doze. Simptomi tokom lečenja uključuju promenu u navikama pražnjenja creva, hitnost u pražnjenju i fekalnu inkontinenciju. Najčešće kasne sekvele su hronična dijareja, proktitis ili rektalno krvarenje. Nekoliko faktora je povezano sa povećanom gastrointestinalnom toksičnošću - veća zapremina creva koja prima velike doze zračenja, starost pacijenta, dijabetes i istovremena upotreba androgen-deprivacione terapije.

Oštećenje mokraćne bešike, indukovano zračenjem, manifestuje se kao radijacioni cistitis (često mokrenje i dizurični poremećaji). Pušenje, prethodne abdominalne operacije i upotreba diuretika značajno utiču na pojavu akutne genitourinarne toksičnosti stepena ≥ 2. Faktori rizika za razvoj kasnih genitourinarnih komplikacija su veće doze zračenja, prethodni urinarni problemi, transuretralne intervencije i akutne genitourinarne komplikacije.

Izuzetno je značajno uspostaviti ravnotežu između potencijalne koristi i neželjenih efekata radioterapije. Ozbiljne kasne komplikacije značajno smanjuju kvalitet života dugoživećih pacijenata sa karcinomom prostate. Rano otkrivanje i pravilna procena terapijskih komplikacija, kao i personalizovani pristup terapiji su zbog toga posebno važni.

Biografije autora

Jelena Stanić, Specijalista radijacioni onkolog

Odsek za radioterapiju malignih tumora abdomena, Institut za onkologiju i radiologiju Srbije

Vesna Stanković, NS dr sc. med prim.

Šef odsekа za radioterapiju malignih tumora abdomena, Institut za onkologiju i radiologiju Srbije

Marina Nikitović, Prof. dr

Pomoćnik direktora za obrazovnu i naučnoistraživačku delatnost

Profesor onkologije i radiologije

Načelnik Odeljenja za radioterapiju solidnih tumora i ostalih malignih hemopatija

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