癌症治疗的新愿景:图像引导近距离放射治疗

源自《国际原子能机构通报》

技术的进步有助于为图像引导近距离放射治疗等技术铺平道路,这些技术能够带来更好的结果,为患者提供更好的生活质量。

详细的医学图像有助于医疗卫生专业人员区分肿瘤、健康组织和器官,以确保放射源正确对准治疗部位。(图/ Auna Oncosalud)

技术的进步有助于为图像引导近距离放射治疗等技术铺平道路,这些技术能够带来更好的结果,为患者提供更好的生活质量。

“图像引导近距离放射治疗是一种高度个性化和精细调节的癌症治疗方法,有助于提高多种癌症的生存率,同时降低并发症的风险,”秘鲁Auna Oncosalud医院放射治疗科医学主任 Gustavo Sarria Bardales说。“随着全世界癌症病例的增加,图像引导近距离放射治疗的使用为一些常见的癌症,如乳腺癌、前列腺癌和宫颈癌提供了安全、有效和高质量的治疗。进一步开发和实施这项技术,是扩大更多患者获得服务和为他们提供有效护理的大好机会。”

虽然近距离放射治疗(一种使用放射源的内照射放射治疗)100多年来一直是许多癌症的常用治疗方法,但由于医学成像、治疗规划和剂量传送方面的进步,图像引导近距离放射治疗在过去15年才成为可能。

图像引导近距离放射治疗旨在使辐射剂量杀死癌细胞的效果最大化,同时尽量减少周围健康细胞受到照射。它使用详细的三维医学图像来捕捉器官体积的变化,以便根据患者的需要定制和优化近距离治疗。这些图像显示了肿瘤和相关器官的确切大小和部位,以便医疗团队精确规划并安全地将放射源直接放置在肿瘤旁边或肿瘤内部进行治疗。这种放置可以是临时性的,使用包含源的可拆卸敷贴器;也可以是永久性的,使用称为种子的源,这些源无限期地留在体内,随着时间的推移,种子源会失去放射性,变得无害。

对于某些类型的癌症,如宫颈癌,图像引导近距离放射治疗与体外射束放射治疗相结合,而对于其他类型的癌症,如乳腺癌和前列腺癌,图像引导近距离放射治疗可以用作一种排他性治疗。通过图像引导近距离放射治疗,可使用较高剂量的辐射直接对准肿瘤,这意味着健康组织接受的辐射剂量较低,因为源直接放置在肿瘤内或肿瘤旁边。

然而,原子能机构放射肿瘤学家Alfredo Polo Rubio解释说,将源放入患者体内需要不同学科的专业知识,如手术、成像和外形修整术,以及治疗规划。“这不是‘一刀切’的过程,因为每个患者的身体和每个肿瘤都不同,而近距离放射治疗是一种个性化治疗。将近距离放射治疗与成像相结合,使医疗团队更清楚地看到肿瘤和周围器官,并有助于放置放射源、评估肿瘤反应和更准确地调整辐射剂量。”

虽然图像引导近距离放射治疗因其高成功率而被认为具有成本效益,但它仍然昂贵。这项技术需要昂贵的软件和硬件来完成个性化治疗计划,还需要一支高素质的专家团队,从肿瘤学家到剂量师和放射治疗师,在某些情况下,还需要外科医生,以协助在患者体内放置放射源敷贴器。

世界上许多国家正在与原子能机构合作,发展其癌症治疗服务,并在这些服务条件成熟时采用创新方法,如图像引导近距离放射治疗。通过原子能机构的技术合作项目和协调研究项目,专家们得到培训和设备,以及接触专业网络的机会,以提高他们的专业知识。原子能机构还编制了导则和技术文件,以支持图像引导近距离放射治疗的实施,并指导专业人员从简单的技术过渡到更复杂的技术。

一些国家,如秘鲁,现正朝着图像引导近距离放射治疗的方向发展,以帮助应付日益增长的癌症负担。

“癌症正在迅速成为秘鲁人的第一死因,而且还在继续增加,”Sarria Bardales说。秘鲁每年约有6.6万人被诊断患有癌症。“卫生系统还没有为这种流行病学转变做好准备,因此需要采用像图像引导近距离放射治疗这样的新解决方案。”

秘鲁已与原子能机构合作30多年,以建立其癌症护理服务。在过去五年中,这种合作包括建设秘鲁在图像引导近距离放射治疗方面的人力资源能力,并使秘鲁专业人员与这一特定领域的国际网络和专家联系起来。

“我们过去仅限于传统的二维和三维近距离放射治疗。现在,我们已经开始使用图像引导近距离放射治疗,并期待看到其使用的全部影响,”Sarria Bardales说。“我们预计,在接下来的十年里,图像引导近距离放射治疗将成为癌症患者的一种更标准的治疗方法,因为它是一种更个性化的方法,成功率更高,使其成为对各种癌症更具成本效益和更适合的治疗方法。”

 

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近距离放射治疗涉及将放射源放置在患者体内或身上,这可以用线、管子或针头等工具来完成。

(图/ Auna Oncosalud)

Although IGBT is considered cost-effective thanks to its high success rate, it remains costly. The technique requires expensive software and hardware to complete the personalized treatment plan, as well as a highly qualified team of specialists, from oncologists to dosimetrists and radiation therapists, and, in some cases, surgeons, to assist with the placement of applicators in the patient’s body.

Many countries worldwide are working with the IAEA to develop their cancer treatment services and, when they are ready, to adopt innovative methods, such as IGBT. Through IAEA technical cooperation and coordinated research projects, experts receive training and equipment, as well as access to professional networks to boost their expertise. The IAEA has also produced guidelines and technical documents to support the implementation of IGBT and to guide professionals in the transition from simple to more complex techniques.

Some countries, such as Peru, are now moving towards IGBT to help manage the growing burden of cancer.

“Cancer is quickly becoming the first cause of death among Peruvians and is continuing to increase,” said Sarria Bardales. Around 66 000 people in Peru are diagnosed with cancer each year. “The health system is not prepared for such an epidemiological transition, so new solutions like IGBT need to be adopted.”

Peru has worked with the IAEA for more than 30 years to build up its cancer care services. In the last five years, this collaboration has included building Peru’s human resources capacity in IGBT and connecting Peruvian professionals with international networks and experts in this particular area.

“We used to be limited to conventional 2D and 3D brachytherapy. Now we have begun using IGBT and are waiting to see the full impact of its use,” Sarria Bardales said. “We expect that, in the next decade, IGBT will become a more standard treatment for cancer patients, as it’s a more personalized approach and has a higher rate of success, making it a more cost-effective and adequate treatment method for various types of cancer.”

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Brachytherapy involves placing radioactive sources inside or on the body, which can be done with tools such as wires, tubes or needles. (Photo: Auna Oncosalud)