Akutna toksičnost pri radioterapiji raka analnega kanala z IMRT ali VMAT obsevalno tehniko : magistrsko delo

Meznarič, Metka (author), Oblak, Irena (mentor), Žager Marciuš, Valerija (comentor), Marinko, Tanja (reviewer)

Uvod: Rak analnega kanala je redko maligno obolenje. Temeljno zdravljenje je kombinacija radioterapije in kemoterapije. Kombinirano zdravljenje omogoča boljšo ozdravljivost bolnika, hkrati pa tudi večjo toksičnost z več neželenimi učinki, tako akutnimi kot kroničnimi. Z razvojem strojne in programske opreme v radioterapiji se uporabljajo vse naprednejše obsevale tehnike, ki omogočajo boljšo dozno porazdelitev v tumorju in manjšo obsevanost okolnih zdravih tkiv. Namen: Namen magistrskega dela je bil ugotoviti vrsto takojšnjih neželenih učinkov in njihovo pojavnost ter izraženost pri bolnikih z rakom analnega kanala, ki so zdravljeni z IMRT (intenzitetno modulirana radioterapija) ali VMAT (volumetrična ločna terapija) obsevalno tehniko in jih primerjati s starejšo 3D CRT (3- dimenzionalna konformna radioterapija) obliko zdravljenja. Metode dela: Izvedli smo retrospektivno raziskavo s pregledom medicinske dokumentacije iz kliničnega informacijskega sistema WebDoctor in ThinClinical. Pregledali in pridobili smo podatke za 93 bolnikov, ki so se v času od novembra 2012 do novembra 2019 radikalno zdravili na Onkološkem inštitutu v Ljubljani zaradi raka analnega kanala. Za statistično obdelavo podatkov smo uporabili osnovno frekvenčno statistiko porazdelitve podatkov akutne toksičnosti. Za oceno preživetja smo uporabili Kaplan-Maierjevo krivuljo preživetja. Izračunali smo Coxov regresijski model. Rezultati: Kompleten odgovor na zdravljenje je bil zabeležen pri 79,1 % bolnikov, pri 20,9 % bolnikih pa je bil potrjen ostanek oziroma ponovitev bolezni, najpogosteje na mestu vznika tumorja, sledijo oddaljeni zasevki in najredkeje ponovitev bolezni v področnih bezgavkah. Petletno PBPBLR (preživetje brez ponovitve bolezni lokoregionalno) znaša 83 %, petletno PBPB (preživetje brez ponovitve bolezni) pa 77 %. Novejšim obsevalnim tehnikam smo dokazali statistično značilen boljši izid zdravljenja (p=0,0026). Življenjsko ogrožajočih akutnih neželenih učinkov pri naših bolnikih nismo beležili. Kot resnejši neželeni učinek stopnje 3 je bil najpogosteje opisan radiodermatitis, kar pri 65,6 % bolnikov, sledi okužba pri 31,2 % bolnikov, radiomukozitis pri 7,7 % bolnikih in slabost z bruhanjem pri 1,1 % bolnikov. Ostali neželeni učinki so bili blažje izraženi. Pri primerjavi izraženosti neželenih učinkov zdravljenja med novejšimi in starejšimi tehnikami obsevanja ugotavljamo, da se le-ti z izjemo radiodermatitisa pojavljajo pri uporabi novejših obsevalnih tehnik v blažji obliki. Zaključek: Pri uporabi sodobnih, novejših obsevalnih tehnikah imajo bolniki blažje akutne neželene učinke zdravljenja, kar omogoča zdravljenje brez škodljivih prekinitev in posledično uspešnejše zdravljenje.

• Language: Slovenian
• Keywords: magistrska dela, radiološka tehnologija, rak analnega kanala, radiokemoterapija, toksičnost, intenzitetno modulirana radioterapija, volumetrična ločna terapija
• Work type: Master's thesis/paper
• Typology: 2.09 - Master's Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [M. Meznarič]
• Year: 2021
• Number of pages: 48 str., [2] str. pril.
• PID: 20.500.12556/RUL-131816
• UDC: 616-07
• COBISS.SI-ID: 79154179
• Publication date in RUL: 04.10.2021

MEZNARIČ, Metka, 2021, Akutna toksičnost pri radioterapiji raka analnega kanala z IMRT ali VMAT obsevalno tehniko : magistrsko delo [online]. Master’s thesis. Ljubljana : M. Meznarič. [Accessed 25 March 2025]. Retrieved from: https://repozitorij.uni-lj.si/IzpisGradiva.php?lang=eng&id=131816

Secondary language

• Language: English
• Title: Acute toxicity in anal canal radiotherapy with IMRT or VMAT radiation technique : master thesis

Abstract

Introduction: Anal cancer is a rare type of malignancy. Basic treatment is a combination of radiotherapy and chemotherapy. Combined therapy allows better healing of the patient, but also causes greater toxicity, with more side effects, acute as well as chronic. With the development of hardware and software in radiotherapy over the years, increasingly advanced irradiation techniques are being used that allow for a better dosage concentrated more on the tumor and less on the surrounding healthy tissue. Purpose: Our purpose was to determine the type of direct toxic effects and their incidence and severity in patients with anal cancer who were undergoing a treatment of IMRT (Intensity Modulated Radiotherapy) or VMAT (Volumetric Modulated Arc Therapy) radiation therapy and compare them with the results of the older 3D CRT (Three-Dimensional Conformal Radiation Therapy) type of treatment. Methods: We conducted a retrospective study, which included review of physical medical records as well as records from the clinical information system WebDoctor and ThinClinical for 93 patients with anal canal cancer who were undergoing a radiotherapy at the Oncology Institute in Ljubljana between November 2012 and November 2019. For statistical data processing, we used the basic frequency statistics for the distribution of acute toxicity and to asses survival rates we used the Kaplan-Meier survival curve. Also we calculated the Cox regression model. Results: Complete response to treatment was reported in 79.1% of patients, while in 20.9% of patients residual or recurrent disease was confirmed, most commonly at the site of tumor onset, followed by distant metastases and least commonly in regional lymph nodes. Locoregional relapse-free survival at five years is 83% and five-year disease-free survival is 77%. Modern radiation techniques demonstrated statistically significant improvements in treatment outcome (p=0,0026). No life-threatening acute side effects were reported in our patients. Grade 3 radiodermatitis was most commonly reported as a more serious adverse reaction in 65.6% of patients, followed by infection in 31.2% of patients, radiomucositis in 7.7% of patients, and nausea with vomiting in 1.1% of patients. Other side effects were milder. When comparing the severity of side effects of the newer and older irradiation techniques, we find that, with the exception of radiodermatitis, they occur in a milder form when using newer radiation techniques. Discussion and conclusion: When using modern, advanced radiation techniques, patients experience milder acute side effects of treatment, which allows for a treatment without detrimental interruptions and consequently more successful treatment.

• Keywords: master's theses, radiologic technology, anal cancer, radiochemotherapy, toxicity, intensity-modulated radiation therapy, volumetric modulated arc therapy