Proton therapy in head and neck cancers

Authors

  • สาริน กิจพาณิชย์ สาขารังสีรักษาและมะเร็งวิทยา ฝ่ายรังสีวิทยา โรงพยาบาลจุฬาลงกรณ์

Abstract

การฉายรังสีด้วยโปรตอน (proton) ได้รับความสนใจมากขึ้น เนื่องจากคุณสมบัติทางฟิสิกส์ของโปรตอนจะถ่ายทอดรังสี ปริมาณสูงไปยังจุดปลายพิสัยในเนื้อเยื่อหรือจุดที่โปรตอนหยุดเคลื่อนที่ เรียกว่า Bragg peak หลังจากนั้นปริมาณรังสีจะลดลง อย่างรวดเร็ว ดังนั้นเนื้อเยื่อปกติหรืออวัยวะข้างเคียงบริเวณด้านหน้าและด้านหลังของก้อนมะเร็งจึงได้รับปริมาณรังสีน้อยมาก ซึ่งแตกต่างจากรังสีเอกซเรย์พลังงานสูงที่ใช้กันอย่างแพร่หลายในปัจจุบันหรือโฟตอน (photon) มีการศึกษามากมายที่แสดง ให้เห็นความสามารถของโปรตอนในการลดปริมาณรังสีไปสู่อวัยวะข้างเคียงหรือ organs at risk (OARs) [1] ซึ่งมะเร็งศีรษะและ ลำคอเป็นหนึ่งในโรคมะเร็งที่ผู้ป่วยได้รับผลข้างเคียงระหว่างและภายหลังการฉายรังสีมาก เนื่องจากก้อนมะเร็งและอวัยวะข้าง เคียงอยู่ในระยะประชิดกัน เพราะฉะนั้นการฉายรังสีในมะเร็งศีรษะและลำคอจึงอาจได้ประโยชน์จากคุณสมบัติทางของโปรตอน จากคำแนะนำด้านนโยบายการใช้และการเบิกจ่ายเพื่อการฉายรังสีโปรตอนโดย American Society for Radiation Oncology หรือ ASTRO model policy เผยแพร่ในปี 2017 [2] ได้จัดมะเร็งศีรษะและลำคอระยะลุกลามเฉพาะที่หรือระยะ T4 หรือไม่ สามารถผ่าตัดได้ มะเร็งของโพรงไซนัส และมะเร็งที่ต้องฉายรังสีซ้ำ อยู่ในกลุ่มมะเร็งที่มีหลักฐานทางคลินิกที่สนับสนุนการใช้ โปรตอน บทความฉบับนี้จึงได้รวบรวมหลักฐานและงานวิจัยต่างๆ เกี่ยวกับการฉายรังสีด้วยโปรตอนในโรคมะเร็งศีรษะและ ลำคอที่พบได้บ่อย ดังจะกล่าวถัดไป

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2018-12-27

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กิจพาณิชย์ ส. Proton therapy in head and neck cancers. J Thai Assn of Radiat Oncol [Internet]. 2018 Dec. 27 [cited 2024 May 2];24(2):48-63. Available from: https://he01.tci-thaijo.org/index.php/jtaro/article/view/203030

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