Obsevanje v globokem zadržanem vdihu po operaciji raka dojk

Breast cancer has high incidence and prevalence. Long-termcause-specific survival of breast cancer patients has increased overthe past decades primarily due to early detection, advanced surgical techniques, systemic therapy and new radiation techniques. Due to higher share of patients who receive radiation and longer survival,ever more patients risk the occurrence of late unwanted effects of the treatment. For the majority of patients, the benefits of radiation with lower chance of disease recurrence greatly surpass the risk of developing cardiovascular complications, the cumulative incidence of which increases with every received dose per heart. Preventing late heart damage has become an important part of comprehensive treatment of breast cancer patients. When planning the therapy, benefits of supplementary radiotherapy and potential risk of side effects are assessed for each patient individually by taking into account dose volume parameters of the radiotherapy plan and existing risk factors for cardiovascular disease, since the presence of these indicates higher absolute risk of late heart damage. The latest radiotherapy techniques are gaining importance, as they allow us to improve dose-volume parameters of radiotherapy plans. Deep inspiration breath-hold radiotherapy technique allows us to significantly lower the average dose of ionizing radiation received by the heart, lung, and liver compared to traditional radiation technique, while the radiation dose per planned target volume remains the same. When taking a deep breath, the diaphragm pulls the heart posteriorly, mediallyand inferiorly – away from the thoracic wall. Deep inspiration breath-hold radiotherapy technique is recommended for all patients with indications for radiation therapy after breast-conserving surgery or mastectomy of the left breast, with or without simultaneous radiation of local lymph nodes, in the event of unfavorable anatomy and when parasternal lymph nodes are included in the radiation field after cancer surgery of the right breast. This paper describes a new radiotherapy method – the deep inspiration breath-hold techniqueRak dojk ima visoko incidenco in prevalenco. Dolgoročno vzročno specifično preživetje bolnic z rakom dojk se je v zadnjih desetletjih izboljšalo predvsem zaradi zgodnjega odkrivanja, naprednih kirurških tehnik, sistemske terapije in novih tehnik obsevanja. Zaradi večjega deleža obsevanih bolnic in daljšega preživetja je več bolnic izpostavljenih tveganju za razvoj poznih neželenih učinkov zdravljenja. Za večino obsevanih bolnic je dobrobit obsevanja z zmanjšanim tveganjem ponovitve bolezni veliko večja od tveganja za razvoj poznih srčno-žilnih zapletov, katerih kumulativna incidenca se povečuje z vsako dodatno prejeto dozo na srce. Preprečevanje poznih okvar srca postaja pomemben del celostne obravnave bolnic z rakom dojk. Ob načrtovanju zdravljenja ocenjujemo koristi dopolnilnega obsevanja in možna tveganja za pojav neželenih učinkov za vsako posamezno bolnico: upoštevamo dozno-volumske parametre obsevalnega načrta in individualne že obstoječe dejavnike tveganja za srčno-žilne bolezni, saj prisotnost le teh napoveduje višje absolutno tveganje za pozno okvaro srca. Moderne obsevalne tehnike imajo vedno večji pomen, saj omogočajo izboljšanje dozno-volumskih parametrov obsevalnih načrtov. Obsevanje v globokem zadržanem vdihu v primerjavi s standardnim obsevanjem značilno zniža povprečno prejeto dozo ionizirajočega sevanja na srce, pljuča in jetra, ob sicer nespremenjeni obsevalni dozi, na planirni tarčni volumen v prsnem košu. Pri globokem vdihu trebušna prepona odmakne srce posteriorno, medialno in inferiorno: stran od stene prsnega koša. Obsevanje v globokem vdihu je priporočeno za vse bolnice, pri katerih obstaja indikacija za obsevanje po ohranitveni operaciji ali mastektomiji zaradi raka leve dojke z ali brez sočasnega obsevanja regionalnih bezgavk, v primeru neugodne anatomije in ko so po operaciji raka desne dojke v obsevalno polje zajete tudi parasternalne bezgavke. V prispevku je opisana nova metoda obsevanja - obsevanje v globokem zadržanem vdihu. ; slv - slovensk