Side effects occurrence during radiotherapy treatment of rectum cancer and anal cancer with bolus

Uvod: Rak danke in rak analnega kanala sta dandanes v porastu, vzrok za nastanek raka danke pa je še vedno dokaj neznan. Zdravljenje s teleterapijo lahko povzroči pojav hudih stranskih učinkov, še posebej pri obsevanju površinsko ležečih tumorjev z uporabo bolusa, saj ta povzroči dvig maksimalne doze iz globine proti površini kože. Visoka doza tako prizadene tudi zdravo kožo in sluznico. Namen: Namen diplomskega dela je ugotoviti, katere stranske učinke povzroča uporaba bolusa med obsevanjem, kako so izraženi in kdaj se pojavijo. Poleg tega želimo ugotoviti razlike med stranskimi učinki pri obsevanju raka danke in raka analnega kanala z uporabo bolusa in stranskimi učinki, ki so se pojavili pri bolnikih po obsevanju raka danke brez uporabe bolusa. Metode: V diplomskem delu smo uporabili retrospektivno metodo dela in pregled strokovne literature. Pri iskanju ustreznih podatkov o bolnikih smo uporabili časovni okvir od 1. 11. 2014 do 31. 1. 2017. Izbrali smo 30 naključno izbranih bolnikov z rakom danke in rakom analnega kanala, obsevanih s tehniko intenzitetno modulirane radioterapije (IMRT) – od tega je bilo 15 bolnikov obsevanih brez in 15 z uporabo bolusa. Podatke smo pridobili v programu Webdoctor in sistemu Mosaiq obsevalnega aparata (Clinac 2100 C/D) Varian na radioterapevtskem oddelku Onkološkega inštituta Ljubljana. Podatke smo analizirali s pomočjo računalniškega programa Microsoft Office Excel 2010. Rezultati: Po obsevanju z uporabo bolusa se pojavi več stranskih učinkov in v večji intenziteti kot pri bolnikih brez uporabljenega bolusa. Razlika je tudi v lokaciji le-teh. Najpogosteje se po uporabi bolusa pojavljata radiodermatitis in bolečina v predelu zadnjika, medtem ko sta najpogosteje izražena stranska učinka pri skupini bolnikov brez bolusa diareja in disurija. Razprava in zaključek: Aplikacija bolusa je pri obsevanju površinsko ležečih tumorjev obvezna, da tarčni volumen prejme optimalno dozo, zato je pomembno, da se nastale stranske učinke spozna in blaži takoj, ko se pojavijo. Stranski učinki pri obsevanju raka danke in raka analnega kanala v izbranem vzorcu niso bili tako težavni, da bi bilo treba zaradi njih prekiniti terapijo za daljše obdobje.Introduction: Rectum cancer and anal cancer are occurring at an increasing rate, however, the cause of rectal cancer is still relatively unknown. Teletherapy treatment may cause severe side effects, especially when the surface lying tumors are irradiated with use of the bolus. Bolus causes the increase of the maximum dose from the depth to the surface, so a high dose affects healthy skin and mucosa. Purpose: The purpose of this degree paper is to determine which side effects are caused by using bolus during irradiation, and the manner and the time they appear. In addition, the paper aims to determine the differences between side effects occurring in the radiotherapy of rectal cancer and anal cancer with the use of bolus and side effects occurring in patients with rectal cancer without the use of bolus. Methods: A retrospective method was used and a review of the scientific literature was conducted. The time frame for the search of relevant patients was from 1.11.2014 to 31.1.2017. 30 patients with rectal cancer and anal cancer treated with intensity modulated radiotherapy (IMRT) were randomly chosen, 15 of which were treated with the use and 15 without the use of bolus. The data were collected via Webdoctor program and Mosaiq system of linear acceleration (Varian Clinac 2100 C/D) at the radiotherapy unit of the Institute of Oncology Ljubljana. Statistical analysis was performed with the use of Microsoft Office Excel 2010 programme. Results: There are more side effects in patients after the irradiation with the use of bolus and greater intensity of symptoms than in those irradiated without of the bolus. The difference is apparent also in the location of side effects. The most commonly occurring side effects after radiotherapy treatment with bolus are radiodermatitis and pain in the anus, while in the group of patients without bolus the most common ones are diarrhea and dysuria. Discussion and conclusion: When surface lying tumors are irradiated, the application of the bolus is required so that the target volume receives the optimal dose. Therefore, it is important to be aware of the possible side effects and to reduce them as soon as they occur. The side effects when irradiating the rectum cancer and anal cancer in this particular sample of people were not so problematic to cause the discontinuation of the therapy for a longer period of time