cancer de prostata radioterapia
TRANSCRIPT
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RadioTerapia
Cáncer Próstata
Dr. Yan Carlos Vargas Caycho MR. RADIOTERAPIA
Hospital E. Rebagliati.
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RT Cáncer Próstata
Riesgo bajo
Riesgo Intermedio
Alto Riesgo
T – TNM Stage
PSA
Gleason Score
Prostatéctomia Radioterapia
Hormonoterapia
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RT Cáncer Próstata
Radical
Adyuvancia
Rescate
RT Externa
3D
IMRT
Ra 223 - Samario
Braquiterapia Mets. osea
IGRT
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Radical
RT Cáncer Próstata
Neoadyuvante
Bajo Riesgo
Riesgo Intermedio Dism. Vol. prostático.
Escalada de Dosis Alto Riesgo
Asociación HT
Dism. Riesgo Recaída local
Reducción de Metástasis
Efectividad de la RT
Neoconcomitante
>10 años; RT <75Gy
6 meses HT
Neoconcoadyuvante
10 años; RT <75Gy
2 – 3 años HT
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Radical
RT Cáncer Próstata
T1b – 3 N0
No HT
301.
MD Anderson
2008
Escalada de Dosis
70 Gy vs 78 Gy
RT 2D – 3D
SLRB 8 años
BR: 63 vs 88 %
RI: 65 vs 94 %
AR: 26 vs 63 %
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Radical
RT Cáncer Próstata
T1 – 3
HT 53%
561.
Selefsky
2006
Escalada de Dosis
81 Gy
IMRT
SLRB 8 años
BR: 89 %
RI: 78 %
AR: 67 %
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Radical
RT Cáncer Próstata
Bajo Riesgo
Riesgo Intermedio
> 75 Gy
VVSS
Alto Riesgo
PROSTATA > 78 Gy
> 78 Gy
(-)
(+)
54 Gy
66 Gy
Linfaticos (-)
(+)
50 Gy
56 - 70 Gy
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Adyuvante
RT Cáncer Próstata
T3 N0
margenes +
1005.
EORT 22911
2005
pT3 – Margenes +
Observacion vs
60 Gy
SLRB 5 años
52.6 vs 74 %
T3 N0
margenes +
431.
SWOG 8794
2009
Observacion vs
60 - 64 Gy
SLRB 5 años
35 vs 64 %
T3 N0
margenes +
307.
Aleman
Wiegel 2005
Observacion vs
60 Gy
SLRB 4 años
60 vs 81 %
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Adyuvante
RT Cáncer Próstata
PSA Indetectable
Rec BQ
60 - 66 Gy
Rec local
Bed Tumor 66 - 70 Gy
> 78 Gy
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Rescate
RT Cáncer Próstata
RecBQ
Rec Local Bed Tumor
66 - 70 Gy
> 78 Gy
RCBQ Post Cirugía: PSA > 0.2ng/ml 21PO
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Organos de Riesgo
RT Cáncer Próstata
Cabezas femorales
Recto
V50 < 5%
V 60 < 42 % - Dmedia: < 50 Gy
Vejiga V 70 < 20 %
Proctitis actínica
Cistitis actínica
Osteonecrosis
Impotencia RTE 45 %
Bulbo peneano V 45 < 20 %
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Dr. Yan Carlos VARGAS
T 2cm = 100 000 000 000 (10 *11)
Cel. Clon = 100 000 000 (10 *8)
1Gy = IONIZACIONES/CEL 100 000 (10*5)
IONIZACIONES DIRECTAS ADN 2000
EXITACIONES DIRECTAS ADN 2000
1Gy =
1 000 (10*3)
ROTURAS
SIMPLES
1Gy =
40
ROTURAS
DOBLES
1Gy =
250
ALTERACIONES
TIMINA
1Gy =
25
ALTERACIONES
DESOXIRRIBOSA
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↑ RT Dose ↓ RT Dose
↑ T – Control ↓ T – Control
↑ Normal Tissue
Toxicidad
↓ Normal Tissue
Toxicidad
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CT Simulacion
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Radioterapia 2D
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• 3DCRT MLC based conformal field
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2D RT 3DCRT
IMRT Rapid Arc
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Braquiterapia
Cancer de Prostata
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Brachytherapy
Intersticial
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HDR - Braquiterapia
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Braquiterapia con Semillas de
125 I en Ca de Prostata
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Braquiterapia de Prostata
Iodo 125
t ½ = 60 dias
Gamma
Energia 35 kV
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Braquiterapia de Prostata
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Tomotherapy - 2003
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Synchrony™
camera
Treatment couch
Linear
accelerator
Manipulator
Image
detectors
X-ray sources
Targeting System
Robotic Delivery System
Cyber Knife – 2003+
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IGRT - 2005
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True beam - All in One FFF SBRT /
4DRT –
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True Beam - 2010
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Proton Beam therapy 2012
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Proton Beam therapy 2012
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RADIATION ONCOLOGY TEAM
Edgardo Rebagliati Martins National
Hospital
Lima - PERU