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Tajuk TERAPI SINARAN IV

1. Terapi Bim Proton


2. Terapi Bim Neutron
3. Terapi Bim Ion
4. Brakiterapi
5. Stereotaktik RT
6. Stereotaktik Radiosurgeri
7. 3D Conformal RT
8. IMRT ( Intensity Modulated RT)
9. IGRT ( Image Guided RT)
10.IORT ( Intraoperative RT)
11.Hipertermia

Terapi Bim Neutron


➢ Partikel berat yang pertama digunakan dalam rawatan radioterapi
➢ unsur nukleus atom berinteraksi terus dengan nucleus tisu
➢ Jisim lebih besar dari proton
➢ 1.67 x 10^-27 kg
➢ Tidak bercas
➢ Kadar 10-20% adalah kadar pesakit yang boleh dirawat menggunkan neutron
➢ Dengan cyclotron moden bertenaga tinggi sesuai untuk kadar pesakit yang tinggi

Neutron sesuai untuk tumor

• Locally advanced =
• Non metastatic = tidak merebak
• Radioresistant = rintang terhadap sinaran

Pengalaman rawatan : neutron digunakan untuk merawat

• Salivary gland ca ( kanser kelenjar)


• Advanced prostate ca ( kanser ca ….)
• Certain sarcoma

Rasional rawatan neutron ( neutron terapi )

LET (linear energy transfer) =

Kesan biologi oleh radiasi yang berbeza tidak hanya bergantung pada :

 Pemberian dos …..tapi

 Penyebaran mikroskopik dos = ditunjukkan melalui kesan LET

Radiasi LET tinggi = neutron,pions, ion berat =tenaga rendah = kesan biologi semakin besar

Radiasi LET rendah =Photon,electron, proton bertenaga tinggi. = tenaga tinggi = kesan biologi
semakin kecil

LET tinggi = kerosakan tisu tidak dapat dibaiki

LET rendah = tisu yang rosak mempunyai kadar tinggi untuk diperbaiki semula= sublethal
(repairable) damage.
LET tinggi sgt efektif untuk rawatan = kanser yang lambat proses pertumbuhan,besar, dan rintang
terhadap sinaran.

Cth : knser kelenjar liur,PNS,kepala dan leher,prostate,tulang dan payudara; tisu lembut
sarcoma,uterine sarcoma,dan melanoma.

RBE (relative biological effectiveness)

Definasi = Nisbah dos radiasi rujukan (biasanya Co60) yang diperlukan untuk menghasilkan
kesan biologi tertentu terhadap kesan radiasi yang diberi yang diperlukan untuk menghasilkan kesan yang
sama.

OER ( oxygen enhancement ratio)

Definasi = Nisbah dos radiasi yang diperlukan untuk menghasilkan kesan biologi yang tertentu di
bawah keadaan kurang oksigen terhadap dos yang diperlukan untuk menghasilkan kesan yang sama di
bawah keadaan beroksigen.

3D CRT (conformal Radiotherapy)..


What is Single-Day Targeted Intraoperative Radiotherapy?
Intraoperative Radiotherapy is a type of Partial Breast Irradiation in which the entire radiation
therapy treatment is given during surgery, immediately following the removal of the breast
cancer. Intraoperative Radiotherapy permits breast cancer surgery and radiotherapy to be given
on a single day, instead of the usual practice of administering radiotherapy over 6-7 weeks after
surgery.

Photo A

Photo B

Figure 1. Photo A shows the Photon Radiosurgery System. Photo B shows


Intrabeam Photon Radiosurgery system covered by one of several different-
sized applicators (arrow) designed to fit the lumpectomy cavity.
The Intrabeam PRS System is placed in the lumpectomy cavity following removal of the berast
cancer (See Figure 2)
Drawing A Drawing B

Figure 2. Drawing A showing breast and lumpectomy cavity (star) after


removal of breast cancer. Drawing B shows Intrabeam Photon
Radiosurgery System and applicator (arrow) positioned within the
lumpectomy cavity. Bright red area shows portion of breast receiving the
highest dose of radiotherapy
The Photon Radio System is capable of delivering radiation to the inside of the breast targeting
breast tissue immediately surrounding the lumpectomy cavity. This permits the entire treatment
to be given in a single dose. Also, since Targeted Intraoperative Radiotherapy can be placed
dierctly into the lumpectomy cavity, radiotherapy can be given to the parts of the breast that need
it most, while sparing the nearby normal breast, chest, and shoulder from the effects of radiation.
Single-Day Targeted Intraoperative Radiotherapy is designed to administer the highest dose of
radiotherapy to a distance of 1cm (1/3 inch) surrounding the lumpectomy cavity. This portion of
the breast is at the greatest risk of developing a breast cancer recurrence. As a result, this area is
targeted for radiotherapy. Although the untreated parts of the breast may still may develop a
breast cancer recurrence, we know that the vast majority of breast cancer recurrrences develop in
the region of the breast immediately surrounding the original breast cancer. For this reason, the
study investigators believe that Single-Day Targeted Intraoperative Radiotherapy may be safely
given to women who have well defined, completely removed breast cancers

Brakiterapi

-kaedah rawatan radioterapi dimana sumber radioterapi yang di ‘sealed’ digunakan untuk memberi radiasi
pada jarak yang pendek melalui cara , meletakkannya di dalam tisu (interstitial), di dalam ruang organ
(intracavitory) dan pada permukaan kulit (surface application).
-Dos radiasi yang tinggi dapat diberi secara terus pada tumor dengan pengurangn sertamerta dos pada tisu
yang berhampiran.(……deliverd locally to tumour with rapid fall-off in sorrunding tissue)

Terapi interstitial ( dalam tisu)