brachyterapi pada kanker ginekologi

8/18/2019 brachyterapi pada kanker ginekologi

1/41

AURORA MAREZKHA FARRAH

PEMBIMBING :Dr. SARAH DINA, M.ked(OG), SpOG.K


2/41

Pengo!"!n p!d! p!#$en k!nkerg$neko%og$ &e%$p'"$ pe&ed!!n,r!d$o"er!p$, d!n ke&o"er!p$.

R!d$o"er!p$ d!p!" d$g'n!k!n #e!g!$"er!p$ '"!&! &!'p'n "!&!!n p!d!k!nker g$neko%og$

R!d$o"er!p$ den$"$* +!ng #'d! !k''n"'k keg!n!#!n g$neko%og$ → externalbeam radiotherapy (EBR) d!nbrachytherapy , !"!' ko&$n!#$ked'!n+!.


3/41


4/41


5/41


6/41

pene&p!"!n !p%$k!"or $n"r!'"er$ne !"!'$n"r!-!g$n!% +!ng #e!r! erk!%! d$$#$deng!n #'&er r!d$o!k"$* /012#, 334R!,/53Ir

S$#"e& !p%$k!"or +!ng p!%$ng #er$ngd$p!k!$ !d!%! Fletcher-Suit-Delcos

system R!d$!#$ p!d! rek"'& d!n k!nd'ng ke&$

d!p!" d$per"!!nk!n d!%!& !"!#"o%er!n#$ deng!n &e"ode afterloading


7/41


8/41


9/41

Do#$# "o"!% 'n"'k "$"$k A : 67869 G+(#"!d$'& I8IIA, non-bulky tumor ), 69857 G+ (#"!d$'& %ok!% %!n'", bulky

tumor ). $"$k B (D$nd$ng pe%-$#) : 97899 G+

(#"!d$'& I8IIA, non-bulky tumor ), 698

47 G+ (#"!d$'& %ok!% %!n'", bulkytumor). Brachytherapy d$er$k!n d!%!& *r!k#$

3 ; /0 G+, deng!n $n"er-!% 1 !r$.


10/41

do#$# per *r!k#$ !r'# < 1,9 G+ per *r!k#$'n"'k &eng'r!ng$ ke&'ngk$n!n "$&'%n+!ko&p%$k!#$ %!n'".

Do#$# erg!n"'ng p!d! -o%'&e "'&or,

ke&!&p'!n 'n"'k &en+$#$k!n k!nd'ngke&$ d!n rek"'&, regre#$ "'&or p!#!r!d$!#$ ek#"ern!.

d$&'%!$ p!d! &$ngg' ke"$g! deng!n do#$#/ k!%$ per &$ngg'. =$k! "'&or e#!rd$%!k'k!n 3; per &$ngg'

>!&! "er!p$ &!k#$&!% 6 &$ngg' (r!d$!#$

ek#"ern! ? brachytherapy ).


11/41


12/41

&e&'"'k!n per!ngk!"afterloading deng!n #'&er %on!"!n"'ngg!% Ir$d$'& /53 (/53Ir). P'%#!#$

"$!p /7 &en$" @ !& &e&er$k!n#e"!r! do#$# 47 G+ per !&.

E*ek $o%og$# !&p$r #!&! deng!n>DR, d!n do#$# op"$&!% HDR.


13/41


14/41

Se'! "!'ng $n"r!'"er$n ("!nde&)d!r$ %og!& deng!n adjustable ange +!ng d!p!" d$!"'r 'n"'k &en+e#'!$k!n

deng!n p!n!ng k!-'& '"er$. D'! '! !p%$k!"or er'p! "!'ng

ko%po#"!" +!ng d$"e&p!"k!n d$ *orn$k#-!g$n!.

Ap%$k!"or d$$#$ deng!n 2e#$'&, d!p!"p'%! d$%!k'k!n deng!n #$#"e&afterloading


15/41


16/41


17/41


18/41


19/41


20/41


21/41

S'&er r!d$o!k"$* d$%e"!kk!n deng!n!r! Permanent Implant f Seed

Mer'p!k!n p$%$!n '"!&! ke"$k!!p%$k!"or $n"r!k!-$"er "$d!k d!p!"d$g'n!k!n

Mengg'n!k!n template


22/41


23/41


24/41


25/41

Pengg'n!!n MRI 'n"'k pengo!"!n d!nperen!n!!n brachytherapy per"!&!k!%$ d$%!pork!n p!d! "!'n /553 o%eSoeppe%, dkk

Brachytherapy $n"r!k!-$"er +!ngd$p!nd' MRI &e&'ngk$nk!n op"$&!#$do#$# r!d$!#$ +!ng !k'r!" d!n

&e&'ngk$nk!n do#$# +!ng %e$ "$ngg$'n"'k d$er$k!n kep!d! !r$ng!n "!rge"


26/41

Ko&p%$k!#$ k%$n$# +!ng p!%$ng #er$ng"er!d$ p!d! I2R !d!%! do#$# r!d$!#$+!ng "$d!k #e#'!$ "!rge", d$ &!n!

do#$# "$ngg$ d$!n"!rk!n ke !g$!n8!g$!n d!r$ rek"'& d!n k!nd'ngke&$ +!ng er!d! d$ dek!" deng!n

#'&er r!d$!#$ !g$n!% dr+ne## ( -!g$n! ker$ng ) S"eno#$# -!g$n!


27/41

D!p!" d$o!"$ !$k deng!n >DR (lo!dose rate), PDR ( pulse dose rate) !"!'HDR (high dose rate) deng!n Disease-

free sur"i"al d!n o"erall sur"i"al +!ng#!&!.

Ko&$n!#$ deng!n EBR,brachytherapy d!p!" &e&er$k!n !#$%+!ng %e$ !$k d!r$p!d! EBR #!!


28/41


29/41


30/41

Se!r! '&'& d$g'n!k!n 'n"'k p!#$en!$k deng!n p!ngg'% +!ng %'!#d!n@!"!' pen+!k$" p!d! -!g$n! d!%!&'p!+! 'n"'k &engon"ro% #e!r! %ok!%

S$"'!#$ +!ng "$d!k &e&'ngk$nk!nd$%!k'k!n intraca"itary brachytherapy deng!n !p%$k!"or #"!nd!r k!ren!

&!#!%! !n!"o&$. ''!n: 'n"'k &en+e#'!$k!n do#$#

r!d$!#$ deng!n !n!"o&$ p!#$en deng!n!k'p!n -o%'&e "!rge" +!ng %e$ !$k


31/41

Beer!p! #"'d$ &e&perk$r!k!n!! ke%!ng#'ng!n $d'perk'r!ng


32/41

Brachytherapy adjuvantHDR B !d'-!n" → An!%$#$# p!d!p!#$en k!nker endo&e"r$'& #"!d$'&

II /9 !n$"! p!#! AH ? BSO.

HDR B d$er$k!n d!%!& 6 !r$

deng!n do#$# "o"!% /4,6 G d!%!&"$g! *r!k#$ deng!n pengg'n!!n!p%$k!"or "ere#!r (3,98,7 &).


33/41

er!p$ p!#! oper!#$ deng!n #$%$nder -!g$n!&e&er%'k!n pe&er$k#!!n +!ng er&!""er!d!p -!g$n! &'ko#! !pe; d!n #ee%'&pen+$#$p!n → d$!&e"er d!n p!n!ng #$%$nder

+!ng !k!n d$g'n!k!n. ''!n → &e&!#'kk!n #$%$nder deng!n

d$!&e"er "ere#!r %!+!k "!np!ke"$d!kn+!&!n!n +!ng #$gn$k!n. Se'!

#$%$nder +!ng %e$ ke$% &'ngk$n "$d!k!po#$#$ p!d! &'ko#! d!r$ -!g$n! !g$!n !"!#d!n d!p!" &en'r'nk!n do#$# per&'k!!n&'ko#!.

R!d$!#$ d!p!" er'p! >DR !"!' HDR.


34/41


35/41

K!nker endo&e"r$'& +!ng #e!r!&ed$# $#! d$oper!#$ &'ngk$n&e&$%$k$ ko&ponen "!nde& g!nd!

+!ng d$"e&p!"k!n 'n"'k&en$ngk!"k!n "er!p$ !"!' 'n"'kendpoint p!%$!"$* !p%$k!"or HDR +!ng

"er#ed$! deng!n !"!' "!np!ko&ponen #$%$nder "erp!#!ng.


36/41

Pengg'n!!n $&p%!n r!d$!#$ p!d! p!#$enk!nker -'%-! → M!rg!re" od (/55) d$Ho%"

!p%$k!"or +!ng '&'& d$g'n!k!n deng!n%'!ng p!d! $n"er-!% +!ng reg'%er 'n"'k&e&'ngk$nk!n pene&p!"!n p$"! Ir8/53.


37/41


38/41

Pere e" !%. &er!n!ng !p%$k!"or-!g$n! +!ng d$#e'" MIRA>A(M!%%$nkrod" In#"$"'"e o* R!d$o%og+

A*"er >o!d$ng !g$n!% App%$!"or) In$ &engg!'ngk!n d'! #'&er

o-o$d d!n p'#!" "!nde& → d!p!"d$g'n!k!n 'n"'k &engo!"$ #e%'r'-!g$n! &e&$%$k$ "'"'p !pek# -!g$n!d!n %eng!n #$%$nder "!&!!n →d!p!" &en$ngk!"k!n d$&en#$.


39/41


40/41

Br!+"er!p+ &er'p!k!n !g$!n pen"$ng d!r$pengo!"!n &'%"$&od!%$"+ &odern 'n"'k p!#$endeng!n keg!n!#!n g$neko%og$ 'n"'k &en!p!$"$ngk!" ke#e&'!n +!ng op"$&!%.

pengo!"!n !r'# $nd$-$d'!%, "er&!#'k pe&$%$!n%!' do#$#, en$# !p%$k!"or, d!n do#$# "o"!%, 'n"'k&e&!k#$&!%k!n po"en#$ pen+e&'!n d!n

&e&$n$&!%k!n "$ngk!" ko&p%$k!#$ ke#e%'r'!n.

r!+"er!p+ g$neko%og$ &e&'"'k!n "$ngk!"#$gn$k!n ke!%$!n #er"! "$& +!ng pro*e#$on!%.


41/41

brachyterapi pada kanker ginekologi

Documents

Transcript of brachyterapi pada kanker ginekologi