İntraoperatif Radyoterapide Radyasyon Maruziyeti ve Cerrahların Dikkat Etmesi Gereken Durumlar
Özet
İntraoperatif radyoterapi (IORT), cerrahi müdahale sırasında tümör yatağına doğrudan yüksek dozda ışın uygulanması esasına dayanan etkin bir brakiterapi yöntemidir. Temel amacı, sağlam dokuları maksimum düzeyde korurken lokal nüks riskini azaltmak ve eksternal radyoterapinin sınırlarını aşan bölgelerde doz yoğunluğunu optimize etmektir. Uygulama; elektron ışını (IOERT), düşük enerjili X ışını ve yüksek doz hızlı brakiterapi (HDR-IORT) gibi farklı tekniklerle, cerrah, radyasyon onkoloğu ve medikal fizikçiden oluşan multidisipliner bir ekip tarafından yürütülür. Meme, pankreas ve kolorektal kanserler başta olmak üzere birçok malignitede lokal kontrolü artırır. Tedavi odalarının kurşun kaplamalı duvarlar ve izole kontrol panelleriyle donatılması, çalışanların ise ALARA prensibi doğrultusunda koruyucu ekipman ve dozimetre kullanması radyasyon güvenliği açısından zorunludur. Görüntü kılavuzluğunun olmaması gibi kısıtlamalarına rağmen, modern 3 boyutlu planlama yöntemleri IORT'nin başarısını ve güvenilirliğini artırmaktadır.
Intraoperative radiotherapy (IORT) is an effective brachytherapy method based on delivering high-dose radiation directly to the tumor bed during surgery. Its primary objective is to reduce the risk of local recurrence while maximizing the preservation of healthy tissues and optimizing dose intensity in areas exceeding external radiotherapy limits. The application is carried out using different techniques such as electron beam (IOERT), low-energy X-ray, and high-dose-rate brachytherapy (HDR-IORT) by a multidisciplinary team consisting of a surgeon, radiation oncologist, and medical physicist. It enhances local control in various malignancies, particularly breast, pancreatic, and colorectal cancers. For radiation safety, it is mandatory that treatment rooms feature lead-lined walls and isolated control panels, and staff must use protective equipment and dosimeters in line with the ALARA principle. Despite limitations like the lack of image guidance, modern 3D planning methods improve the success and reliability of IORT.
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