and serum IL-2 level in systemic lupus erythematosus, Journ, Immunol., 141 (3), pp. 827-33.
6. Kytlaris V.C, Tsokos G.C. (2004), T lymphocytes in systemic lupus erythematosus: an update, Curr, Opin.
Rheum.. 16(5), pp 548-52.
7. Papadaki H.A,, Boumpas D,T., Gibson F.M., Jayne D.R„ et al. (2001), Increased apoptosis of bone marrow CD34* cells and impaired function of bone marrow stromal cells In patients with systemic lupus erythematosus, Br. Joum, Haematol. 115, pp. 167-74.
8. Toubi E., Kessel A., Rosnert 1., Rozenbaum M., Paran D., Shoenfeld Y. (2006), The reduction of semm B-lymphocyte activating fac tor levels following
quinacrine add-on therapy in systemic lupus erythematosus, Scan, Journ. Immunol, 63, pp, 299-303.
9. Viallard J.F., Bloch-Michel C , Neau-Cransac M,, el al. (2001), HLA-DR expression on lymphocyte subsets as a marker of disease activity in patients with systemic lupus erythematosus, Clin. Exp. Immunol. 125, pp, 485- 91.
10. Wenzel J., Gerdsen R., Ueriich M.. Bauer R., Tueting T,, Bieber T. (2004), Lymphocytopenia in lupus erythematosus: close in vivo association to autoantibodies targeting nuclear antigens, British joum.
Dennatol., 150, pp. 994-8.
XAY D U N G QUY TRiNH LAP KE HQACH XA TRj DIEU BIEN LIEU (IMRT) von CT VA PET/CT Md PHONG TRONG DIEU TRI UNG THU VU TAI BENH VIEN BACH MAI
MAI TRQNG KHOA
Trung tim Y hpc h^ nhin vd Ung budu-BV Bach Mai
TOM T A T
Xa tri, la mit trong nhdng biin phip ea bin di diiu tri binh ung thd vO. Viic tao duae ki ho^ch xa tri, tii Uu liiu xa tri tap tmng cao vao vung tin thuang, liiu xa tri_ tii thiiu vio cic ti chdc linh xung quanh ddng vai trd quan trgng trong nang cao hiiu qui diiu tri va giim thiiu cac biin chdng. Phuang phip xa tri 3D giiip tao dugc ke hoach xa tri tuang dii tit tuy nhiin vin eon h§n ehi trong nhiiu trddng hgp vi giy ra mdt si biin ehi/ng, die biet la xa phii. Viic i/ng dung xa tri diiu biin liiu vdi CT vi die biit vdi PET/CT trong diiu tri binh ung thu vu giup mang lai hiiu qui diiu tri cao va han chi biin chdng trong vi sau xa tri.
Dii tugng va phuong phap: Nghiin cdu tiin cdu trin cic binh nhan ung thu vu cd chi dmh xa tri, dugc xa tri theo phuang phap xa tri diiu biin liiu (IMRT).
Kit qua nghien eUu: Da xay dmg dugc quy trinh xa tri diiu biin Hiu trong diiu tri binh ung thu vO. Vi lim sang, kit qui ban diu cho thiy, lap ki ho?ch xa tti diiu biin liiu cho kit qui xa tri tii, an toin, hiiu qui cao.
Kit iuan: dng dung phuang phip xa tri diiu biin liiu trong lip ki hoach xa tri gia tic cho cic binh nhan ung thu vU giOp dat hiiu qui cao han, an toan va it tie dung phij do xa tri.
Tdkhda: Xa tri. ung did vO.
SUMMARY
Radiation is one of the common therapeutic modalities for breast cancer treatment An optimized treatment plan is developed that respects the target dose requirements as welt as the dose constraints of the surrounding dose-limiting structures. 3D radiotherapy creats plans well but still limited in many cases, especially pulmonary fibrosis. Application of IMRT with CT and specially with PET/CT In breast
cancer improves efficiency and minimizes complication.
Patients and Method: prospective study with radiation therapy indication for breast cancer patients.
Results: Building process of IMRT planning with CT and specially with PET/CT in the treatment of breast cancer was built. In clinical practice, the primary result is good and safe.
Conclusion: Application of IMRT for breast cancer treatment improves signifieantly in radiation planning.
Keywords: Radiation, breast cancer OAT VAN D ^
Tai V i i t nam, ung thu vu la benh ung thu pho bien nhd't d nu'gidi, Tuy giai doan b i n h , dieu trj ung thUvu c i n phai phdi hpp phdu thual, xa trj, hda trj, npi tiltva midn djch. Trudc d i y , ty le bdnh nhdn ung thu vO di/pc phSu thudt cat toan bd tuyIn vd k i t hpp vet hach naeh cao (khoang 90% sd benh n h i n ung thif vd) da dem lai nhilu bien chCmg sau md cho benh nhdn nhd. phu bach mach tay, ngudi phu nu'cam thay m i l tu tin khi giao t i l p .
Cac nghidn cCfu gan day da dUpc t i l n hanh nham muc dfch dieu tri bao ton vd cho nhung benh nhin ung thu vd giai doan sdm sau dd d i l u tri hda tri, xa tn.
Do do vai trd cda xa trj ngay cdng duoc n i n g cao. Vdi phUdng phdp xa tri thdng thudng ty l i to chCfc phoi Idnh phai chju lieu bCre xa cao nhieu nen cd nhieu b i n h nhdn bj xo phdi sau xa trj. Nham muc dich giam thieu tdi da tdc dung phu eho cae b i n h n h i n ung thit vd cd chi dinh xa tri, phuong phdp xa tri dieu biln lieu ra ddi [4], [5].
Xa tri trong d i l u tri benh ung thU vu dupe chl i^nh xa tri bd trp ddi vdi ung thU vd giai doan sdm vd xa trj trieu chCmg cho cac benh nhdn ung thU vd giai doan mudn, Xa trj bd Irg dupc chia lam hai loai. tan b l trcl
Y HOC THUC HANH (848) - SO 11/2012
trudc phlu thudt (xa tri tien phiu) vao vd v i xa trj hdu phdu vdo dien thdnh nguc d i phdu Ihudt vd hach vung. Xa tn gidp k i l m sodt benh tai chd, tai vdng v i tang thdi gian sdng them [1], [3],
Xa trj dieu b i l n l i l u (Intensity Modulated Radiation Therapy: IMRT) trong dieu trj tan bd trp giup t i p trung lieu xa tri vdo td chCrc vd, han c h l dupe l i l u xa trj v i o md phoi Idnh va d i e biit n l u ung thU vd trdi thi han c h l dupc tdi da l i l u xa trj vdo tim [6].
Xa In d i l u b i l n lieu trong dieu trj bd trd giup han che tdi da lieu xa tri vao tim nhung khdng eai thiin dupc lieu xa trj t i p trung vao dien thanh ngUC, hach nach va khdng giam dUOc iieu xa tri nhilu tai phdi idnh [6],
TCr thdng 7 n i m 2008 tai Trung tam y hpc hat nhan va ung budu bdnh v i i n Bach mai da dp dung phuong phap xa trj d i l u biln lilu vdi CT md phdng d i e biet l i PET/CT md phdng trong d i l u trj eho mdt sd benh nhdn ung thU vung dau mdt co, ung thU vCi, ung thu cd tCr cung, ung thU thuc quan
Chung tdi thuc hien nghien cCru ndy nham muc tieu: "Xay dung quy trinh xa tri diiu biin liiu trong diiu tri binh ung thu vii vdi CT vi PET/CT md phdng tmng diiu kiin nude ta."
PHUONG P H A P V A DO'I T I / O N G NGHIEN CLTU 1. Dd'l tUdng nghien cdxi:
Cac benh n h i n ung thu vd cd chan doan x i e dinh v i e d chi djnh xa tri,
2. PhUdng phap nghien curu:
+ Md ta t i l n cdu, x i y dung quy trinh xa trj dilu biln lilu trong d i l u trj bdnh ung thu vd v i md ta mpt sd binh nhin ung thir vd da dugc d i l u trj xa trj dieu biln lilu tai Trung tdm y hoc hat nhdn vd Ung budu Benh vien Bach mai tir 10/2009 den 1/2011
2.1. Chuan bjb^nh nhan:
- Benh nhdn dupc giai thich ro v l benh, hudng dieu tri v i mpt sd d i l u c i n thilt khi xa trj nhU: binh nhin phai nam yen trong qua trinh md phdng cung nhu xa trj
- T u t h I binh nhan: Benh nhdn nam ngd'a, hai tay gio len tren.
Md phdng:
a), Thue hien chup md phdng bang chup cat Idp vi tfnh (CT) hodo tdt nhat la PET/CT. Benh' nhin dupc
dpi ngi3 nhin vien xa trj gan mdt sd diem m i e danh d i u tren eo the vdi h i thdng laser djnh vj khdng gian 3 chilu.
b). Chup CT hodc PET/CT md phdng vung nguc, c i c hinh anh thu dupe cd khoang c i c h 5 mm. Chuyin hinh anh CT, PET/CT md phdng vao mdy tinh l i p ke hoach xa In vdi p h i n m i m Prowess Panther 4.6
c). Chup PET/CT md phdng
+ Dupc chat phdng xa: Dung dieh F-18 FDG (2- fluoro-2-deoxy-D-glucose), l i l u ddng 0,15 - 0,20 mCi/Kg can ndng (7 -12 mCi).
+ Chuan bj b i n h n h i n : theo quy trinh ddnh rieng cho bdnh nhdn c l i u l n bi chup PET/CT
+ Chup hinh PET/CT (cua hdng Slemen): t i l n hdnh sau t i i m F-18 FDG 45 - 60 phdt.
+ XCf ly hinh anh va nhdn djnh k i t qua' K i t qua dupc phdn tfch, danh gid vd dua ra n h i n djnh cudi cdng sau khi khao sat hinh anh CT, hinh anh PET, hinh ldng ghep PET/CT v l tinh chat hap thu, phdn bo hoat chit phdng xa F-18 FDG. Cdc hinh anh sau khi xCr ly xong s i duoc chuyen sang phdng l i p k l hoach xa trj vdi phan mem chuyin dung rieng.
L i p k l hoach xa trj;
+ Xie dinh cae thi tieh diiu tri:
- T h i tich bia ldm sang (CTV: clinical target volume): khdi u vd, nen khdi u vd ± hach ndch.
- The tich k l hoach (dich) dieu trj (PTV: planning target volume): bao gdm todn bp tuyen vd ben cd u ± hach hoac thanh ngUc ben ton thuong u da phdu thuat ± hach. Neu da p h i u thuit eat tuyIn vd v i vet hach nach (phiu thuit Patey) thi gidi ban tren: dau trong xuong ddn. gidi han dudi: 2 cm tir n i p lan vu, gidi ban trong: vupt q u i dudng giu'a 1 cm, gidi ban ngoai: dudng nach giita.
- The tfch dfch sinh hoc BTV (Biotogical Target Volume) trin PET/CT vdi ngudng SUV = 2.5
2.2. Kiem tra chSt lupng ki hoach (QA: Quality Assurance): Ky sU vdt ly cung ky t l i u i l vien kiem tra k l hoach xa tri bang phantom chuyen dung trude khi lien hinh d i l u trj. Sai sd cho phep giu'a lieu ke hoach vd lilu thuc t l phai nhd hon 5%. tdt nhat nhd hon 3%.
2.3, Tien hinh xa tn cho benh nhdn theo k l hoach trin may xa In gia tdc
KET QUA
1. Quy trinh xa trj bao gdm cac budc sau:
1. Chuin bib9nh nhdn 2, Chgp CT, PET/CT md phdng
3, Lip k l hogch xg tri
5. Tien hanh xg tri
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+ Quy trinh t r i n dUdc ap dung thudng quy trong xa trj d i l u biln l i l u eho cdc bdnh nhdn ung thuvd tai Trung t i m Y hoc hat n h i n vd ung budu-Bdnh vidn Bach Mai, Cdc k l hoach xa trj dat c i c tidu chuin v i c i c thdng sd ky thudt theo quy djnh.
- Lieu xa trj;
+ > 4 hach ndch di cdn: xa tri todn bp tuyln vd 50 Gy (+/- bd sung l i l u tai k h i i u. n i n khdi u 10 - 1 6 Gy) + hach vung hd ndch, hach dUdi ddn, hach trdn ddn, cd t i l l xa trj hach vd trong,
+ 1-3 hach ndch di c i n : xa tn t o i n bd tuyln vd 50 Gy (+/-bd sung l i l u tai khdi u, n i n khdi u 10 - 1 6 Gy), Cd t h i xa tri hach di/di ddn, hach t r i n ddn. hach vd trong.
+ Hach ndch khdng di cdn: xa trj todn bp tuyln vd 50 Gy (+/-bl sung l i l u tai khdi u, n i n khdi u 10 Gy).
+ Xie dinh cic t^ng cin bio vi (Cic t?ng nguy cip: OARVs: The organ at risk volumes): Bao g l m phdi eung bdn, d i u t r i n xuOng c i n h tay, tim vd cdc mach mdu Idn vdi gidi han l i l u tai cdc tang c i n bSo vd trong gidi ban l i l u nhusau;
Bang 1, Gidi ban l i l u cho mpt s l md Idnh MO Idnh
Phdi cCing M n Phdidfiibfin
Gidi han \\&\i (dp dung cho ung thu vu) 5Gychodif(5i30%th^tfchph6i 20 Gy cho difiJi 10% Ih^ ti'ch ph6\
HoSn to^n khftnq bi chi^u xg
5 Gy cho dtrdi 50% thS tich cQa tim 10 Gy cho dirdi 33% t h i tfch cOa fini 20 Gy cho dudi 10% I h l tfch cQa tim 40 Gy cho dirdi 3% t h i tfch cOa tim + Ning lugng chum tia, hUOng va si lugng cic tn/dng chiiu:
MCto ndng luong, sd lupng v i hudng cac chdm tia' Thudng dung mCrc ndng lupng photon 6 MV, electron cho xa n i n g l i l u .
S l luong va hUdng eac chum tia Vdi ky thuat IMRT-JAW Only, cd t h i sit dung 5.6, 9 chum tia v6i n h i l u gdc dp khac nhau. Tuy nhidn, ed the sCf dung 2 trudng c h i l u ludt t i l p t u y l n (nhu trong xa trj quy Udc) vdl mdi trudng c h i l u khoang 20 segments ma khdng can sijr dung wedge nhU trong xa tri quy udc dd cho k i t quS r i t tdt v l s u ddng nhat cda dUdng ddng l i l u vdi cdc the tich tia xa ddng thdi giam thieu cho tim v i phdi.
+ Thuc hiin tH uu hoi lliu: bang phin mem chuyin dung Prowess Panther 4.6. Tinh l i l u , kiem tra phdn l i l u tren md u vd tang Idnh xung quanh; ^en ban dd dudng ddng l i l u , hinh anh ba chilu va bieu do l i l u - t h i tfch (DVH: Dose Volume Histogram)
IMRT lanoentiai ftc«»
^%,
- - M c d g a onty tiir-gonBainaiiJ*
'\ \
\ I —
•
Hinh 1: Hinh anh 3 c h i l u vd b i l u do DVH cua benh nhdn ung t h U v u
- Vdi ky thuit IMRT, dudng ddng lieu bao sat khdi u hop ly hOn ddng thdi khdng bj nhiJng d i l m ndng (hot spot) vd giam thilu nguy cd loet, hoai tijf vung vu do tia xa so vdi ky thuit xa tri thdng thudng [6).
- C d t h e sCr d u n g C T h o d c P E T / C T d l m d p h d n g .
Hinh 2: Hinh PET/CT d mat phSng axlai tha'y khd'l u nhd d vu trai t i n g h^p thu FDG (mui ten vang). Tren hinh k h CT kh6 d^nh g i i dupc tinh chat ci)a t ^ n thUtfng,
Y HOC THVC HANH (848) - SO 11/2012
2. Cac bien chdmg do tia xa:
Vdi ky thuit IMRT, c i c b i l n ehCmg do tia xa it hdn rat nhilu, thudng cd t h i gdp:
Biln chdng d p tinh: Met mdi, viem da do tia xa ft gap.
Bien chCmg man tinh: Khdng thudng gdp nhu phd tay voi, t i n thUdng mupn nhu xO phii, suy tim. hoai tCf xUong sudn, xo hda da.
3. Mo tk mot so trudng hdp lam sang:
Trudng hpp lim sing 1:
Binh n h i n NguySn Thj Vinh H., nu- 65 tuoi, duoc chin dodn ung Ihd vd T4bNxM1, md binh hoc; ung thu bilu md t h i I n g xdm nhip, Bdnh nhdn tudi cao, t h i trang chung y l u ndn bdnh nhdn v i gia dinh tir chdi phau thudt. Bdnh nhdn dupe ehi djnh xa tri 60Gy.
Binh n h i n da dudc xa trj dieu b i l n l i l u vdi vdi 5 beams/ 25 segments, p l i i n lieu 2 Gy/ngdy tai u
Hinh 3. So sanh do thj bilu diln lieu - the tfch xa trj
{DVH: Dose Volume Histogram) cQa ki hoach IMRT va 3D: trong ky thuit IMRT, cae ti chdc xung quanh chiu liiu thip ban trong khi lieu tai md ein xa tri, cao (u va hach) van dugc dim bio (dudng nit liin biiu thi ki hoach IMRT, dudng net ddt la ki hoach 3D).
Trong va sau qua trinh xa tri benh nhdn khdng bj loet da, khdng bj ho, dau nguc, khd thd.
Tmdng hpp l i m sang 2;
Benh nhin Ha Thj Hang nu' 52 tuoi, dUdc chan dodn; ung thu vd trai T2N1 MO da dupe p h l u thuit Patey vd trai; md binh hpc; ung thu bieu md the dng xdm nhap dp 11.
Benh nhin dupe chi djnh xa trj hdu phdu sau dd tiep tuc dieu trj hda tii.
Benh nhan da dupe xa trj i^eu biln lilu 50Gy vdl 6 beams gdc 95°, 115", 130°, 310°, 325°, 345°
Tren dd thj b i l u diin lieu-thl tfch cho thay tdn thuong u vd hach dat dupe lieu xa tn tdi da md lai giam dupc lilu xa trj tai c i c tang ianh.
Hinh 4. Hinh dnh bieu diln dUdng dong lilu the tich Hinh 5,06 thj bilu diin lieu - the tich cdc co quan bj chieu xa vdi ke hoach dir^c chilu xa vdl ke hoach IMRT iMRT Trudng hdp Idm sang 3: Benh n h i n Nguyln Thj Ng. 48 tuoi, chan doan Ung thu vu T2N0M0, da phdu thuat Patey, eat budng trCmg. Giai phdu binh: ung thU bilu md tuyen dng x i m lan dp 2, ER dUdng tinh, PR duong tfnh, Her/2-Neu (+). Binh nhdn da dupe xa trj d i l u bien lieu vdi hai trudng chieu chech, 40 segments
Y HOC THUC HANH (848) - s 6 11/2012
Hinh 6. Trtn bdn dd dUfmg d6ng lilu, k9 thudt IMRT (bin trdi) ta thiy dudng ddng tiiu 50 Gy bao sit PTV, giim thiiu liiu x^ tri tai phii, ding thdi liiu lugng phin bi ddng nhit tmng PTV, khdng cd diim ndng nhu ky thuit 3D (hinh bin phii).
Hinh 7. Tren bleu 66 lilu-the tfch (DVH), ky thudt IMRT (ndt lien) bao sdt PTV, khdng cd diim qui 105%; cdn ky thuit 3D (nit ddt) cd phan md vO chiu liiu 110%.
PhSi linh tai ky thuat IMRT cung chiu liiu thip han ky thuat 3D.
Nhu vdy. ke hoach IMRT eho thay hieu qua xa tn tdt hon k l hoach 3D. vdi lieu xa tn t i p trung tdt vao ton Ihuong tir do dem lai hieu qua dieu trj cao. hdn nCfa lieu xa tri tai cac cd quan lanh xung quanh thap nen giam thieu dupc cac b i l n chdng trong va sau xa tri
B A N LUAN
Xa trj dieu b i l n lieu (IMRT) l i mdt ky thuit hien dai trong dieu trj ung Ihu, lieu xa dupc phdn bd tdi da theo hinh dang khdi u ddng thdi han c h l tdi thilu d md Idnh xung quanh.
Viec giam lieu bCtc xa d i n mCrc thap nhat dam bao trong gidi han binh thudng ma eO quan do cd the chiu dung dupc cd mdt y nghTa h i t sd'c quan trpng, dam bao chat lupng sdng tdt hdn cho ngUdi benh.
Chdng tdi da t i l n hanh d i l u trj cho mdt sd benh n h i n ung vu cd chi djnh xa trj bang ky thuat xa In d i l u b i l n l i l u va da dat dupe hieu qua dieu trj cao, da sd tdn thuong deu thoai lui sau dieu trj, trong va sau qua trinh dieu tri khdng gdp cdc bien chdng ndng.
Cdc b i n h n h i n ndy it bj xd phdi, khdng binh nhan ndo cd cdc tridu chCmg b i n h ly tim mach sau dieu tri, khdng b i n h n h i n ndo bj hoai tiJf xuong sUdn.
Nghidn cdu cda hai tdc gia McComtick B cung cpng sU vd McDonald MW cdng cdng sU deu cho t h i y hidu quS cda phOdng phap xa trj dieu biln lieu cao hdii m i ddc tinh trdn da, phoi. tim it hdn so vdi phUdng phdp xa trj 3D thdng thudng (viem da cap dp 2, 3 Id 39% d nhdm dude d i l u trj theo phudng phap IMRT so vdi 52% cl nhdm dupe d i l u tri theo phUdng phdp 3D, p = 0.047). V6i phUdng phap IMRT lieu xa trj tai khdi u vd cd t h i ndng cao den 66-70Gy, ma lieu xa tri tai cdc t l ehCte Idnh cd t h i chap nhdn dUOc [2], [3). [6],'
TCr khi PET ra ddi, xuat hiin Ihem khai mem mdi la the tfch dfch sinh hpc - BTV (biologic target volume) hay GTV-PET. GTVCT vd GTVMRl l i the tidi khdi u thd md cac nhd ldm sdng phdn biet bSng mat thudng, thudng khdng chfnh xdc vi giCia md linh vd t l chdc ung Ihi/
khdng cd ranh gidi rd ring.
Vdi cdc b i n h nhdn ung thU vd dirpc dieu trj xa trj dieu b i l n l i l u trong 1 n i m qua chdng tdi nhdn thiy ddy Id phuong phap xa trj dem lai h i i u qua dieu tri cao, han c h l cac bien chCmg trong vd sau j<a trj, Tuy nhiin ddy chi l i nhCmg n h i n xet ban dau, vdi^sl lupng bdnh n h i n chua n h i l u chdng tdi ehua t h i tong k i t vd bdo cao d i y dd v l cac thdng so danh gia hieu qua d i l u trj cung nhU b i l n chCmg trong vd sau xa trj.
Trong thdi gian tdi chung tdi se t i l p tuc t i l n hinh dieu trj xa trj d i l u bien lieu cho c i c benh nhdn ung thu vii cd chi djnh xa trj de dua ra cae k i t ludn rd rang va chinh xdc hdn.
KE'T LUAN
Tmng tdm Y hpc hat nhdn v i Ung bUdu Benh vien Bach Mai da Cmg dung thdnh cdng ky thudt xa trj dieu b i i n l i l u (IMRT) cho bdnh nhan ung thU vd. Kit qua thu dupe nhusau,
1. b a tien hanh xay di/ng vd chuan dUdc quy trinh xa tri dieu bien lieu (IMRT) eho bdnh nhdn b;
ung thu vu v6i CT md phdng hodc PET/CT md phong, Cdc thdng sd thu dupc d i u dat yeu cau theo quy djnh cho phep.
- Xac dinh duoc cac the tich d i l u trj (GTV, CTV, PTV va d i e biet Id t h i tich dfch sinh hpc BTV) va cac CO quan can bao vd v i cae cd quan can bao vd (phoi, tim...)
- Sd tn;dng c h i l u ; 6. 9 chum tia vdi nhilu gdc dp khac nhau hodc 2 tnJdng c h i l u ludt tiep tuyln, vdi mdi tn/dng c h i i u khoang 20 segments.
- Sai sd gid^ lieu ke hoach vd lieu xa Ihdc t l deu nho hdn 5%.
2. Da tien hanh ky thuat xa trj dieu b i l n lieu tren mpt so' benh nhan ung t h u vCi cho ket qua tot, an toan, Trong thdi gian tdi vdi sd lUdng benh nhdn nhilu hdn chdng tdi se tong ket va dua ra cac ket ludn d i y dd hdn.
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TAI LI$U THAM K H A O
1. Jags! R, Moran J, Marsh R, Masi K et al (2010), Evaluation of four techniques using inlensily-moduiated radiation therapy for comprehensive iocoregional irradiation of breast cancer, int J Radial Oncol Biol Phys.
Dec 1; 78(5), 1594-1603
2. McComriick B, Hunt M (2011). Intensity-modulated radiation therapy for breast: is it for everyone?, Semin Radial Oncol. Jan;21(1):51-54
3. McDonald MVl/, Godette KD, Butker EK et al (2008), Long-term outcomes of IMRT for breast cancer:
a single-inslilution cohort analysis, Int J Radial Oncol Biol Phys Nov 15;72(4), 1031-1040.
4, Shinzaburo Noguchi (2011), Breast Cancer, Springer
5, Smith W, Menon G, Wolfe N et al (2010), IMRT for the breast: a comparison of tangential planning techniques, Phys Med Bioi. Feb 21;55(4):1231-41
6, Thomas Borlfeld, Rupert Schmidt,Uilrich, Wiifried De Neve, David E, Wazer (2006), Image-Guided IMRT, Springer, Germany.
MOT SO YEU Td NGUY CO NHliM HPV QT PHU NUf VIEM c d TUT CUNG DEN KHAM TAI BENH VIEN VIET TIEP HAI PHONG
T6M TAT
Md diu: Human Papilloma Vius (HPV) li mdt trong nhOng nguyin nhin giy ra viim ci td cung va day la nguyin nhan hing diu gay ung thd ei td cung.
Viic phit hiin sdm yiu ti nguy ca lam nhiim va phat triin HPV la rat quan trgng va die biit ed y nghia di phdng tranh liy lan tmng cdng ding.
Dii tugng phuang phap nghiin cdu: 80 phu nd tu6i td18 din 55 cd viim ci td eung, dap ting diy dO cac tiiu chuin nghiin ciJu.
Kit luin: quan hi tinh diJC tin dau sdm (dudi 20 tudi) cd ty le nhiim HPV caa, cd tdi 64,3%. Nhiem HPV d phu nd cd nao phi thai la 94,4%. Cd 14,3%
phti nd nhiim HPV liin quan din hut thuic la. Phu nd sit dung bao cao su thudng xuyen cd khi ning tam ty le nhihm HPV thip ban so vdi nhdm ngudi khdng sd dung bao cao su.
SUMMARY
Introduction: Human Papilloma Viral (HPV) is one cause of cervicitis and this is the leading cause of cer/ical cancer. Eariy detection of risk factors and development of HPV infection is very important and special meaning to prevent spread in the community.
Subjects and Methods: 80 women aged 18 to 55 have cen/ieitis. met the study criteria.
Conclusion: The first sex eariy (under 20) have higher rates of HPV infection, up to 64.3%. HPV infection in women who have abortions is 94.4%.
14.3% of women have HPV infection related to smoking. Women who used condoms regulariy have the potential to tower HPV infection rates compared with those who did not use condoms.
MdeAu
Viem CO tuf eung (VCTC) la mdt benh ly rat phd biln d phu nCf. Theo thdng ke, tl l i nhdng ngUdi mac benh nay id hon 50% d nhung phu nQ trong dp tuoi tU 20 - 50, 6 phu nijf da cd con Id 90 - 95 %. Cdc bien
PHAM TH! THU TRANG - D^l hpc YHai Phong H U V N H Q U A N G T H U A N , NGUVeN ANH T U A ' N
Hpc vi^n Quin y
ddi cda VCTC da sd Id Idnh tinh, tuy nhien cd mdt ty l i i c tinh rat dUpc quan tam.
Human Papilloma Vius (HPV) la mpt trong nhdng nguyen nhan g i y ra viem e l tCf cung vd ddy la nguyen nhan hang d i u g i y ung thu c l tCr eung, mpt b i n h ly phd b i l n dCmg hang thCf hai tnang sd cdc ung thu t r i n t h i gidi vd id mdt trong nhung nguyen nhan tCr vong hdng dau cda gidi nu' d eac nude dang phit triln mdc dd thue te d i y id benh cd t h i phdng ngd^
dupc.
Trong tn/dng hdp VCTC do HPV thi ed nguy cd bien doi nghjch san, trd thanh cac tdn thUdng tien xdm l i n va ung thu cd tijf cung. Nguy co ndy cao hon gap 10 lan so vdi ngudi binh thudng neu khdng duac dieu trj dCft diem.
V i i c tim hilu, phit hien sdm c i c y l u td anh hudng den nhiim HPV l i rat quan trpng v i d i e biet cd y nghTa de phdng trdnh l i y lan tnang cdng dong. Vl v i y chdng tdi t i l n hanh nghien cdU: "Mdt sd y l u td nguy cd nhilm HPV tren phu nu" viem c l tCr cung d i n khdm 6 benh vien Viet Tiep Hai Phdng"
D 6 I T L / O N G V A PHL/ONG P H A P NGHIEN CLTU 1. Dia diem va thdi gian nghien cdu.
Dia di^.
Benh vidn Viet Tiep Hai Phdng, Bp mdn- Khoa Hda sinh Hoc vien Q u i n y.
Thdi gian: 1- 2010 d i n 6 - 2010.
2. Ddi tupng nghien cdu.
80 phu nuf viem cd nhilm HPV qua tham kham idm s i n g v i c i n l i m sing, ed dd tuoi t i ; 18 den 55, dap Cfng d i y dd cac tieu chuan iua chpn va loai trU eda nghien cCfU.
3. PhUdng phap nghien c u ^ . 3.1. Thiet ki'nghien cdu Nghien cdu md ta dieu tra cat ngnni-
Y HOC THUC HANH (848) - SO 11/2012