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Relatório de estágio: o impacto da técnica DIBH em doentes com carcinoma de mama submetidos a radioterapia externa
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Abstract(s)
O carcinoma da mama é um dos tipos de cancro que atinge cada vez mais indivíduos, e por isso, deve ser considerada terapêutica que permita a melhor qualidade de vida depois do tratamento, bem como minimizar as consequências que da terapêutica possam advir.
A radioterapia é uma das principais abordagens terapêuticas, utilizadas nesta patologia, que envolve uma exposição significativa de vários órgãos adjacentes à radiação, tais como: coração, pulmões e mama contralateral. Uma das consequências, resulta muitas vezes da associação da quimioterapia com a radioterapia, decorrente do aumento de toxicidade, essencialmente ao nível cardíaco e pulmonar, sendo necessário minimizar as doses de exposição a que estes órgãos são sujeitos. Nesse sentido surgiu a técnica Deep Inspiration Breath Hold - DIBH, a qual é utilizada em radioterapia, no tratamento (principalmente) dos carcinomas da mama esquerda. A mesma, consistiu na temática major do estágio curricular realizado, em todas as suas práticas nas diversas fases do workflow da radioterapia, nas doentes que realizaram esta técnica aquando do seu tratamento.
O presente relatório provém da minha participação na prática diária ocorrida no Serviço de Radioterapia, da Unidade Local de Saúde de Coimbra e tem como objetivos apresentar o resultado do domínio de conhecimento, especificidade dos procedimentos a serem realizados, mais-valia da utilização desta técnica e input da literatura no âmbito desta temática, através de um método descritivo, de modo a evidenciar a redução da dose cardíaca e pulmonar, com a utilização desta técnica. Dado que o serviço, onde decorreu o estágio, utiliza como técnica acessória para a realização desta técnica, a Surface Guided Radiation Therapy - SGRT, esta também irá ser abordada e descrita, para maior especificação da DIBH. Porém, durante esse período de estágio dedicado ao tema principal, foi também possível vivenciar a experiência de poder aprofundar conceitos no âmbito da braquiterapia prostática, ginecológica e adquirir novos conhecimentos na área da braquiterapia ocular, por disponibilização e cortesia do serviço.
Concluiu-se que, nos casos de carcinoma da mama esquerda, que realizam RT externa com a técnica DIBH, e esta associada a SGRT, contribui para uma significativa redução da dose cardíaca e pulmonar, contribuindo para menores níveis de toxicidade e alterações agudas e tardias.
Breast carcinoma is one of the types of cancer that affects more and more people, and for this reason, therapy should be considered that allows for the best quality of life after treatment, as well as minimizing the consequences that therapy may have. Radiotherapy is one of the main therapeutic approaches used in this pathology, which involves significant exposure of several adjacent organs to radiation, such as the heart, lungs and contralateral breast. One of the consequences of combining chemotherapy with radiotherapy is the increase in toxicity, essentially to the heart and lungs, making it necessary to minimize the doses to which these organs are exposed. The Deep Inspiration Breath Hold (DIBH) technique was developed, which is used in radiotherapy to treat (mainly) carcinomas of the left breast. This was the main theme of the internship, in all its practices during the various phases of the radiotherapy workflow, with patients who underwent this technique during their treatment. This report stems from my participation in daily practice at the Radiotherapy Service of the Coimbra Local Health Unit and its objectives are to present the results of my knowledge, the specificity of the procedures to be carried out, the added value of using this technique and input from the literature on this subject, in order to highlight the reduction in cardiac and pulmonary dose with the use of this technique. Given that the service where the internship took place uses Surface Guided Radiation Therapy (SGRT) as an accessory technique for performing this technique, this will also be addressed and described, to further specify DIBH. However, during this period of training dedicated to the main topic, it was also possible to deepen my understanding of prostate and gynecological brachytherapy and acquire new knowledge in ocular brachytherapy, thanks to the availability and courtesy of the service. It was concluded that in cases of carcinoma of the left breast, external RT with the DIBH technique, combined with SGRT, contributes to a significant reduction in cardiac and pulmonary dose, contributing to lower levels of toxicity and acute and late changes.
Breast carcinoma is one of the types of cancer that affects more and more people, and for this reason, therapy should be considered that allows for the best quality of life after treatment, as well as minimizing the consequences that therapy may have. Radiotherapy is one of the main therapeutic approaches used in this pathology, which involves significant exposure of several adjacent organs to radiation, such as the heart, lungs and contralateral breast. One of the consequences of combining chemotherapy with radiotherapy is the increase in toxicity, essentially to the heart and lungs, making it necessary to minimize the doses to which these organs are exposed. The Deep Inspiration Breath Hold (DIBH) technique was developed, which is used in radiotherapy to treat (mainly) carcinomas of the left breast. This was the main theme of the internship, in all its practices during the various phases of the radiotherapy workflow, with patients who underwent this technique during their treatment. This report stems from my participation in daily practice at the Radiotherapy Service of the Coimbra Local Health Unit and its objectives are to present the results of my knowledge, the specificity of the procedures to be carried out, the added value of using this technique and input from the literature on this subject, in order to highlight the reduction in cardiac and pulmonary dose with the use of this technique. Given that the service where the internship took place uses Surface Guided Radiation Therapy (SGRT) as an accessory technique for performing this technique, this will also be addressed and described, to further specify DIBH. However, during this period of training dedicated to the main topic, it was also possible to deepen my understanding of prostate and gynecological brachytherapy and acquire new knowledge in ocular brachytherapy, thanks to the availability and courtesy of the service. It was concluded that in cases of carcinoma of the left breast, external RT with the DIBH technique, combined with SGRT, contributes to a significant reduction in cardiac and pulmonary dose, contributing to lower levels of toxicity and acute and late changes.
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Keywords
Neoplasias da mama Radioterapia Deep Inspiration Breath Hold Surface Guided Radiation Therapy Breast Carcinoma Radiotherapy