{"id":5089,"date":"2023-06-12T12:19:11","date_gmt":"2023-06-12T10:19:11","guid":{"rendered":"https:\/\/www.ptc.cz\/sto-lijecimo\/prostata\/jak-poznat-rakovinu-prostaty\/svet-preferuje-protony\/"},"modified":"2024-06-21T14:46:58","modified_gmt":"2024-06-21T12:46:58","slug":"svijet-preferira-protone","status":"publish","type":"page","link":"https:\/\/www.ptc.cz\/hr\/sto-lijecimo\/prostata\/rak-prostate\/svijet-preferira-protone\/","title":{"rendered":"Svijet preferira protone"},"content":{"rendered":"<div class=\"gdc_row\">\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<p><strong>Karcinom prostaty je nej\u010dast\u011bj\u0161\u00ed diagn\u00f3zou l\u00e9\u010denou ve sv\u011btov\u00fdch protonov\u00fdch centrech<\/strong>. Jedn\u00e1 se t\u00e9\u017e o&nbsp;diagn\u00f3zu, kde byl protony l\u00e9\u010den nejv\u011bt\u0161\u00ed po\u010det pacient\u016f, a&nbsp;to v&nbsp;\u0159\u00e1dech mnoha des\u00edtek tis\u00edc. D\u016fvodem je relativn\u00ed pravidelnost a&nbsp;mal\u00e1 velikost oza\u0159ovan\u00e9ho objemu a&nbsp;stabilita tk\u00e1n\u00ed, p\u0159es kter\u00e9 mus\u00ed protonov\u00fd svazek proj\u00edt (svaly a&nbsp;skelet). A\u010dkoli se jedn\u00e1 o&nbsp;diagn\u00f3zu zna\u010dn\u011b diskutovanou v&nbsp;odborn\u00e9 komunit\u011b je nutn\u00e9 sd\u011blit, \u017ee v&nbsp;sou\u010dasnosti neexistuj\u00ed randomizovan\u00e9 studie srovn\u00e1vaj\u00edc\u00ed fotonovou a&nbsp;protonovou radioterapii pro tuto diagn\u00f3zu. V\u00fdsledky mnoha tis\u00edc l\u00e9\u010den\u00fdch pacient\u016f hovo\u0159\u00ed jednozna\u010dn\u011b pro protonovou radioterapii.<\/p>\n<h3>Shrnut\u00ed v\u00fdsledk\u016f publikovan\u00fdch prac\u00ed t\u00fdkaj\u00edc\u00edch se karcinomu prostaty<\/h3>\n<ol>\n<li>Pravd\u011bpodobnost vyl\u00e9\u010den\u00ed m\u011b\u0159en\u00e1 v\u00a05let\u00e9m p\u0159e\u017eit\u00ed bez PSA relapsu je dle posledn\u00edch publikovan\u00fdch dat pro\u00a0<strong>n\u00edzce rizikov\u00e9 karcinomy prostaty 96,5 %, pro st\u0159edn\u011b rizikov\u00e9 karcinomy prostaty p\u0159\u00edzniv\u00e9ho rizika 93,7 %, pro st\u0159edn\u011b rizikov\u00e9 karcinomu prostaty nep\u0159\u00edzniv\u00e9ho rizika 91,2&nbsp;% a&nbsp;pro vysoce rizikov\u00e9 karcinomy prostaty mezi 75-85&nbsp;%<\/strong>.\u00a0<strong>Takov\u00fdch v\u00fdsledk\u016f obvykle nen\u00ed dosahov\u00e1no p\u0159i pou\u017eit\u00ed fotonov\u00fdch technik ani opera\u010dn\u00edch z\u00e1krok\u016f.<\/strong><\/li>\n<li><strong>Protonov\u00e1 radioterapie m\u00e1 minim\u00e1ln\u00ed toxicitu<\/strong>\u00a0(vedlej\u0161\u00ed \u00fa\u010dinky). Posledn\u00ed publikovan\u00e9 pr\u00e1ce popisuj\u00ed na&nbsp;rozs\u00e1hl\u00fdch souborech nemocn\u00fdch\u00a0<strong>z\u00e1va\u017enou toxicitu l\u00e9\u010dby u&nbsp;m\u00e9n\u011b ne\u017e 1&nbsp;% nemocn\u00fdch.<\/strong>\u00a0Ve srovn\u00e1n\u00ed s\u00a0publikovan\u00fdmi daty pro fotonovou radioterapii a&nbsp;opera\u010dn\u00edmi z\u00e1kroky je tato toxicita minim\u00e1ln\u00ed a&nbsp;v\u00fdznamn\u011b ni\u017e\u0161\u00ed ne\u017e pro ostatn\u00ed metody.<\/li>\n<li>Ve srovn\u00e1n\u00ed s&nbsp;chirurgickou terapi\u00ed<strong> protonov\u00e1 radioterapie v\u00fdznamn\u011b sni\u017euje riziko vzniku impotence, <\/strong>a v\u00fdznamn\u011b tak zlep\u0161uje kvalitu \u017eivota nemocn\u00fdch.<\/li>\n<li>U vysoce rizikov\u00e9ho karcinomu prostaty umo\u017e\u0148uje protonov\u00e1 radioterapie oza\u0159ov\u00e1n\u00ed p\u00e1nevn\u00edch lymfatick\u00fdch uzlin, ve kter\u00fdch je vysok\u00e1 pravd\u011bpodobnost subklinick\u00e9ho posti\u017een\u00ed. V\u00a0t\u00e9to klinick\u00e9 situaci se nejv\u00fdrazn\u011bji projev\u00ed dozimetrick\u00e1 a&nbsp;klinick\u00e1\u00a0<strong>v\u00fdhoda protonov\u00e9 radioterapie v\u00a0\u0161et\u0159en\u00ed org\u00e1n\u016f\u00a0dutiny b\u0159i\u0161n\u00ed, zejm\u00e9na kli\u010dek st\u0159evn\u00edch.<\/strong><\/li>\n<li><strong>Protonov\u00e1 radioterapie je pln\u011b ambulantn\u00ed l\u00e9\u010dba,<\/strong>\u00a0ve v\u011bt\u0161in\u011b p\u0159\u00edpad\u016f bez nutnosti pracovn\u00ed neschopnosti. Pro n\u00edzce a&nbsp;st\u0159edn\u011b rizikov\u00fd karcinom prostaty je mo\u017en\u00e9 pou\u017e\u00edt stereotaktick\u00e9 oz\u00e1\u0159en\u00ed s\u00a0celkov\u00fdm trv\u00e1n\u00edm 10 dn\u016f.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<h5>Dle aktu\u00e1ln\u00edch guidelines (mezin\u00e1rodn\u00edch doporu\u010den\u00ed) se ob\u011b metody (fotonov\u00e9 i&nbsp;protonov\u00e9 z\u00e1\u0159en\u00ed) pova\u017euj\u00ed za pou\u017eiteln\u00e9. <strong>Protonov\u00e1 radioterapie nen\u00ed novou metodou<\/strong>\u00a0\u2013 od roku 1991 existuje prvn\u00ed v\u00fdlu\u010dn\u011b klinick\u00e9 (nikoliv akademick\u00e9) pracovi\u0161t\u011b (Loma Linda, Kalifornie, USA) a\u00a0<strong>po\u010det nemocn\u00fdch l\u00e9\u010den\u00fdch protony pro karcinom prostaty dosahuje mnoha des\u00edtek tis\u00edc.\u00a0<\/strong>Jedn\u00e1 se o&nbsp;technologicky naprosto zralou l\u00e9\u010dbu ov\u011b\u0159enou v&nbsp;t\u00e9m\u011b\u0159 t\u0159ech desetilet\u00edch klinick\u00e9ho provozu. B\u011bhem posledn\u00edch dvou let se objevilo mnoho publikac\u00ed, kter\u00e9 popisuj\u00ed v\u00fdhody proton\u016f pr\u00e1v\u011b u&nbsp;dan\u00e9 diagn\u00f3zy.<\/h5>\n<p><strong>K dispozici jsou nyn\u00ed vynikaj\u00edc\u00ed dlouhodob\u00e9 v\u00fdsledky z\u00a0velk\u00fdch prospektivn\u00edch studi\u00ed a&nbsp;data, kter\u00e1 poukazuj\u00ed na&nbsp;vy\u0161\u0161\u00ed \u00fa\u010dinnost i&nbsp;bezpe\u010dnost protonov\u00e9ho oza\u0159ov\u00e1n\u00ed ve srovn\u00e1n\u00ed s\u00a0fotonov\u00fdm oza\u0159ov\u00e1n\u00edm (IMRT)<\/strong>. Tato data p\u0159ich\u00e1z\u00ed zejm\u00e9na z&nbsp;USA a&nbsp;Japonska, tedy ze zem\u00ed, kde m\u00e1 protonov\u00e1 radioterapie nejsiln\u011bj\u0161\u00ed z\u00e1zem\u00ed a&nbsp;pat\u0159\u00ed k&nbsp;b\u011b\u017en\u00fdm v\u00fdkon\u016fm. P\u0159esv\u011bd\u010div\u00e1 data a&nbsp;publikovan\u00e9 pr\u00e1ce se odrazily tak\u00e9 v&nbsp;roce 2018 v&nbsp;aktualizovan\u00fdch doporu\u010den\u00edch Americk\u00e9 spole\u010dnosti pro radia\u010dn\u00ed onkologii, kdy je protonov\u00e1 radioterapie karcinomu prostaty je podle jejich sou\u010dasn\u00fdch guidelines (NCCN Guidelines v. 4&nbsp;2018) pova\u017eov\u00e1na za standardn\u00ed l\u00e9\u010debnou metodu pro karcinom prostaty.<\/p>\n<p><strong><em>V\u00a0roce 2016 byla publikov\u00e1na v\u00a0New England Journal of Medicine\u00a0z\u00e1sadn\u00ed randomizovan\u00e1 studie hodnot\u00edc\u00ed efektivitu a&nbsp;kvalitu \u017eivota nemocn\u00fdch s\u00a0karcinomem prostaty l\u00e9\u010den\u00fdch chirurgicky, z\u00e1\u0159en\u00edm nebo inici\u00e1ln\u011b pouze aktivn\u011b sledovan\u00fdch.\u00a0Studie byla provedena na&nbsp;1643\u00a0pacientech a&nbsp;doba sledov\u00e1n\u00ed byla 10 let. Studie prok\u00e1zala, \u017ee:<\/em><\/strong><\/p>\n<ul>\n<li>mortalita na&nbsp;karcinom prostaty se mezi skupinami neli\u0161\u00ed a&nbsp;nebyl prok\u00e1z\u00e1n ani rozd\u00edl v\u00a0\u00famrt\u00edch z\u00a0jak\u00fdchkoliv p\u0159\u00ed\u010din,<\/li>\n<li>u pacient\u016f l\u00e9\u010den\u00fdch chirurgicky nebo oza\u0159ov\u00e1n\u00edm bylo ni\u017e\u0161\u00ed riziko progrese nemoci a&nbsp;vzniku metastatick\u00e9ho onemocn\u011bn\u00ed,<\/li>\n<li>radioterapie m\u011bla do\u010dasn\u00fd negativn\u00ed vliv na&nbsp;sexu\u00e1ln\u00ed funkce s\u00a0n\u00e1sledn\u00fdm zlep\u0161en\u00edm a&nbsp;nem\u011bla vliv na&nbsp;mo\u010dovou inkontinenci. Gastrointestin\u00e1ln\u00ed probl\u00e9my byly pozorov\u00e1ny po radioterapii v\u00a06 m\u011bs\u00edc\u00edch s\u00a0n\u00e1sledn\u00fdm zlep\u0161en\u00edm, u&nbsp;ostatn\u00edch modalit nebyly pozorov\u00e1ny,<\/li>\n<li><strong>z pohledu kvality \u017eivota hodnocen\u00ed prok\u00e1zalo, \u017ee\u00a0chirurgick\u00e1 l\u00e9\u010dba m\u00e1 nejhor\u0161\u00ed v\u00fdsledky z\u00a0hlediska sexu\u00e1ln\u00edch funkc\u00ed a&nbsp;mo\u010dov\u00e9 inkontinence, a&nbsp;i&nbsp;kdy\u017e bylo v\u00a0\u010dase pozorov\u00e1no ur\u010dit\u00e9 zlep\u0161en\u00ed, z\u016fstaly v\u00fdsledky pro chirurgickou l\u00e9\u010dbu v\u00a0t\u011bchto oblastech nejhor\u0161\u00ed po celou dobu trv\u00e1n\u00ed klinick\u00e9 studie.<\/strong><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<p style=\"text-align: center;\"><a  target=\"\"  class=\"button\" href=\"\/kontakt\/\">Kontaktujte n\u00e1s<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":5090,"parent":5082,"menu_order":480,"comment_status":"closed","ping_status":"closed","template":"template-service-detail-with-sidebar.php","meta":{"footnotes":""},"class_list":["post-5089","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages\/5089","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/comments?post=5089"}],"version-history":[{"count":1,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages\/5089\/revisions"}],"predecessor-version":[{"id":5134,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages\/5089\/revisions\/5134"}],"up":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages\/5082"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/media\/5090"}],"wp:attachment":[{"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/media?parent=5089"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}