Methodical Instruction of practical lesson №5 Theme: Radial therapy of tumors of different locations icon

Methodical Instruction of practical lesson №5 Theme: Radial therapy of tumors of different locations




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Methodical Instruction of practical lesson № 5

Theme: Radial therapy of tumors of different locations.


I. Actuality of theme:

Knowledge of basic principles and possibilities of application of different methods of radial therapy of tumors of different locations will help correctly to choose tactic of medical treatment, depending on their location, stage, histological form of cancer, term of disease.


ІІ. Training purpose:

2.1. A student must know:


  • possibilities of radial therapy of malignant tumors;

  • methods of radial therapy, which are used independently, at the combined or complex medical treatment of malignant tumors;

  • planning of radial therapy (preparation of patient to radial therapy);

  • rehabilitation period of radial therapy;

^ 2.2. To Be Able:

  • to plan radial therapy (independent, combined, complex methods) for medical treatment of patients with the malignant tumors;

  • to determine the basic parameters of plan of radial therapy of these diseases depending on location, stage and histological structure of tumors.



ІІІ. Educational purpose:
  • ^

    to pay attention to importance of deontological, ethics moments of radiotherapy of oncological patients;

IV. Intersubject integration.





The name of discipline and proper department

To Know

To Be Able

Physiology (department of normal and pathological physiology)

Metabolic processes in a mew, physiology of exchange of matters and crovotvorennya

To be able to determine the pathological changes in the organism cased by radiation

Topographical anatomy

Anatomy of organs, their topography

To project a location of organ on body surface
^

V. Plan and organization of practical lesson


5.1. Duration of lesson - 2 hours.

5.2. Stages of lesson (table):



№ p.p.

Basic stages of lesson

Educational purpose in the levels of mastering

Methods of control

Time

1.

Preparatory stage:

-organization of lesson;

-determination of educational purpose and motivation;

-control of initial level of knowledges, abilities and skills;


^ L = II-III

Frontal questioning, test control (sets of tests).

15
min.

2.

Basic stage:

forming of professional abilities and skills:;

teaching of a new material, where a teacher with participation of students considers the question of planning of the gamma-therapy controlled from distance independently, in combined with surgical or complex medical treatment of malignant tumors;

б) in the department students meet with the methods of radial therapy controlled from distance and methodics of treatment of malignant tumors,.

L= ІІІ

In written form to work out an approximate plan of radial therapy on the model of patients with malignant tumor. For this purpose every student gets the concrete task in which must be indicated a diagnosis of tumor in international classification after TNM, histological diagnosis, localization in an organ, presence of complications, concomitant diseases. On the basis of these data a student makes the plan of radial therapy.



60 hv.

3.

Final stage:

- control and correction of level of professional skills and knowledges;

- general result of lesson;

- homework.


L= ІІІ


L = ІІ


Individual control of results of writing works.

Solution of tests.

Tests and standards of answers.

15 min.



5.2.1. Preparatory stage:

At the beginning of losson a teacher acquaints students with the basic tasks of employment, plan. For the control of initial level of knowledges of students to each of them the list of tests is offered.

^

5.2.2. Basic stage:


  • Forming of professional abilities and skills is conducted by exposition of possibilities and principles of conducting of radial therapy to the patients with the cancer of different localizations. A teacher explains the basic tasks and principles of conducting of radial therapy of tumors ofdifferent organs.


The amount of radiation used in radiation therapy is measured in gray (Gy), and varies depending on the type and stage of cancer being treated. For curative (radical) cases, the typical dose for a solid epithelial tumor ranges from 60 to 80 Gy, while lymphoma tumors are treated with 20 to 40 Gy. Preventative (adjuvant) doses are typically around 45 - 60 Gy in 1.8 - 2 Gy fractions (for Breast, Head and Neck cancers respectively.) Many other factors are considered by radiation oncologists when selecting a dose, including whether the patient is receiving chemotherapy, whether radiation therapy is being administered before or after surgery, and the degree of success of surgery.

Fractionation


The total dose is fractionated (spread out over time) in order to give normal cells time to recover. In the USA, Australia, and Europe, the typical fractionation schedule for adults is 1.8 to 2 Gy per day, five days a week. In the northern United Kingdom, fractions are more commonly 2.67 to 2.75 Gy per day, which eases the burden on thinly spread resources in the National Health Service. For children, a typical fraction is 1.5 to 1.7 Gy per day, reducing the chance and severity of late-onset side effects.

In some cases, two fractions per day are used near the end of a course of treatment. This schedule, known as a concomitant boost regimen and/or hyperfractionation, is used on tumors that regenerate more quickly when they are smaller. In particular, tumors in the head and neck demonstrate this behavior.

One of the best-known alternative fractionation schedules is Continuous Hyperfractionated Accelerated Radiotherapy (CHART). CHART, used to treat lung cancer, consists of three smaller fractions per day. Although reasonably successful, CHART can be a strain on radiation therapy departments.

Implants can be fractionated over minutes or hours, or they can be permanent seeds which slowly deliver radiation until they become inactive.
^

Mechanism of action


Radiation therapy works by damaging the DNA of cells. The damage is caused by a photon, electron, proton, neutron, or ion beam directly or indirectly ionizing the atoms which make up the DNA chain. Indirect ionization happens as a result of the ionization of water, forming free radicals, notably hydroxyl radicals, which then damage the DNA. In the most common forms of radiation therapy, most of the radiation effect is through free radicals. Because cells have mechanisms for repairing DNA damage, breaking the DNA on both strands proves to be the most significant technique in modifying cell characteristics. Because cancer cells generally are undifferentiated and stem cell-like, they reproduce more, and have a diminished ability to repair sub-lethal damage compared to most healthy differentiated cells. The DNA damage is inherited through cell division, accumulating damage to the cancer cells, causing them to die or reproduce more slowly. Proton radiotherapy works by sending protons with varying kinetic energy to precisely stop at the tumor.

One of the major limitations of radiotherapy is that the cells of solid tumors become deficient in oxygen. This is because solid tumours usually outgrow their blood supply, causing a low-oxygen state known as hypoxia. The more hypoxic the tumours are the more resistant they are to the effects of radiation because oxygen makes the radiation damage to DNA permanent. Much research has been devoted to overcoming this problem including the use of high pressure oxygen tanks, blood substitutes that carry increased oxygen, hypoxic cell radiosensitizers such as misonidazole and metronidazole, and hypoxic cytotoxins, such as tirapazamine. There is also interest in the fact that high LET particles such as carbon or neon ions may have an antitumour effect which is independent of tumour hypoxia.


5.3. Control questions to the theme of lesson:


  1. Indications and contra-indications to radial therapy of patients with the malignant tumors.

  2. Methods, types of radial therapy and methods of radiation, which are used at the tumors.

  3. Combined or complex methods of medical treatment with the use of radial therapy of patients with a cancer.

  4. Prophylaxis of radial complications of different organs that can develop under time and after the course of radial therapy .

  5. Conducting of radial therapy of cancer of skin. Methods, doses and fields.

  6. Radial therapy of breast cancer. Doses and fields.

  7. Radial therapy of cancer of uterus. Methods, doses and fields.

  8. Radial therapy of malignant tumours of lungs, malignant lymphomas.


5.4. Final stage.

The control of solution of tasks and eventual level of knowledges is conducted by their verification and raising of questions of practical direction. Rating of mastering the material of theme is depends on theoretical knowledges, practical skills, independent work of student.

In a result a teacher considers typical errors which are assumed by students at implementation of self-education work and assigns to a next lesson. A teacher sets the homework, recommends literature after the theme of the following lesson: basic and additional.


VІ. Materials for the methodical providing of lesson.


^ 6.1. Place of conducting of lesson: class room, department of radial therapy.


6.2. Material providing of lesson:

Tables:

  • types of radial therapy;

  • methods ofrradiation;

  • principles of planning of radial therapy at patients with the malignant tumours of uterus.


^ 6.3. Materials of control of basic (initial level) preparation of students

Tests for determination of initial level of knowledges

1. Method of radial therapy, which is used for medical treatment of breast cancer:

а) x-ray therapy;

б) gamma-therapy;

в) contact methods;


2. Method of radiation, which is used for medical treatment of breast cancer:

а) by one field;

б) by a some fields.


3. The controlled gamma-therapy from distance can be connected with tumours:

а) lungs;

б) breast;

в) esophagus;


4. The choice of tactic of irradiation (all groups of lymphatic nodes from one or from two sides to the diaphragm, or all on both sides of a diaphragm) in medical treatment of lymphogranulomatosis on the radical program depends on:

а) histological form of disease;

б) primary localization;

в) stages;

г) presence of concomitant diseases.


5. What method of medical treatment is used for 1 stage of uterus cancer?

а) combined;

б) united;

в) surgical;

г) one of radial methods.


To work out a plan of medical treatment and plan of radial therapy for patients with a diagnosis:

  1. Cancer of uterus 1 stage, histological structure – small cell cancer.

  2. Cancer of uterus of the ІІ stage, histological structure – squamous cell carcinoma.

  3. Cancer of uterus of the ІІІ stage, histological structure of – squamous cell carcinoma.

  4. Cancer of uterus of the ІV stage, squamous cell carcinoma.

  5. Cancer of vagina of the ІІ stage, the histological structure is squamous cell carcinoma.

  6. The cancer of rectum of the ІІ stage, squamous cell carcinoma.

  7. The cancer of rectum of the ІІI stage, squamous cell carcinoma.


VІІ. Literature


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