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Зміст2.2. To Be Able
to pay attention to importance of deontological, ethics moments of radiotherapy of oncological patients; IV. Intersubject integr
V. Plan and organization of practical lesson
L = ii-iii
5.2.2. Basic stage
Mechanism of action
6.1. Place of conducting of lesson
6.3. Materials of control of basic (initial level) preparation of students
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:
ІІІ. Educational purpose:
IV. Intersubject integration.
5.1. Duration of lesson - 2 hours.
5.2. Stages of lesson (table):
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.
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.
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.
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:
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.
^ class room, department of radial therapy.
6.2. Material providing of lesson:
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;
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:
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;
г) presence of concomitant diseases.
5. What method of medical treatment is used for 1 stage of uterus cancer?
г) one of radial methods.
To work out a plan of medical treatment and plan of radial therapy for patients with a diagnosis:
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