Patient treatment path in the radiotherapy department at ST. Marina University Hospital - Varna

Лъчелечението води началото си от 1895 г., като от тогава е постигнат висок технологичен прогрес. Основната цел на лъчелечението е реализирането на предписаната лъчева доза в определен мишенен обем с едновременно минимално увреждане на съседните здрави тъкани. Резултатът е локален туморен контрол, подобрено качество на живот и удължена преживяемост.Лъчелечението в Клиниката по лъчелечение на УМБАЛ „Св. Марина` преминава през следните етапи: клинико-биологично планиране, анатомо-томографско планиране, дозиметрично планиране и изпълнение на плана на облъчване, контрол и проследяване състоянието на пациента. При консулта на пациента лекар лъчетерапевт определя целта на лъчелечението на базата на диагнозата и стадия на заболяването и назначава дата за виртуална симулация - планиращ компютърен томограф. При симулацията според подбрания протокол лъчетерапевтичният рентгенов лаборант имобилизира пациента на масата и провежда сканирането. Симулацията се включва в етапа на анатомо-томографско планиране, при което лаборантът контурира органите в риск, a лекарят дефинира клиничните мишенни обеми и предписва общата и дневната огнищни дози. На следващия етап медицинският физик изготвя индивидуален дозиметричен план, като се прилагат прецизни техники на облъчване - 3 DC, IMRT, VMAT. След като лъчетерапевтът одобри плана, физикът изготвя предварителен верификационен план, изпълняващ се от лаборанта преди първата фракция на пациента. При първото облъчване на пациента задължително присъстват лъчетерапевт, физик и рентгенов лаборант. При всяка следваща фракция рентгеновият лаборант облъчва пациента самостоятелно на линейния ускорител.При всички пациенти с цел прецизно изпълнение на плана се прилага образно насочено ЛЛ (IGRT) - верификации на позицията на пациента чрез рентгенографии, CBCT. На всички етапи медицинската радиологична сестра отговаря за манипулациите на пациента и вливанията на химиотерапевтици. По време и след терапията лечетерапевтът проследява състоянието на пациента. Тези етапи се повтарят при нужда от свръхдозиране в тумора или при бързо обратно развитие на тумора.Целта на настоящия доклад е да проследи пътя на пациента в Клиниката по лъчелечение на УМБАЛ „Св. Марина` - Варна.Since the first implementation of radiotherapy in 1896, high technology progress has been achieved in that field. The aim of radiotherapy is precise delivery of certain radiation dose in clinical target volumes with minimal damage of healthy tissues. The result is high tumor control with good quality of life and prolonged survival.The radiotherapy workflow at the Radiotherapy Department at the St. Marina University Hospital - Varna has the following specific stages: clinical and biological planning; anatomical topographic planning; treatment planning and delivering the plan, control of the symptoms and follow-up of the patients. During the consultation the radiation oncologist defines the aim of the treatment according to the cancer type and stage and an appointment for virtual simulation (planning CT) is given.During the simulation according to the selected protocol, the radiation technology technician (RTT) immobilizes the patient on the CT table and performs the CT scanning. The simulation is part of the anatomical topography planning where technicians contour organs at risk and the physician defines the target volumes and prescribes the daily and total radiation dose. At the next stage, the medical physicist per forms treatment planning, applying precise radiation techniques - 3 DC, IMRT, and VMAT. After the radiation oncologist approves the plan, the physicist prepares a preliminary verification plan running from the RTTS before the first fraction of irradiation. During the first patient irradiation a radiation oncologist, physicist and RTT are present at the linear accelerator. Then the following irradiation procedures of the patient are responsibility of RTT. In all patients to accurately implement the plan image guided radiotherapy (IGRT) is applied - verification of the position of the patient by radiographs and CBCT. At all stages a radiological nurse takes care of the patient and infuses the chemotherapeuticals. During and after treatment, the radiation oncologist follows up the patient. These stages could be repeated in case of boost or fast shrinking tumors. The aim of the present report is to demonstrate the patient treatment path at the Radiotherapy Department at the St. Marina University Hospital - Varna

Potensi ekstrak kulit Pisang Kepok (musa balbisiana) sebagai kandidat terapeutik kanker payudara secara in vitro dengan menggunakan sel T-47D

INDONESIA: Pemanfaatan bahan alam seperti buah sebagai agen terapi kanker payudara mulai banyak diteliti oleh para ilmuwan. Salah satu bahan alam yang berpotensi sebagai antikanker adalah kulit pisang kepok (Musa balbisiana). Pisang ini mengandung berbagai senyawa fitokimia yang dapat menginduksi apoptosis sel kanker. Oleh karena itu, tujuan dari penelitian ini adalah untuk mengetahui nilai IC50 ekstrak kulit pisang kepok dan persentase sel yang mengalami apoptosis sehingga dapat diketahui potensinya sebagai kandidat terapeutik kanker payudara. Penelitian ini bersifat eksperimental menggunakan RAL (Rancangan Acak Lengkap) dengan tahapan penelitian: ekstraksi, uji sitotoksik (MTT assay) dan uji induksi apoptosis. Metode ekstraksi yang digunakan yaitu maserasi dengan etanol 95%. Uji sitotoksik dilakukan dengan pemberian ekstrak kulit pisang kepok pada sel T-47D, kemudian dibaca absorbansi dengan ELISA reader (λ 595 nm) dan dianalisis dengan SPSS Probit. Untuk konfirmasi efektifitas ekstrak dalam menginduksi apoptosis sel T-47D, digunakan flowcytometry dengan reagen Annexin V/PI. Hasil uji sitotoksik menunjukkan bahwa persentase sel hidup setelah diberi ekstrak kulit pisang kepok dengan konsentrasi 1000 µg/mL, 500 µg/mL, 250 µg/mL, 125 µg/mL, 62,5 µg/mL, dan 31,25 µg/mL berturut-turut adalah 3,74%, 3,94%, 63, 90%, 81,23%, 91,45%, dan 91,97% serta memiliki nilai IC50 sebesar 220,375 µg/mL. Untuk hasil uji induksi apoptosis pada konsentrasi IC50 menunjukkan bahwa jumlah sel yang mengalami apoptosis awal adalah 2,50%, apoptosis akhir 3,10%, nekrosis 5,40%, dan sel yang hidup 89,0%. Berdasarkan hasil penelitian ini, dapat disimpulkan bahwa ekstrak kulit pisang kepok memiliki toksisitas sedang terhadap sel T-47D yang menunjukkan potensinya sebagai kandidat agen kemoprevensi kanker payudara, terutama pada konsentrasi tinggi (>250 µg/mL). ENGLISH: Utilization of natural ingredients such fruit as a breast cancer treatment agent is beginning to be widely studied by scientists. One of the potential natural ingredients as anticancer is pisang kepok peel (Musa balbisiana). This kind of banana contains various phytochemical compounds that can induce cancer cell apoptosis. The purpose of this research is to know the IC50 value of pisang kepok peel extract and percentage of cancer cells that undergo apoptosis so that can be known its potential as therapeutic candidate of breast cancer. This research is experimentally done by using CRD (Completely Randomized Design). The stages of this research are extraction, cytotoxic test (MTT assay) and apoptosis induction test. The extraction method used was maceration (ethanol 95%). The cytotoxic test was performed by giving pisang kepok peel extract on T-47D cell, then read the absorbance with ELISA reader at λ 595 nm and analyzed by SPSS Probit. To confirm the effectiveness of extract in inducing T-47D cell apoptosis, flow cytometry was used with Annexin V/PI reagents. The result of cytotoxic test showed that the percentage of viable cell after given pisang kepok peel extract with concentration of 1000 μg/mL, 500 μg/mL, 250 μg/mL, 125 μg/mL, 62,5 μg/mL, and 31,25 μg/mL were 3.74%, 3.94%, 63.90%, 81.23%, 91.45%, and 91.97% respectively; and also has an IC50 value of 220.375 μg/mL. Meanwhile the test result for apoptotic induction test at IC50 concentrations showed that the number of cells undergoing initial apoptosis: 2.50%, late apoptosis: 3.10%, necrosis: 5.40%, and viable cells: 89.0%. Based on this results, it can be concluded that pisang kepok peel extract has moderate cytotoxic to T-47D cells, therefore indicate its potential as a candidate for breast cancer chemoprevention agents, especially at high concentrations (>250 μg/mL)

Abstracts Of The Proceedings And The Posters From The Third Scientific Session Of The Medical College Of Varna

October 2-3, 201