近距離治療
Brachytherapy

context: zh_tw: 近距離放射治療的歷史可以追溯到 1901 年（1896 年貝克勒爾發現放射性元素不久）。當時皮埃爾・居里（Pierre Curie） 向亨利亞歷山大・當洛（Henri-Alexandre Danlos）提議可以將放射源植入腫瘤，
en: Brachytherapy dates back to 1901 (shortly after the discovery of radioactivity by Henri Becquerel in 1896) when Pierre Curie suggested to Henri-Alexandre Danlos that a radioactive source could be inserted into a tumour.
qas: question: zh_tw: 誰發現了放射現象？
en: Who discovered radioactivity?
answers: zh_tw: text: 皮埃爾・居里
en: text: Henri Becquerel

context: zh_tw: 短期近距離治療是指在放射源撤回前停留一段固定的時間（一般是幾分鐘或幾小時）。 具體的治療時間長短受許多因素影響，包括治療劑量率、腫瘤的型別、大小、位置。對於低劑量率及脈衝式劑量率近距離放療，放射源通常要在治療部位停留時間達 24 小時，但高劑量率近距離放療，治療時常通常只有幾分鐘。永久性近距離治療， 也稱為粒子植入，是指將小的低劑量率放射性粒子或小球（大約為米粒的大小）植入腫瘤或治療位置，永久的留在體內，放射性逐漸衰減。幾周或幾月後，放射源放出的放射性水平會趨近於零。不具有放射性的粒子將永久留在治療部位，不再具有任何作用。 永久性近距離治療大多用於前列腺癌的治療.
en: Temporary brachytherapy involves placement of radiation sources for a set duration (usually a number of minutes or hours) before being withdrawn. The specific treatment duration will depend on many different factors, including the required rate of dose delivery and the type, size and location of the cancer. In LDR and PDR brachytherapy, the source typically stays in place up to 24 hours before being removed, while in HDR brachytherapy this time is typically a few minutes.Permanent brachytherapy, also known as seed implantation, involves placing small LDR radioactive seeds or pellets (about the size of a grain of rice) in the tumour or treatment site and leaving them there permanently to gradually decay. Over a period of weeks or months, the level of radiation emitted by the sources will decline to almost zero. The inactive seeds then remain in the treatment site with no lasting effect. Permanent brachytherapy is most commonly used in the treatment of prostate cancer.
qas: question: zh_tw: 具體治療時間依賴於哪些因素？
en: What are the many elements specific treatment time relies on?
answers: zh_tw: text: 治療劑量率、腫瘤的型別、大小、位置。
en: text: required rate of dose delivery and the type, size and location of the cancer

context: zh_tw: 對於少部分人群，近距離治療可能會因臨近組織或器官的損傷導致長期的副作用。長期副作用通常是輕微、適度的。例如：宮頸癌或前列腺癌的近距離治療可能會導致泌尿或消化道的問題，可能需要長期的調理。前列腺癌的近距離治療可能會導致勃起功能障礙，發生的機率約為 15-30%。但是，發生此副作用的風險與患者的年齡（老年患者比年輕患者的風險更大）及治療前勃起功能的水平都有關係。對於確實有勃起功能障礙的患者，大部分患者可以透過藥物治療，如偉哥。重要的是，相比根治性前列腺切除術，近距離治療導致勃起功能障礙的風險要低。乳腺癌或皮膚癌的近距離治療可能會引起治療區域附近產生疤痕組織。乳腺癌的近距離治療病例中，由於脂肪酸進入乳腺組織可能會導致脂肪壞死，從而使得乳房組織腫脹和變軟。乳腺脂肪壞死屬於良性症狀，一般會在治療後的 4-12 個月出現，大概會影響 2% 的患者。
en: In a small number of people, brachytherapy may cause long-term side effects due to damage or disruption of adjacent tissues or organs. Long-term side effects are usually mild or moderate in nature. For example, urinary and digestive problems may persist as a result of brachytherapy for cervical or prostate cancer, and may require ongoing management.Brachytherapy for prostate cancer may cause erectile dysfunction in approximately 15-30% of patients. However, the risk of erectile dysfunction is related to age (older men are at a greater risk than younger men) and also the level of erectile function prior to receiving brachytherapy. In patients who do experience erectile dysfunction, the majority of cases can successfully be treated with drugs such as Viagra. Importantly, the risk of erectile dysfunction after brachytherapy is less than after radical prostatectomy.Brachytherapy for breast or skin cancer may cause scar tissue to form around the treatment area. In the case of breast brachytherapy, fat necrosis may occur as a result of fatty acids entering the breast tissues. This can cause the breast tissue to become swollen and tender. Fat necrosis is a benign condition and typically occurs 4–12 months after treatment and affects about 2% of patients.
qas: question: zh_tw: 誰有更高的機會患有前列腺癌？
en: who has a higher chance of developing ED?
answers: zh_tw: text: 老年患者
en: text: older men

question: zh_tw: 有多少人接受近距離放射治療後造成長期影響？
en: For how many people does brachytherapy cause long term affects?
answers: zh_tw: text: 少部分人群
en: text: a small number of people

context: zh_tw: 患者經常會詢問在接受近距離治療後，對於周圍的家人和朋友，他們是否需要特殊的安全防範措施。如果是短期近距離放療，治療結束後，沒有放射源存留在體內。因此對於周圍親近的朋友或家人是沒有放射性危險的。如果是永久性近距離治療，低劑量放射源（粒子）在治療後仍然停留在人體內 - 輻射水平很低，並且隨著時間減小。此外，輻射只會影響放射源（接受治療的腫瘤）附近幾毫米的組織。為了安全起見，部分接受永久性近距離治療的患者會被告知在治療後的短期內，不要近距離接觸小孩或懷孕婦女。放療醫生或護士會告知患者需要注意的事項，以及需要注意多長時間。
en: Patients often ask if they need to have special safety precautions around family and friends after receiving brachytherapy. If temporary brachytherapy is used, no radioactive sources remain in the body after treatment. Therefore, there is no radiation risk to friends or family from being in close proximity with them.If permanent brachytherapy is used, low dose radioactive sources (seeds) are left in the body after treatment – the radiation levels are very low and decrease over time. In addition, the irradiation only affects tissues within a few millimeters of the radioactive sources (i.e. the tumour being treated). As a precaution, some people receiving permanent brachytherapy may be advised to not hold any small children or be too close to pregnant women for a short time after treatment. Radiation oncologists or nurses can provide specific instructions to patients and advise for how long they need to be careful.
qas: question: zh_tw: 近距離治療有什麼好處？
en: What is the good thing about brachytherapy?
answers: zh_tw: text: 治療結束後，沒有放射源存留在體內
en: text: no radioactive sources remain in the body after treatment

context: zh_tw: 為保證準確的計劃近距離治療流程，瞭解腫瘤的性質，需要進行全面的臨床檢查。除此之外，還需要藉助一些成像裝置檢視腫瘤的形狀和大小，及其相對於臨近組織及器官的位置關係。這些成像裝置包括：X 光機、超聲、計算機斷層掃描（CT 或 CAT）及核磁共振成像（MRI）。獲得的影像可用於腫瘤及臨近組織的三維模擬成像。藉助這些資訊，可確定最佳化的放射源分佈，其中包括放射源的載體 —— 施源器（用於將放射源輸送到治療部位）的放置方式和位置。施源器不具有放射性，常見的是插植針或塑膠導管。依據治療癌症的種類和靶區腫瘤的性質，選擇合適的施源器型別 。初始計劃可以避免治療中出現 “冷點”（過低輻射）及 “熱點”（過高輻射），他們分別會影響治療失敗及副作用。
en: To accurately plan the brachytherapy procedure, a thorough clinical examination is performed to understand the characteristics of the tumour. In addition, a range of imaging modalities can be used to visualise the shape and size of the tumour and its relation to surrounding tissues and organs. These include x-ray radiography, ultrasound, computed axial tomography (CT or CAT) scans and magnetic resonance imaging (MRI). The data from many of these sources can be used to create a 3D visualisation of the tumour and the surrounding tissues.Using this information, a plan of the optimal distribution of the radiation sources can be developed. This includes consideration of how the source carriers (applicators), which are used to deliver the radiation to the treatment site, should be placed and positioned. Applicators are non-radioactive and are typically needles or plastic catheters. The specific type of applicator used will depend on the type of cancer being treated and the characteristics of the target tumour.This initial planning helps to ensure that ‘cold spots’ (too little irradiation) and ‘hot spots’ (too much irradiation) are avoided during treatment, as these can respectively result in treatment failure and side-effects.
qas: question: zh_tw: 使用了哪些成像裝置？
en: Which imaging modalities are used?
answers: zh_tw: text: X 光機、超聲、計算機斷層掃描（CT 或 CAT）及核磁共振成像（MRI）
en: text: x-ray radiography, ultrasound, computed axial tomography (CT or CAT) scans and magnetic resonance imaging (MRI).

context: zh_tw: 多種成像技術，如 X 射線、熒光透視和超聲，常用於引導施源器的正確定位，及進一步最佳化治療計劃。也可使用 CAT 掃描及核磁成像 MRI。施源器置入體內後，透過縫合線或膠布將其固定在皮膚上，防止移動。確認施源器處於正確位置後，可進行進一步成像，制定具體的治療計劃。
en: Imaging techniques, such as x-ray, fluoroscopy and ultrasound are typically used to help guide the placement of the applicators to their correct positions and to further refine the treatment plan. CAT scans and MRI can also be used. Once the applicators are inserted, they are held in place against the skin using sutures or adhesive tape to prevent them from moving. Once the applicators are confirmed as being in the correct position, further imaging can be performed to guide detailed treatment planning.
qas: question: zh_tw: 當改變治療計劃的時候，什麼科技是被用於產生正確的定位？
en: When modifying plans for treatments, what technologies are utilized in order to facilitate proper applicator placement?
answers: zh_tw: text: X 射線、熒光透視和超聲
en: text: x-ray, fluoroscopy and ultrasound

context: zh_tw: 包含施源器的病人影象匯入治療計劃系統後，患者被轉移到專用的帶遮蔽的治療機房。治療計劃系統可將多張治療部位的二維影象轉化成三維 “虛擬病人” 影象，由此可以確定施源器的位置。在 “虛擬病人” 影象上的施源器、治療部位及周圍健康組織三者的空間位置關係，與真實患者體內的關係是一致的。
en: The images of the patient with the applicators in situ are imported into treatment planning software and the patient is brought into a dedicated shielded room for treatment. The treatment planning software enables multiple 2D images of the treatment site to be translated into a 3D ‘virtual patient’, within which the position of the applicators can be defined. The spatial relationships between the applicators, the treatment site and the surrounding healthy tissues within this ‘virtual patient’ are a copy of the relationships in the actual patient.
qas: question: zh_tw: 哪種影象能夠被製作成三維影象？
en: what kind of images are able to be made into 3d images?
answers: zh_tw: text: 多張治療部位的二維影象
en: text: multiple 2D images

context: zh_tw: 遠端後裝治療系統可以將放射源安放在帶遮蔽的保險罐中，為後裝操作人員提供輻射防護。施源器在病人體內正確定位後，透過一系列的連線導管與後裝機（載有放射源）連線。後裝機按照匯入的治療計劃， 控制放射源透過連線導管到達施源器內預先設定的位置。這一過程完全是在治療醫師遠離機房時完成的。依據治療計劃，放射源駐留相應的時長，之後透過套管返回後裝機內。
en: Remote afterloading systems provide protection from radiation exposure to healthcare professionals by securing the radiation source in a shielded safe. Once the applicators are correctly positioned in the patient, they are connected to an ‘afterloader’ machine (containing the radioactive sources) through a series of connecting guide tubes. The treatment plan is sent to the afterloader, which then controls the delivery of the sources along the guide tubes into the pre-specified positions within the applicator. This process is only engaged once staff are removed from the treatment room. The sources remain in place for a pre-specified length of time, again following the treatment plan, following which they are returned along the tubes to the afterloader.
qas: question: zh_tw: 用什麼將施源器連線到後裝機？
en: What is used to connect the applicators to the afterloader?
answers: zh_tw: text: 導管
en: text: guide tubes