‫ﻣﺘﺮﺟﻢ ﻣﻦ "?" ﺇﻟﻰ ﺍﻟﻌﺮﺑﻴﺔ ‪www.onlinedoctranslator.

com -‬‬

‫ﺭﺍﺟﻊﺍﻟﻤﻨﺎﻗﺸﺎﺕ ﻭﺍﻹﺣﺼﺎﺉﻴﺎﺕ ﻭﻣﻠﻔﺎﺕ ﺗﻌﺮﻳﻒ ﺍﻟﻤﺆﻟﻒ ﻟﻬﺬﺍ ﺍﻟﻤﻨﺸﻮﺭ ﻋﻠﻰ‪https://www.researchgate.net/publication/349249852:‬‬

‫ﻭﺭﻡﺍﻟﺪﻣﺎﻍ ﺍﻷﺳﺒﺎﺏ ﻭﺍﻷﻋﺮﺍﺽ ﻭﺍﻟﺘﺸﺨﻴﺺ ﻭﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‬

‫ﺷﺮﻁﻓﻲﺍﻟﺘﺼﻮﻳﺮ ﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ · ﻳﻨﺎﻳﺮ ‪2021‬‬

‫ﺩﻭﻯ‪10.2174/1573405617666210126160206:‬‬

‫ﻳﻘﺮﺃ‬ ‫ﺍﻗﺘﺒﺎﺳﺎﺕ‬

‫‪597‬‬ ‫‪4‬‬

‫‪3‬ﻣﺆﻟﻔﻴﻦ‪:‬‬

‫ﺑﺎﻧﻜﺎﺝﺳﻴﻨﺠﺮﻭﻝ‬ ‫ﻫﺎﺭﻳﻜﺎﺭﺍﺟﺎﻓﺎﺑﻮﺩﻱ‬
‫ﺍﻟﺠﺎﻣﻌﺔﺍﻟﺘﻘﻨﻴﺔ ﻓﻲ ﻣﻴﻮﻧﻴﺦ‬ ‫ﺍﻟﻤﻌﻬﺪﺍﻟﻮﻃﻨﻲ ﻟﻠﺘﻜﻨﻮﻟﻮﺟﻴﺎ‪ ،‬ﻭﺍﺭﺍﻧﺠﺎﻝ‬
‫‪2‬ﺍﻟﻤﻨﺸﻮﺭﺍﺕ‪5‬ﺍﻗﺘﺒﺎﺳﺎﺕ‬ ‫‪1‬ﺍﻟﻨﺸﺮ‪4‬ﺍﻗﺘﺒﺎﺳﺎﺕ‬

‫ﺍﻧﻈﺮﺍﻟﻤﻠﻒ ﺍﻟﺸﺨﺼﻲ‬ ‫ﺍﻧﻈﺮﺍﻟﻤﻠﻒ ﺍﻟﺸﺨﺼﻲ‬

‫ﻛﻮﻫﻴﻼﻓﻴﻼﻳﺘﺸﺎﻣﻲ‬
‫ﺍﻟﻤﻌﻬﺪﺍﻟﻮﻃﻨﻲ ﻟﻠﺘﻜﻨﻮﻟﻮﺟﻴﺎ‪ ،‬ﻭﺍﺭﺍﻧﺠﺎﻝ‬
‫‪11‬ﺍﻟﻤﻨﺸﻮﺭﺍﺕ‪60‬ﺍﻗﺘﺒﺎﺳﺎﺕ‬

‫ﺍﻧﻈﺮﺍﻟﻤﻠﻒ ﺍﻟﺸﺨﺼﻲ‬

‫ﺗﻢﺗﺤﻤﻴﻞ ﺟﻤﻴﻊ ﺍﻟﻤﺤﺘﻮﻳﺎﺕ ﺍﻟﺘﺎﻟﻴﺔ ﻟﻬﺬﻩ ﺍﻟﺼﻔﺤﺔ ﺑﻮﺍﺳﻄﺔﻛﻮﻫﻴﻼ ﻓﻴﻼﻳﺸﺎﻣﻲﻓﻲ ‪ 14‬ﻧﻮﻓﻤﺒﺮ ‪.2023‬‬

‫ﻟﻘﺪﻃﻠﺐ ﺍﻟﻤﺴﺘﺨﺪﻡ ﺗﺤﺴﻴﻦ ﺍﻟﻤﻠﻒ ﺍﻟﺬﻱ ﺗﻢ ﺗﻨﺰﻳﻠﻪ‪.‬‬

 ‫ﺃﺭﺳﻞﻃﻠﺒﺎﺕ ﺇﻋﺎﺩﺓ ﺍﻟﻄﺒﻊ ﺇﻟﻰ ‪reprints@benthamscience.net‬‬

‫‪1‬‬ ‫ﺍﻟﺘﺼﻮﻳﺮﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ‪1-12 ،17,2021 ,‬‬

‫ﻣﻘﺎﻟﺔﻣﺮﺍﺟﻌﺔ ﻣﺼﻐﺮﺓ‬

‫ﻭﺭﻡﺍﻟﺪﻣﺎﻍ ﺍﻷﺳﺒﺎﺏ ﻭﺍﻷﻋﺮﺍﺽ ﻭﺍﻟﺘﺸﺨﻴﺺ ﻭﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‬

‫‪*،1‬‬ ‫ﻫﺎﺭﻳﻜﺎﺭﺍﺟﺎﻓﺎﺑﻮﺩﻱ‪ ،†،1‬ﺑﺎﻧﻜﺎﺝ ﺳﻴﻨﺠﺮﻭﻝ‪†،1‬ﻭ ﻑ‪ .‬ﻛﻮﻫﻴﻼ‬

‫‪1‬ﻗﺴﻢ ﺍﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺍﻟﺤﻴﻮﻳﺔ‪ ،‬ﺍﻟﻤﻌﻬﺪ ﺍﻟﻮﻃﻨﻲ ﻟﻠﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﻭﺍﺭﺍﻧﺠﺎﻝ‪ ،‬ﻭﺍﺭﺍﻧﺠﺎﻝ ‪ ،506004-‬ﺗﻴﻼﻧﺠﺎﻧﺎ‪ ،‬ﺍﻟﻬﻨﺪ‬
‫ﺗﻌﺘﺒﺮﺍﻹﺳﺘﺮﺍﺗﻴﺠﻴﺔ ﺍﻟﻤﺴﺘﺨﺪﻣﺔ ﻟﻌﻼﺝ ﺳﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ ﺃﻣﺮﺍً ﺑﺎﻟﻎ ﺍﻷﻫﻤﻴﺔ ﻓﻲ ﺗﺤﺪﻳﺪ ﺍﻟﺘﺄﺛﻴﺮﺍﺕ ﺍﻟﻼﺣﻘﺔ ﻭﺍﻟﺒﻘﺎء ﻋﻠﻰ ﻗﻴﺪ ﺍﻟﺤﻴﺎﺓ‪ .‬ﻳﻘﻮﻡ‬
‫ﺗﺸﺨﻴﺺﺍﻷﻭﺭﺍﻡ ﻟﻠﻮﺭﻡ ﺑﺘﻘﻴﻴﻢ ﻣﺠﻤﻮﻋﺔ ﻣﻦ ﺍﻟﻌﻮﺍﻣﻞ ﻣﺜﻞ ﺍﻟﺸﻜﻞ ﻭﺍﻟﺤﺠﻢ ﻭﺍﻟﺤﺠﻢ ﻭﺍﻟﻤﻮﻗﻊ ﻭﺍﻟﺘﻌﻘﻴﺪ ﺍﻟﻌﺼﺒﻲ ﺍﻟﺬﻱ ﻳﺤﺪﺩ ﺷﺪﺓ‬ ‫ﺗﺎﺭﻳﺦ‬ ‫ﺷﺮﻁ‬
‫ﺍﻷﻋﺮﺍﺽ‪.‬ﻳﺤﺪﺩ ﺍﻟﺘﻘﻴﻴﻢ ﻧﻬﺞ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻨﺎﺳﺐ ﺍﻟﺬﻱ ﻳﺘﻢ ﺍﺧﺘﻴﺎﺭﻩ ﻣﻦ ﺑﻴﻦ ﻣﺠﻤﻮﻋﺔ ﻣﻦ ﺍﻟﺨﻴﺎﺭﺍﺕ ﻣﺜﻞ ﺍﻟﺠﺮﺍﺣﺔ ﻭﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‬
‫ﻭﺍﻟﻌﻼﺝﺍﻟﻬﺮﻣﻮﻧﻲ ﻭﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻭﻏﻴﺮﻫﺎ ﻣﻦ ﺍﻟﻌﻼﺟﺎﺕ ﺍﻟﻤﺴﺘﻬﺪﻓﺔ‪ .‬ﻓﻲ ﻛﺜﻴﺮ ﻣﻦ ﺍﻷﺣﻴﺎﻥ‪ ،‬ﻳﺘﻢ ﺗﻄﺒﻴﻖ ﻣﺠﻤﻮﻋﺔ ﻣﻦ ﻫﺬﻩ‬ ‫ﺗﻢﺍﻻﺳﺘﻼﻡ‪ 24 :‬ﺃﻏﺴﻄﺲ ‪2020‬‬
‫ﺍﻟﻌﻼﺟﺎﺕﻟﺘﺤﻘﻴﻖ ﻧﺘﺎﺉﺞ ﻣﺘﻔﻮﻗﺔ‪ .‬ﻳﻌﺘﺒﺮ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺑﻤﺜﺎﺑﺔ ﺍﺳﺘﺮﺍﺗﻴﺠﻴﺔ ﻋﻼﺟﻴﺔ ﺃﻓﻀﻞ ﺑﺴﺒﺐ ﺍﺭﺗﻔﺎﻉ ﻣﻌﺪﻝ ﺍﻟﺒﻘﺎء ﻋﻠﻰ ﻗﻴﺪ‬ ‫ﺗﻤﺖﺍﻟﻤﺮﺍﺟﻌﺔ‪ 15 :‬ﺩﻳﺴﻤﺒﺮ ‪2020‬‬
‫ﺗﻢﺍﻟﻘﺒﻮﻝ‪ 17 :‬ﺩﻳﺴﻤﺒﺮ ‪2020‬‬
‫ﺍﻟﺤﻴﺎﺓ‪.‬ﻓﻬﻮ ﻳﻮﻓﺮ ﻣﺮﻭﻧﺔ ﺍﻟﺘﺂﺯﺭ ﻣﻊ ﺍﺳﺘﺮﺍﺗﻴﺠﻴﺎﺕ ﺍﻟﻌﻼﺝ ﺍﻷﺧﺮﻯ ﻭﺗﺄﺛﻴﺮﺍﺕ ﺟﺎﻧﺒﻴﺔ ﺃﻗﻞ ﻋﻠﻰ ﺍﻷﻋﻀﺎء ﺍﻟﻤﻌﺮﺿﺔ ﻟﻠﺨﻄﺮ‪ .‬ﺗﻘﺪﻡ ﻫﺬﻩ‬
‫ﺍﻟﻤﺮﺍﺟﻌﺔﻭﺟﻬﺔ ﻧﻈﺮ ﺑﻴﻮﻟﻮﺟﻴﺔ ﺇﺷﻌﺎﻋﻴﺔ ﻓﻲ ﻋﻼﺝ ﻭﺭﻡ ﺍﻟﻤﺦ‪ .‬ﻳﺘﻢ ﺗﻠﺨﻴﺺ ﺍﻟﺴﺒﺐ ﻭﺍﻷﻋﺮﺍﺽ ﻭﺍﻟﺘﺸﺨﻴﺺ ﻭﺍﻟﻌﻼﺝ ﻭﺁﺛﺎﺭ ﻣﺎ ﺑﻌﺪ ﺍﻟﻌﻼﺝ‬
‫ﻭﺍﻹﻃﺎﺭﺍﻟﺬﻱ ﻳﻨﻄﻮﻱ ﻋﻠﻴﻪ ﺍﻟﻘﻀﺎء ﻋﻠﻴﻪ‪.‬‬
‫ﻣﻌﺮﻑﺍﻟﻬﻮﻳﺔ ﺍﻟﺮﻗﻤﻲ‪:‬‬

‫‪10.2174/1573405617666210126160206‬‬

‫ﺍﻟﻜﻠﻤﺎﺕﺍﻟﺪﺍﻟﺔ‪:‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‪ ،‬ﺳﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ‪ ،‬ﺧﻴﺎﺭﺍﺕ ﺍﻟﻌﻼﺝ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﺆﻳﻦ‪ ،‬ﺁﺛﺎﺭ ﻣﺎ ﺑﻌﺪ ﺍﻹﺷﻌﺎﻉ‪ ،‬ﺍﻟﻌﻼﺝ ﺑﺄﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ‪.‬‬

‫ﺍﻟﻔﺮﻭﻉﺍﻟﺮﺉﻴﺴﻴﺔ ﺍﻟﺨﺎﺭﺟﻴﺔ ﻭﺍﻟﺪﺍﺧﻠﻴﺔ )ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﻮﺿﻌﻲ( ]‪[6‬‬ ‫‪1‬ﺍﻟﻤﻘﺪﻣﺔ‬

‫‪.‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﻮﺿﻌﻲ ﻫﻮ ﻋﻼﺝ ﻣﺘﻮﺍﻓﻖ ﻟﻠﻐﺎﻳﺔ ﻳﺘﻀﻤﻦ‬
‫ﻟﻘﺪﻛﺎﻥ ﺍﺳﺘﺨﺪﺍﻡ ﺍﻟﻌﻠﻢ ﻟﻌﻼﺝ ﺍﻷﻣﺮﺍﺽ ﻓﻜﺮﺓ ﻣﺤﻞ ﺍﻫﺘﻤﺎﻡ ﻋﻠﻤﺎء‬
‫ﺍﺳﺘﺨﺪﺍﻡﻣﺼﺪﺭ ﺇﺷﻌﺎﻉ ﻳﺘﻢ ﺇﺩﺧﺎﻟﻪ ﻓﻲ ﺟﺴﻢ ﺍﻟﻤﺮﻳﺾ ﻭﻳﺴﺘﺨﺪﻡ‬
‫ﺑﺸﻜﻞﺭﺉﻴﺴﻲ ﻟﻌﻼﺝ ﺳﺮﻃﺎﻧﺎﺕ ﺍﻟﺒﺮﻭﺳﺘﺎﺗﺎ ﻭﺍﻟﺜﺪﻱ ﻭﺍﻷﻣﺮﺍﺽ‬
‫ﺍﻟﻨﺴﺎﺉﻴﺔ‪،‬ﺑﻴﻨﻤﺎ ﻓﻲ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﺨﺎﺭﺟﻲ‪ ،‬ﻳﺘﻠﻘﻰ ﺍﻟﻤﺮﻳﺾ‬
‫ﺇﺷﻌﺎﻋﺎًﻣﻦ ﺧﺎﺭﺝ ﺍﻟﺠﺴﻢ ]‪.[ 8 ،7‬‬
‫ﻳﺘﻢﻋﻼﺝ ﻣﺎ ﻳﻘﺮﺏ ﻣﻦ ‪ ٪67‬ﻣﻦ ﻣﺮﺿﻰ ﺍﻟﺴﺮﻃﺎﻥ ﺑﺎﻟﻌﻼﺝ‬
‫ﺍﻹﺷﻌﺎﻋﻲﻭﻣﻦ ﺑﻴﻨﻬﻢ‪ ،‬ﻧﺴﺒﺔ ﺍﻷﺷﺨﺎﺹ ﺍﻟﺬﻳﻦ ﻳﺘﻠﻘﻮﻥ ﺍﻟﻌﻼﺝ‬
‫ﺑﺎﻟﺠﺴﻴﻤﺎﺕﺍﻟﻤﺸﺤﻮﻧﺔ ﺃﻗﻞ ﺟﺪﺍً‪ ،‬ﻭﻫﻲ ﺗﺘﺰﺍﻳﺪ ﺗﺪﺭﻳﺠﻴﺎً ﻋﻠﻰ ﻣﺮ ﺍﻟﺴﻨﻴﻦ‬
‫]‪ .[9‬ﻳﻤﺜﻞ ﻋﺎﻡ ‪ 1952‬ﺑﺪﺍﻳﺔ ﺗﻄﺒﻴﻖ ﺃﺷﻌﺔ ﺍﻟﻬﻴﻠﻴﻮﻡ ﻭﺍﻟﺪﻳﻮﺗﺮﻭﻥ‬
‫ﺍﻟﻤﺸﺤﻮﻧﺔﻷﻏﺮﺍﺽ ﺍﻟﻌﻼﺝ ﻋﻠﻰ ﺍﻟﺒﺸﺮ ]‪ .[10‬ﺟﺬﺑﺖ ﻣﺮﺍﻓﻖ ﺍﻟﺒﺮﻭﺗﻮﻥ‬
‫ﺍﻟﻨﺎﺷﺉﺔﻭﺗﺄﺛﻴﺮﻫﺎ ﺍﻟﺒﻴﻮﻟﻮﺟﻲ ﺍﻟﻌﺎﻟﻲ ﻋﻠﻰ ﺍﻷﺷﻌﺔ ﺍﻟﺴﻴﻨﻴﺔ ﺍﻧﺘﺒﺎﻩ ﺍﻟﺨﺒﺮﺍء‬
‫ﻧﺤﻮﺍﻷﻳﻮﻧﺎﺕ ﺍﻟﺜﻘﻴﻠﺔ ]‪ .[11‬ﻭﻣﻦ ﺑﻴﻦ ﺍﻟﺨﺼﺎﺉﺺ ﺍﻟﻔﻴﺰﻳﺎﺉﻴﺔ ﺍﻟﻌﺪﻳﺪﺓ‬
‫ﺍﻟﻤﻔﻀﻠﺔﻟﻠﺠﺴﻴﻤﺎﺕ ﺍﻟﻤﺸﺤﻮﻧﺔ‪ ،‬ﺗﻌﺰﺯ ﻗﻤﺔ ﺑﺮﺍﻍ ﻣﻔﻬﻮﻡ ﺗﻄﺒﻴﻖ‬
‫ﺍﻟﺠﺴﻴﻤﺎﺕﺍﻟﻤﺸﺤﻮﻧﺔ ﻟﻸﺷﻌﺔ ﺍﻟﺴﻴﻨﻴﺔ ]‪ .[12‬ﻳﻤﻜﻦ ﻟﺤﺰﻣﺔ ﻭﺍﺣﺪﺓ ﻣﻦ‬
‫ﺇﺷﻌﺎﻉﺍﻟﺠﺴﻴﻤﺎﺕ ﺍﻟﻤﺸﺤﻮﻧﺔ ﺃﻥ ﺗﻘﻠﻞ ﻣﻦ ﺍﻟﺘﺄﺛﻴﺮ ﻋﻠﻰ ﺍﻷﻧﺴﺠﺔ‬
‫ﺍﻟﺴﻠﻴﻤﺔﺍﻟﻤﺠﺎﻭﺭﺓ ﺑﺎﻟﻤﻘﺎﺭﻧﺔ ﻣﻊ ﺍﻷﺷﻌﺔ ﺍﻟﺴﻴﻨﻴﺔ ]‪ .[13‬ﻭﻳﻨﺘﺞ ﻋﻦ ﺫﻟﻚ‬
‫ﻓﻌﺎﻟﻴﺔﺑﻴﻮﻟﻮﺟﻴﺔ ﻧﺴﺒﻴﺔ ﺃﻋﻠﻰ )‪ (RBE‬ﻟﻠﺠﺴﻴﻤﺎﺕ ﺍﻟﻤﺸﺤﻮﻧﺔ ﻣﻘﺎﺭﻧﺔ‬
‫ﺑﺎﻟﻔﻮﺗﻮﻧﺎﺕ]‪ .[14‬ﺇﻥ ﺍﻻﺧﺘﻼﻑ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﺒﻴﻮﻟﻮﺟﻲ ﺍﻟﻨﺎﺗﺞ ﻋﻦ‬
‫ﺍﻟﺠﺴﻴﻤﺎﺕﺫﺍﺕ ﻧﻘﻞ ﺍﻟﻄﺎﻗﺔ ﺍﻟﺨﻄﻴﺔ ﺍﻟﻌﺎﻟﻴﺔ ﻳﻘﻠﻞ ﻣﻦ ﺗﺄﺛﻴﺮ ﻣﺮﺣﻠﺔ‬
‫ﺩﻭﺭﺓﺍﻟﺨﻠﻴﺔ ﻭﺍﻷﻛﺴﺠﻴﻦ ﻓﻲ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻟﻠﻮﺭﻡ ]‪.[15‬‬
‫ﻣﻨﻈﻤﺔﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ ﺑﺘﺼﻨﻴﻒ ﺣﻮﺍﻟﻲ ‪ 150‬ﻧﻮﻋﺎً ﻣﺨﺘﻠﻔﺎً ﻣﻦ ﺃﻭﺭﺍﻡ‬
‫ﺍﻟﺠﻬﺎﺯﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺮﻛﺰﻱ ﺣﺘﻰ ﺍﻵﻥ ]‪ .[4‬ﻣﻦ ﺑﻴﻦ ﺃﻧﻮﺍﻉ ﺍﻟﺴﺮﻃﺎﻥ ﺍﻟﺘﻲ‬
‫ﺃﺩﺕﺍﻟﺘﻄﻮﺭﺍﺕ ﺍﻟﺘﻜﻨﻮﻟﻮﺟﻴﺔ ﻓﻲ ﻋﻼﺝ ﺍﻷﻭﺭﺍﻡ ﺑﺎﻹﺷﻌﺎﻉ ﻟﺘﻌﺰﻳﺰ‬
‫ﺟﺮﻋﺔﺍﻟﻮﺭﻡ ﻭﺇﺷﻌﺎﻉ ﺍﻷﻧﺴﺠﺔ ﺍﻟﻄﺒﻴﻌﻴﺔ ﺇﻟﻰ ﻧﺴﺒﺔ ﻋﻼﺟﻴﺔ ﺃﻋﻠﻰ ]‪.[16‬‬
‫ﻭﻗﺪﺃﺩﺕ ﺍﻟﺘﻄﻮﺭﺍﺕ ﺍﻹﺿﺎﻓﻴﺔ ﺇﻟﻰ ﺍﺳﺘﺨﺪﺍﻡ ﺟﺰﻳﺉﺎﺕ ﻣﺸﺤﻮﻧﺔ ﻋﺎﻟﻴﺔ‬
‫ﺍﻟﻄﺎﻗﺔﻟﻌﻼﺝ ﺍﻷﻭﺭﺍﻡ ﻓﻲ ﺍﻷﻋﻀﺎء ﺍﻟﺤﺴﺎﺳﺔ ﻭﺍﻷﻃﻔﺎﻝ ]‪ .[14‬ﻛﺎﻥ‬
‫ﺍﻟﻐﺮﺽﺍﻷﺳﺎﺳﻲ ﻟﻠﻤﺠﻤﻮﻋﺔ ﺍﻟﺘﻌﺎﻭﻧﻴﺔ ﻟﻠﻌﻼﺝ ﺑﺎﻟﺠﺴﻴﻤﺎﺕ )‪(PTCOG‬‬
‫ﻫﻮﺗﻄﻮﻳﺮ ﻣﺮﺍﻓﻖ ﺍﻟﺠﺴﻴﻤﺎﺕ ﻓﻲ ﺍﻟﻤﺴﺘﺸﻔﻰ ﻟﻌﻼﺝ ﺍﻷﻭﺭﺍﻡ ﻓﻲ ﺃﻱ‬
‫ﻣﻜﺎﻥﻓﻲ ﺍﻟﺠﺴﻢ‪ ،‬ﻋﻠﻰ ﻏﺮﺍﺭ ﻣﺴﺮﻋﺎﺕ ﺍﻟﻔﻮﺗﻮﻥ ﺍﻟﺨﻄﻴﺔ ﺍﻟﺴﺮﻳﺮﻳﺔ‬
‫ﺍﻟﻘﻴﺎﺳﻴﺔ]‪ .[17‬ﻭﻣﻊ ﺫﻟﻚ‪ ،‬ﻧﻈﺮﺍً ﻻﺭﺗﻔﺎﻉ ﺗﻜﻠﻔﺔ ﺍﻻﺳﺘﺜﻤﺎﺭ ﺍﻷﻭﻟﻲ )‪200‬‬
‫ﻣﻠﻴﻮﻥﺩﻭﻻﺭ ﺃﻣﺮﻳﻜﻲ( ﻭﺍﻟﻤﻌﺪﺍﺕ ﺍﻟﻜﺒﻴﺮﺓ‪ ،‬ﻓﺈﻥ ﺍﻟﻌﻼﺝ ﺑﺎﻟﺠﺴﻴﻤﺎﺕ‬
‫ﺍﻟﻤﺸﺤﻮﻧﺔﻟﻴﺲ ﻓﻲ ﻣﺘﻨﺎﻭﻝ ﺍﻟﺠﻤﺎﻫﻴﺮ ]‪ .[19 ،18‬ﻫﺬﻩ ﺍﻟﻤﻘﺎﻟﺔ‬
‫ﺍﻟﻤﺮﺍﺟﻌﺔﻣﻠﺨﺼﺔ‪-‬‬
‫ﻣﺜﻞﻧﻴﻮﺗﻦ ﻭﺟﺎﻟﻴﻠﻴﻮ‬
‫ﻣﻨﺬﺍﻟﻘﺮﻥ ﺍﻟﺴﺎﺩﺱ ﻋﺸﺮ ]‪ .[1‬ﻓﻲ ﺍﻝ ‪18‬ﺫﻓﻲ ﺍﻟﻘﺮﻥ ﺍﻟﻌﺸﺮﻳﻦ‪ ،‬ﺍﻗﺘﺮﺡ‬
‫ﺍﻟﺠﺮﺍﺡﺍﻻﺳﻜﺘﻠﻨﺪﻱ ﺍﻟﺸﻬﻴﺮ ﺟﻮﻥ ﻫﺎﻧﺘﺮ ﻋﻼﺟﺎً ﺟﺮﺍﺣﻴﺎً ﻟﻌﻼﺝ ﺍﻟﺴﺮﻃﺎﻥ‪،‬‬
‫ﻣﻤﺎﺃﺩﻯ ﺇﻟﻰ ﻭﻻﺩﺓ ﺍﻟﻄﺐ ﺍﻟﺤﺪﻳﺚ‪.‬‬
‫ﺩﺭﺍﺳﺔﻣﺮﺿﻴﺔ ﻟﻠﻮﺭﻡ ﻓﻲ ﻣﻨﻄﻘﺔ ‪19‬ﺫﺍﻟﻘﺮﻥ ]‪ .[2‬ﻛﺎﻧﺖ ﻫﻨﺎﻙ ﻧﻈﺮﻳﺎﺕ‬
‫ﻣﺘﻌﺪﺩﺓﻣﻘﺘﺮﺣﺔ ﻟﺘﻔﺴﻴﺮ ﺳﺒﺐ ﺍﻟﺴﺮﻃﺎﻥ‪ ،‬ﻭﺍﻟﺘﻲ ﺷﻤﻠﺖ ﺍﻟﻨﻈﺮﻳﺎﺕ‬
‫ﺍﻟﺸﺎﺉﻌﺔﻣﺜﻞ ﺍﻟﻨﻈﺮﻳﺔ ﺍﻟﺨﻠﻄﻴﺔ‪ ،‬ﻭﻧﻈﺮﻳﺔ ﺍﻟﻠﻴﻤﻔﺎﻭﻳﺔ‪ ،‬ﻭﻧﻈﺮﻳﺔ ﺍﻟﺼﺪﻣﺔ‪،‬‬
‫ﻭﻧﻈﺮﻳﺔﺍﻷﻣﺮﺍﺽ ﺍﻟﻤﻌﺪﻳﺔ‪ .‬ﻭﺑﻌﺪ ﺍﻟﻜﺜﻴﺮ ﻣﻦ ﺍﻷﺑﺤﺎﺙ ﻭﺍﻟﺘﻘﺪﻡ‬
‫ﺍﻟﺘﻜﻨﻮﻟﻮﺟﻲ‪،‬ﺧﻄﺮﺕ ﻓﻜﺮﺓ ﺍﻟﻤﻮﺍﺩ ﺍﻟﻤﺴﺮﻃﻨﺔ ﺍﻟﻔﻴﺮﻭﺳﻴﺔ ﻭﺍﻟﻜﻴﻤﻴﺎﺉﻴﺔ‬
‫ﻟﻌﺎﻟﻢﺍﻟﻘﺮﻥ ﺍﻟﻌﺸﺮﻳﻦ ]‪ .[3‬ﻭﺳﺮﻋﺎﻥ ﻣﺎ ﺗﻢ ﺇﺟﺮﺍء ﺃﺑﺤﺎﺙ ﻋﻠﻰ ﺍﻟﺠﻴﻨﺎﺕ‬
‫ﺍﻟﻤﺴﺮﻃﻨﺔﻭﺍﻟﺠﻴﻨﺎﺕ ﺍﻟﻜﺎﺑﺘﺔ ﻟﻠﻮﺭﻡ ﻟﺘﻄﻮﻳﺮ ﻋﻼﺟﺎﺕ ﻣﺴﺘﻬﺪﻓﺔ ]‪ .[3‬ﺑﻌﺪ‬
‫ﻣﺰﻳﺪﻣﻦ ﺍﻟﺘﻄﻮﻳﺮ‪ ،‬ﻭﺻﻞ ﺍﻟﺒﺸﺮ ﺇﻟﻰ ﻣﺮﺣﻠﺔ ﺗﺘﻮﻓﺮ ﻓﻴﻬﺎ ﺧﻴﺎﺭﺍﺕ ﻣﺘﻌﺪﺩﺓ‬
‫ﻟﻌﻼﺝﺍﻟﺴﺮﻃﺎﻥ‪.‬‬
‫ﻳﻤﺜﻞﺍﻟﺴﺮﻃﺎﻥ ﺟﺰءﺍً ﻛﺒﻴﺮﺍً ﻣﻦ ﺍﻟﺤﺰﻥ ﻭﺍﻟﻮﻓﻴﺎﺕ ﻓﻲ ﺍﻟﻌﺎﻟﻢ‪ .‬ﻣﻊ‬
‫ﺯﻳﺎﺩﺓﺣﺎﻻﺕ ﺍﻟﺴﺮﻃﺎﻥ ﺍﻟﻤﺮﺗﺒﻄﺔ ﺑﺎﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺮﻛﺰﻱ‪ ،‬ﺃﺻﺒﺤﺖ‬
‫ﺍﻟﺤﺎﺟﺔﺇﻟﻰ ﻋﻼﺝ ﻣﺘﻘﺪﻡ ﺑﻴﻮﻟﻮﺟﻴﺎً ﺃﻛﺜﺮ ﻣﻦ ﺃﻱ ﻭﻗﺖ ﻣﻀﻰ‪ .‬ﻗﺎﻣﺖ‬
‫ﺗﺼﻴﺐﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺮﻛﺰﻱ‪ ،‬ﺗﻌﺪ ﺃﻭﺭﺍﻡ ﺍﻟﻤﺦ ﻫﻲ ﺍﻟﻨﻮﻉ ﺍﻷﻛﺜﺮ‬
‫ﻋﺪﻭﺍﻧﻴﺔﻣﻊ ﺍﺭﺗﻔﺎﻉ ﻣﻌﺪﻝ ﺍﻟﻮﻓﻴﺎﺕ‪ ،‬ﻭﻋﻠﻰ ﻣﺪﻯ ﻋﻘﻮﺩ ﻣﻦ ﺍﻟﺪﺭﺍﺳﺔ‪،‬‬
‫ﺃﺻﺒﺢﺍﻟﻌﻼﺝ ﻟﻬﺎ ﺃﻛﺜﺮ ﻛﻔﺎءﺓ ﻣﻨﺬ ﺑﺪﺍﻳﺔ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‪/‬ﺍﻟﻌﻼﺝ‬
‫ﺍﻹﺷﻌﺎﻋﻲ]‪.[5‬‬
‫ﻳﺴﺘﺨﺪﻡﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻔﻮﺗﻮﻧﺎﺕ )ﺍﻷﺷﻌﺔ ﺍﻟﺴﻴﻨﻴﺔ( ﻭﺍﻟﺠﺴﻴﻤﺎﺕ‬
‫ﺍﻟﻤﺸﺤﻮﻧﺔ)ﺍﻟﺒﺮﻭﺗﻮﻧﺎﺕ ﻭﺍﻷﻳﻮﻧﺎﺕ ﺍﻟﺜﻘﻴﻠﺔ( ﻟﻌﻼﺝ ﺍﻟﻮﺭﻡ‪ .‬ﻭﻟﻬﺎ ﺍﺛﻨﺎﻥ‬
‫* ﻋﻨﻮﺍﻥ ﺍﻟﻤﺮﺍﺳﻼﺕ ﻣﻊ ﻫﺬﺍ ﺍﻟﻤﺆﻟﻒ ﻓﻲ ﻗﺴﻢ ﺍﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺍﻟﺤﻴﻮﻳﺔ‪ ،‬ﺍﻟﻤﻌﻬﺪ ﺍﻟﻮﻃﻨﻲ‬
‫ﻟﻠﺘﻜﻨﻮﻟﻮﺟﻴﺎﻭﺍﺭﺍﻧﺠﺎﻝ‪ ،‬ﻭﺍﺭﺍﻧﺠﺎﻝ ‪ ،506004 -‬ﺗﻴﻼﻧﺠﺎﻧﺎ‪ ،‬ﺍﻟﻬﻨﺪ؛ ﻫﺎﺗﻒ‪+ :‬‬
‫‪،8332969460-91‬ﻓﺎﻛﺲ‪2459547-870-91+ :‬؛‬
‫ﺍﻟﺒﺮﻳﺪﺍﻹﻟﻜﺘﺮﻭﻧﻲ‪v.kohila@nitw.ac.in :‬‬
‫†ﻭﻗﺪ ﺳﺎﻫﻢ ﺟﻤﻴﻊ ﺍﻟﻤﺆﻟﻔﻴﻦ ﻋﻠﻰ ﻗﺪﻡ ﺍﻟﻤﺴﺎﻭﺍﺓ‪.‬‬

‫© ‪ 2021‬ﺩﺍﺭ ﻧﺸﺮ ﺑﻨﺜﺎﻡ ﻟﻠﻌﻠﻮﻡ‬ ‫‪ 65.00 1573-4056/21‬ﺩﻭﻻﺭﺍً ﺃﻣﺮﻳﻜﻴﺎً ‪00.+‬‬

‫ﺭﺍﺟﺎﻓﺎﺑﻮﺩﻱﻭﺁﺧﺮﻭﻥ‪.‬‬ ‫‪2‬ﺍﻟﺘﺼﻮﻳﺮ ﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ‪ ،2021،‬ﺭﺣﻠﺔ ﺟﻮﻳﺔ‪ ،17 .‬ﻻ‪00 .‬‬

‫ﺭﺳﻢﺑﻴﺎﻧﻲ ‪.(1‬ﺭﺳﻢ ﺗﺨﻄﻴﻄﻲ ﻳﺘﻀﻤﻦ ﻟﻤﺤﺔ ﻋﺎﻣﺔ ﻋﻦ ﻭﺟﻬﺔ ﻧﻈﺮ ﻋﺎﻟﻢ ﺍﻷﺣﻴﺎء ﺍﻹﺷﻌﺎﻋﻲ ﻟﺴﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ‪) .‬ﻳﺘﻮﻓﺮ ﺇﺻﺪﺍﺭ ﺃﻋﻠﻰ ﺩﻗﺔ‪/‬ﻟﻮﻥ ﻟﻬﺬﺍ ﺍﻟﺮﻗﻢ ﻓﻲ ﺍﻟﻨﺴﺨﺔ‬
‫ﺍﻹﻟﻜﺘﺮﻭﻧﻴﺔﻣﻦ ﺍﻟﻤﻘﺎﻟﺔ(‪.‬‬
 ‫ﺍﻟﺘﺼﻮﻳﺮﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ‪ ،2021،‬ﺭﺣﻠﺔ ﺟﻮﻳﺔ‪ ،17 .‬ﻻ‪300 .‬‬
‫ﻣﻦﺍﻟﻬﻮﺍﺗﻒ ﺍﻟﻤﺤﻤﻮﻟﺔ ﻓﻲ ﺍﻟﺘﺴﺒﺐ ﻓﻲ ﻭﺭﻡ ﻓﻲ ﺍﻟﻤﺦ ﻟﺪﻯ ﺍﻟﺒﺎﻟﻐﻴﻦ‬
‫ﻭﺍﻷﻃﻔﺎﻝ]‪ .[40 ،39‬ﺗﺴﺎﻫﻢ ﺍﻷﺷﻌﺔ ﻓﻮﻕ ﺍﻟﺒﻨﻔﺴﺠﻴﺔ ﺍﻟﻤﺴﺘﺨﺪﻣﺔ ﻓﻲ‬
‫ﺍﻟﺼﻨﺎﻋﺎﺕﻭﺍﻟﻤﺨﺘﺒﺮﺍﺕ ﻓﻲ ﺍﺭﺗﻔﺎﻉ ﺧﻄﺮ ﺍﻹﺻﺎﺑﺔ ﺑﺎﻟﺴﺮﻃﺎﻥ ]‪.[41‬‬
‫ﺍﻟﻤﺮﺿﻰﺍﻟﺬﻳﻦ ﺧﻀﻌﻮﺍ ﺳﺎﺑﻘﺎً ﻟﻠﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻟﻠﺪﻣﺎﻍ ﻫﻢ ﺃﻛﺜﺮ ﻋﺮﺿﺔ‬
‫ﻟﻺﺻﺎﺑﺔﺑﻮﺭﻡ ﻓﻲ ﺍﻟﻤﺦ ]‪ .[43 ،42‬ﻭﺑﺎﻟﻤﺜﻞ‪ ،‬ﻣﻦ ﺍﻟﻤﺮﺟﺢ ﺃﻥ ﻳﺘﻢ‬
‫ﺗﺸﺨﻴﺺﺇﺻﺎﺑﺔ ﺳﻜﺎﻥ ﺍﻟﻤﻨﺎﻃﻖ ﺍﻟﻘﺮﻳﺒﺔ ﻣﻦ ﺍﻟﻤﺤﻄﺎﺕ ﺍﻟﻨﻮﻭﻳﺔ ﺍﻟﺘﻲ‬
‫ﺑﻬﺎﺗﺴﺮﺑﺎﺕ ﺳﺎﺑﻘﺔ ﺑﻮﺭﻡ ﻓﻲ ﺍﻟﻤﺦ ]‪.[46-44‬‬
‫‪.2.5‬ﻭﺭﻡ ﺧﺒﻴﺚ‬
‫ﺇﻧﻪﺃﺳﻮﺃ ﺟﺰء ﻣﻦ ﺍﻟﻮﺭﻡ ﺍﻟﺠﻬﺎﺯﻱ ﻭﻳﺆﺩﻱ ﺍﻧﺘﺸﺎﺭﻩ ﺇﻟﻰ ﺍﻟﺪﻣﺎﻍ ﺇﻟﻰ‬
‫ﺗﺄﺛﻴﺮﺍﺕﻏﻴﺮ ﻣﺮﻏﻮﺏ ﻓﻴﻬﺎ ﻋﻠﻰ ﺍﻟﻌﺪﻳﺪ ﻣﻦ ﺍﻟﻮﻇﺎﺉﻒ ﺍﻟﺤﻴﻮﻳﺔ ﺍﻟﺘﻲ‬
‫ﻳﺘﺤﻜﻢﻓﻴﻬﺎ ﻫﺬﺍ ﺍﻟﻌﻀﻮ ]‪ .[49-47‬ﺩﺍﺉﻤﺎً ﻣﺎ ﻳﺤﺪﺩ ﺍﻟﺘﺸﺨﻴﺺ ﺍﻟﺴﻴﺊ‬
‫ﻟﻠﻤﺮﺿﻰﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺍﻟﺴﺮﻃﺎﻧﺎﺕ ﺍﻟﺼﻠﺒﺔ ﻧﺘﺎﺉﺞ ﻣﻤﻴﺘﺔ ﻭﺭﻡ‬
‫ﺧﺒﻴﺚﻓﻲ ﺍﻟﺪﻣﺎﻍ ]‪ .[50 ،49‬ﺑﺴﺒﺐ ﺍﻟﺘﻘﻨﻴﺎﺕ ﺍﻟﻤﺘﺨﻠﻔﺔ‪ ،‬ﻻ ﺗﻮﺟﺪ‬
‫ﺗﺪﺍﺑﻴﺮﻣﻮﺛﻮﻗﺔ ﻣﺘﺎﺣﺔ ﻟﺘﺠﻨﺐ ﻫﺬﺍ ﺍﻟﺤﺪﺙ‪ .‬ﺃﺛﺒﺖ ﻋﻼﺝ ﺁﻓﺎﺕ ﺍﻟﺪﻣﺎﻍ‬
‫ﺍﻟﻤﻨﺘﺸﺮﺓﻋﻦ ﻃﺮﻳﻖ ﺍﻻﺳﺘﺨﺪﺍﻡ ﺍﻻﻧﺘﻘﺎﺉﻲ ﻟﻠﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻣﻊ ﺍﻟﻌﻼﺝ‬
‫ﺍﻟﻜﻴﻤﻴﺎﺉﻲﻭﺍﻟﺠﺮﺍﺣﺔ ﻓﻌﺎﻟﻴﺘﻪ ]‪ .[52 ،51‬ﻳﺴﺎﻫﻢ ﺍﻟﺴﺮﻃﺎﻥ ﺍﻷﻭﻟﻲ ﻓﻲ‬
‫ﺍﻟﺮﺉﺘﻴﻦﺑﻨﺴﺒﺔ ‪ %50-40‬ﻣﻦ ﻭﺭﻡ ﺧﺒﻴﺚ ﻓﻲ ﺍﻟﺪﻣﺎﻍ‪ ،‬ﻳﻠﻴﻪ ﺳﺮﻃﺎﻥ‬
‫ﺍﻟﺜﺪﻱﻭﺍﻟﻮﺭﻡ ﺍﻟﻤﻴﻼﻧﻴﻨﻲ ﺑﺤﻮﺍﻟﻲ ‪ %20‬ﻟﻜﻞ ﻣﻨﻬﻤﺎ ]‪.[54 ،53‬‬
‫ﺍﻟﺘﺼﻠﺐﺍﻟﺤﺪﺑﻲ‪ ،‬ﻭﻣﺘﻼﺯﻣﺔ ﺗﻮﺭﻛﻮﺕ‪ ،‬ﻭﺍﻟﻮﺭﻡ ﺍﻟﻠﻴﻔﻲ ﺍﻟﻌﺼﺒﻲ )ﺍﻟﻨﻮﻉ ‪1‬‬
‫‪.3‬ﺍﻷﻋﺮﺍﺽ‬
‫ﻣﻦﺍﻟﺼﻌﺐ ﺗﺤﺪﻳﺪ ﺍﻟﻮﺭﻡ ﻓﻲ ﻣﺮﺣﻠﺔ ﻣﺒﻜﺮﺓ‪ ،‬ﺣﻴﺚ ﺗﺘﻄﻮﺭ ﺑﻌﺾ‬
‫ﺃﻭﺭﺍﻡﺍﻟﻤﺦ ﺩﻭﻥ ﺃﻱ ﺃﻋﺮﺍﺽ ﺑﻴﻨﻤﺎ ﺗﻈﻬﺮ ﺍﻷﻋﺮﺍﺽ ﻟﺪﻯ ﺍﻟﺒﻌﺾ ﺍﻵﺧﺮ‬
‫ﺗﺪﺭﻳﺠﻴﺎً]‪ .[55‬ﻳﺤﺪﺩ ﻣﻮﻗﻊ ﺍﻟﻮﺭﻡ ﻭﺣﺠﻤﻪ ﺍﻷﻋﺮﺍﺽ ﺍﻟﻤﻤﻴﺰﺓ ﻭﺗﺄﺛﻴﺮﻫﺎ ]‬
‫‪ .[56‬ﻳﻤﻜﻦ ﺃﻥ ﻳﺴﺎء ﻓﻬﻢ ﻫﺬﻩ ﺍﻷﻋﺮﺍﺽ ﻋﻠﻰ ﺃﻧﻬﺎ ﻟﻴﺴﺖ ﻋﻼﻣﺎﺕ‬
‫ﺗﺸﺨﻴﺼﻴﺔﻭﺑﺎﻟﺘﺎﻟﻲ ﻻ ﻳﺴﻌﻰ ﺍﻟﻤﺮﻳﺾ ﻟﻠﺤﺼﻮﻝ ﻋﻠﻰ ﺭﻋﺎﻳﺔ ﻃﺒﻴﺔ‪ ،‬ﻋﻠﻰ‬
‫ﺳﺒﻴﻞﺍﻟﻤﺜﺎﻝ‪ ،‬ﺍﻟﺼﺪﺍﻉ ﻭﺍﻟﻐﺜﻴﺎﻥ ﻣﻦ ﺍﻷﻋﺮﺍﺽ ﺍﻟﻘﻴﺎﺳﻴﺔ ﻟﺴﺮﻃﺎﻥ‬
‫ﺍﻟﺪﻣﺎﻍﻋﻠﻰ ﺍﻟﺮﻏﻢ ﻣﻦ ﻋﺪﻡ ﻇﻬﻮﺭﻫﺎ ﺣﺘﻰ ﺍﻟﻤﺮﺍﺣﻞ ﺍﻟﻤﺘﻘﺪﻣﺔ ]‪.[59-57‬‬
‫ﻳﺠﺐﻋﻠﻰ ﺍﻷﺷﺨﺎﺹ ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺷﻌﻮﺭ ﺩﺍﺉﻢ ﺑﺎﻟﻐﺜﻴﺎﻥ‬
‫ﻭﺍﻟﺼﺪﺍﻉﻭﻓﻘﺪﺍﻥ ﺍﻟﺸﻬﻴﺔ ﻭﺍﻟﻘﻲء ﻏﻴﺮ ﺍﻟﻤﻌﺘﺎﺩ ﺍﻟﺘﺤﻘﻖ ﻓﻮﺭﺍً ﻣﻦ ﻭﺟﻮﺩ‬
‫ﻭﺭﻡﻓﻲ ﺍﻟﻤﺦ ]‪ .[59‬ﻳﺆﺛﺮ ﺳﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ ﻋﻠﻰ ﺍﻟﻤﻬﺎﺭﺍﺕ ﺍﻟﺤﺮﻛﻴﺔ‬
‫ﻟﻠﻤﺮﻳﺾﻣﻤﺎ ﻳﺴﺒﺐ ﻧﻮﺑﺎﺕ ﻣﺜﻞ ﺍﻟﺘﺸﻨﺠﺎﺕ ]ﺍﻟﻨﻮﺑﺎﺕ ﺍﻟﺤﺮﻛﻴﺔ[‬
‫ﻭﻓﻘﺪﺍﻥﺍﻹﺣﺴﺎﺱ ﺑﺎﻷﻃﺮﺍﻑ ﻭﺍﻟﺤﺮﻛﺔ ﻭﺍﻟﻀﻌﻒ ﻭﺻﻌﻮﺑﺔ ﺍﻟﺘﻮﺍﺯﻥ‬
‫ﻭﺍﻟﻤﺸﻲ]‪ .[60‬ﻳﺆﺛﺮ ﺍﻟﻮﺭﻡ ﻋﻠﻰ ﻗﺪﺭﺍﺕ ﺍﻟﺘﻔﻜﻴﺮ ﻭﺍﻟﺸﻌﻮﺭ ﻟﺪﻯ ﺍﻟﻤﺮﻳﺾ‪،‬‬
‫ﻣﻤﺎﻳﺆﺩﻱ ﺇﻟﻰ ﺻﻌﻮﺑﺔ ﻓﻲ ﺍﻟﻨﻄﻖ‪ ،‬ﻭﺗﻘﻠﺐ ﺍﻟﻤﺰﺍﺝ‪ ،‬ﻭﺗﻐﻴﺮ ﻣﺴﺘﻮﻳﺎﺕ‬
‫ﺍﻟﺘﺮﻛﻴﺰ‪،‬ﻭﻓﻘﺪﺍﻥ ﺍﻟﺬﺍﻛﺮﺓ ﻭﺍﻟﺸﺮﻭﺩ‪ ،‬ﻭﻋﺪﻡ ﻭﺿﻮﺡ ﺍﻟﺮﺅﻳﺔ ﻭﻣﺸﺎﻛﻞ ﻓﻲ‬
‫ﺍﻟﺴﻤﻊ]‪.[64-61‬‬
‫ﺍﻟﺪﻣﺎﻍﻷﻥ ﺍﻟﺪﻣﺎﻍ ﺃﻛﺜﺮ ﺣﺮﺍﺳﺔ ﻧﺴﺒﻴﺎً ]‪ .[21‬ﻭﻣﻊ ﺫﻟﻚ‪ ،‬ﻳﺘﻢ ﺇﺟﺮﺍء ﺍﻟﻤﺰﻳﺪ‬
‫‪.4‬ﺍﻟﻌﻼﺝ‬
‫ﻳﻨُﺼﺢﺍﻟﻤﺮﺿﻰ ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺍﻷﻋﺮﺍﺽ ﺍﻟﻤﺬﻛﻮﺭﺓ ﺃﻋﻼﻩ ﻟﻮﺭﻡ‬
‫ﻓﻲﺍﻟﻤﺦ ﺑﺘﻘﻴﻴﻢ ﺍﻟﻤﻌﻠﻤﺎﺕ ﺍﻟﺘﺎﻟﻴﺔ‪ :‬ﻧﻮﻉ ﺍﻟﻮﺭﻡ ﻭﺩﺭﺟﺘﻪ ﻭﺣﺠﻤﻪ ﻭﻣﻮﻗﻌﻪ‬
‫ﻭﻣﺪﻯﺗﻌﻘﻴﺪﻩ ﻣﻊ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﻭﺗﺎﺭﻳﺨﻬﻢ ﺍﻟﻄﺒﻲ )ﺍﻟﺠﺪﻭﻝ‪ .(1‬ﻳﺘﻢ‬
‫ﺇﺟﺮﺍءﻫﺬﻩ ﺍﻟﺘﻘﻴﻴﻤﺎﺕ ﺑﺎﺳﺘﺨﺪﺍﻡ ﺗﻘﻨﻴﺎﺕ ﺍﻟﺘﺸﺨﻴﺺ ﺍﻟﻤﺨﺘﻠﻔﺔ ﻣﺜﻞ‬
‫ﻳﻘﻠﻞﻣﻦ ﻓﺮﺹ ﺍﻹﺻﺎﺑﺔ ﺑﺴﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ ]‪ .[35-32‬ﻭﻣﻦ ﺛﻢ‪ ،‬ﻓﺈﻥ ﺗﺄﺛﻴﺮ‬
‫ﺍﻟﺘﺼﻮﻳﺮﺍﻟﻤﻘﻄﻌﻲ ﺍﻟﻤﺤﻮﺭﻱ )‪ ،(CT‬ﻭﺍﻟﺘﺼﻮﻳﺮ ﺑﺎﻟﺮﻧﻴﻦ ﺍﻟﻤﻐﻨﺎﻃﻴﺴﻲ‬
‫)‪ ،(MRI‬ﻭﺗﺨﻄﻴﻂ ﻛﻬﺮﺑﻴﺔ ﺍﻟﺪﻣﺎﻍ )‪ ،(EEG‬ﻭﺍﻟﺘﺼﻮﻳﺮ ﺑﺎﻟﺮﻧﻴﻦ‬
‫ﺍﻟﻤﻐﻨﺎﻃﻴﺴﻲﺍﻟﺘﺮﻭﻳﺔ‪ ،‬ﻭﺍﻟﺘﺼﻮﻳﺮ ﺑﺎﻟﺮﻧﻴﻦ ﺍﻟﻤﻐﻨﺎﻃﻴﺴﻲ ﺍﻟﻮﻇﻴﻔﻲ )‪fMRI‬‬
‫(‪ ،‬ﻭﺍﻟﺘﺤﻠﻴﻞ ﺍﻟﻄﻴﻔﻲ ﺑﺎﻟﺮﻧﻴﻦ ﺍﻟﻤﻐﻨﺎﻃﻴﺴﻲ )‪ .[65-68] (MRS‬ﻳﺘﻢ‬
‫ﺗﺠﻤﻴﻊﻧﺘﺎﺉﺞ ﻫﺬﻩ ﺍﻟﻔﺤﻮﺻﺎﺕ ﻣﻦ ﻗﺒﻞ ﻣﺘﺨﺼﺼﻴﻦ ﻃﺒﻴﻴﻦ ﻣﺨﺘﻠﻔﻴﻦ‬
‫ﻟﺘﺸﻜﻴﻞﺍﺳﺘﺮﺍﺗﻴﺠﻴﺔ ﻋﻼﺝ ﻣﺜﺎﻟﻴﺔ ﻟﻠﻮﺭﻡ‪ .‬ﻭﻳﻠﻌﺐ ﺍﻟﺘﻨﻤﻴﻂ ﺍﻟﺠﺰﻳﺉﻲ‬
‫ﻟﻠﻤﺮﻳﺾﺃﻳﻀﺎً ﺩﻭﺭﺍً ﺣﺎﺳﻤﺎً ﻓﻲ ﻓﻬﻢ ﺍﻟﺘﺮﻛﻴﺐ ﺍﻟﺠﻴﻨﻲ ﻟﻠﻮﺭﻡ‪ ،‬ﻣﻤﺎ‬
‫ﻳﺴﺎﻋﺪﻓﻲ ﺗﺼﻤﻴﻢ ﺃﻓﻀﻞ ﺍﺳﺘﺮﺍﺗﻴﺠﻴﺔ ﻋﻼﺟﻴﺔ‪ .‬ﺑﻴﻦ ﺍﻟﺤﺎﻟﻲ‬
‫ﻋﺎﻣﻞﻣﺴﺮﻃﻦ ﻭﺗﻘﻮﻡ ﺣﺎﻟﻴﺎً ﺑﺘﻘﻴﻴﻢ ﺩﻭﺭ ﺍﻹﺷﻌﺎﻋﺎﺕ ﺍﻟﻜﻬﺮﻭﻣﻐﻨﺎﻃﻴﺴﻴﺔ‬
‫ﻭﺭﻡﺍﻟﺪﻣﺎﻍ ﺍﻷﺳﺒﺎﺏ ﻭﺍﻷﻋﺮﺍﺽ ﻭﺍﻟﺘﺸﺨﻴﺺ‬
‫ﺗﺒﺮﺯﺍﻟﻌﻮﺍﻣﻞ ﺍﻟﻤﺨﺘﻠﻔﺔ ﺍﻟﺘﻲ ﺗﺪﺧﻞ ﻓﻲ ﻋﻼﺝ ﺳﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ‪ ،‬ﺑﺪءﺍً ﻣﻦ‬
‫ﺃﺳﺒﺎﺑﻪﻭﺣﺘﻰ ﺗﺄﺛﻴﺮﺍﺕ ﻣﺎ ﺑﻌﺪ ﺍﻟﻌﻼﺝ ﺑﺴﺒﺐ ﺳﻮء ﺍﻟﺘﺸﺨﻴﺺ‬
‫ﻭﺍﺳﺘﺨﺪﺍﻡﺍﻹﺷﻌﺎﻉ ﺃﺛﻨﺎء ﺍﻟﻌﻼﺝ )ﺍﻟﺸﻜﻞ ‪.(1.(1‬‬
‫‪.2‬ﺍﻷﺳﺒﺎﺏ‬
‫ﻋﻠﻰﺍﻟﻤﺴﺘﻮﻯ ﺍﻟﺠﺰﻳﺉﻲ‪ ،‬ﻳﻌﺪ ﺗﻠﻒ ﺍﻟﺠﻴﻨﺎﺕ ﺩﺍﺧﻞ ﺍﻟﺨﻼﻳﺎ ﻫﻮ‬
‫ﺍﻟﺴﺒﺐﺍﻟﺮﺉﻴﺴﻲ ﻟﻠﺴﺮﻃﺎﻥ ]‪ .[20‬ﺃﺳﺒﺎﺏ ﻣﻌﻈﻢ ﺳﺮﻃﺎﻧﺎﺕ ﺍﻟﺪﻣﺎﻍ‬
‫ﻏﻴﺮﻣﻜﺘﺸﻔﺔ ﻭﻟﻜﻦ ﺍﻷﺑﺤﺎﺙ ﺍﻟﻌﻠﻤﻴﺔ ﺃﺩﺕ ﺇﻟﻰ ﺗﺤﺪﻳﺪ ﺑﻌﺾ ﻋﻮﺍﻣﻞ‬
‫ﺍﻟﺨﻄﺮﺍﻟﺘﻲ ﻗﺪ ﺗﺆﺩﻱ ﺇﻟﻰ ﺗﻄﻮﺭ ﻭﺭﻡ ﻓﻲ ﺍﻟﻤﺦ ]‪ .[21‬ﺍﻟﻄﻔﺮﺓ ‪ /‬ﺍﻟﻀﺮﺭ‬
‫ﺍﻟﺬﻱﻳﺆﺩﻱ ﺇﻟﻰ ﺗﺸﻐﻴﻞ ﻭﺇﻳﻘﺎﻑ ﺍﻟﺠﻴﻦ ﺍﻟﻮﺭﻣﻲ ﺃﻭ ﺍﻟﺠﻴﻦ ﺍﻟﻜﺎﺑﺖ ﻟﻠﻮﺭﻡ‬
‫ﻋﻠﻰﺍﻟﺘﻮﺍﻟﻲ ﻳﺴﺒﺐ ﺍﻟﺴﺮﻃﺎﻥ ]‪ .[22‬ﺗﻜﻮﻥ ﻓﺮﺹ ﺣﺪﻭﺙ ﻫﺬﻩ ﺍﻷﺿﺮﺍﺭ‬
‫ﺍﻟﺠﻴﻨﻴﺔﻣﺮﺗﻔﻌﺔ ﺧﻼﻝ ﺣﻴﺎﺓ ﺍﻟﻤﺮﻳﺾ ﻣﻘﺎﺭﻧﺔ ﺑﻮﺭﺍﺛﺔ ﺍﻟﺠﻴﻦ ﺍﻟﻤﺘﺤﻮﺭ ﻣﻦ‬
‫ﺍﻟﻮﺍﻟﺪﻳﻦ‪،‬ﻭﻫﻮ ﻣﺎ ﺃﺩﻯ ﺇﻟﻰ ﺇﺟﺮﺍء ﺍﻟﺪﺭﺍﺳﺎﺕ ﺣﻮﻝ ﻋﻮﺍﻣﻞ ﺍﻟﺨﻄﺮ‬
‫ﺍﻟﺨﺎﺭﺟﻴﺔ]‪.[21‬‬
‫‪.2.1‬ﻣﻴﺮﺍﺙ‬
‫ﺍﻟﺘﺎﺭﻳﺦﺍﻟﻌﺎﺉﻠﻲ ﻣﻊ ﺃﻧﻮﺍﻉ ﻗﻠﻴﻠﺔ ﻣﻦ ﺃﻭﺭﺍﻡ ﺍﻟﻤﺦ ﻳﺰﻳﺪ ﻣﻦ ﻓﺮﺹ‬
‫ﺍﻹﺻﺎﺑﺔﺑﻮﺭﻡ ﻓﻲ ﺍﻟﻤﺦ ]‪ .[23‬ﺍﻟﻤﺘﻼﺯﻣﺎﺕ ﺍﻟﻤﺴﺆﻭﻟﺔ ﻋﻦ ﺫﻟﻚ ﻫﻲ‬
‫ﻭ‪ ،(2‬ﻭﻣﺘﻼﺯﻣﺔ ﻟﻴﻔﻔﺮﻭﻣﻴﻨﻲ‪ ،‬ﻭﻣﺘﻼﺯﻣﺔ ﺗﻴﺮﻧﺮ‪ ،‬ﻭﻣﺘﻼﺯﻣﺔ ﺟﻮﺭﻟﻴﻦ ﻭﻓﻮﻥ‬
‫ﻫﻴﺒﻞﻟﻴﻨﺪﺍﻭ‪ ،‬ﻭﻗﺪ ﺗﺘﺮﺍﻓﻖ ﻣﻊ ﻋﻮﺍﻣﻞ ﻭﺭﺍﺛﻴﺔ ]‪.[24‬‬
‫ﺇﺣﺼﺎﺉﻴﺎً‪،‬ﻟﻮﺣﻆ ﺃﻥ ﺍﻟﻘﻮﻗﺎﺯﻳﻴﻦ ﺃﻛﺜﺮ ﻋﺮﺿﺔ ﻟﻺﺻﺎﺑﺔ ﺑﺴﺮﻃﺎﻥ‬
‫ﺍﻟﺪﻣﺎﻍﻣﻦ ﺍﻷﻋﺮﺍﻕ ﺍﻷﺧﺮﻯ‪ .‬ﻭﻣﻦ ﺛﻢ‪ ،‬ﻓﺈﻥ ﺍﻟﻌﺮﻕ‪/‬ﺍﻹﺛﻨﻴﺔ ﻫﻮ ﺃﻳﻀﺎً ﺃﺣﺪ‬
‫ﺍﻟﻌﻮﺍﻣﻞﺍﻟﺘﻲ ﻳﺠﺐ ﺃﺧﺬﻫﺎ ﻓﻲ ﺍﻻﻋﺘﺒﺎﺭ ]‪.[25‬‬
‫‪.2.2‬ﺍﻟﺘﻌﺮﺽ ﻟﻠﻤﻮﺍﺩ ﺍﻟﻜﻴﻤﻴﺎﺉﻴﺔ‬
‫ﻗﺪﺗﺆﺩﻱ ﺑﻌﺾ ﺍﻟﻤﻮﺍﺩ ﺍﻟﻜﻴﻤﻴﺎﺉﻴﺔ ﺍﻟﻤﺴﺘﺨﺪﻣﺔ ﻓﻲ ﺃﻣﺎﻛﻦ ﺍﻟﻌﻤﻞ‬
‫ﺇﻟﻰﺯﻳﺎﺩﺓ ﺧﻄﺮ ﺍﻹﺻﺎﺑﺔ ﺑﺴﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ‪ ،‬ﻋﻠﻰ ﺳﺒﻴﻞ ﺍﻟﻤﺜﺎﻝ‪،‬‬
‫ﺍﻟﻜﻠﻮﺭﻭﻓﻮﺭﻡﻭﺛﻨﺎﺉﻲ ﺑﺮﻭﻣﻴﺪ ﺍﻹﻳﺜﻴﻠﻴﻦ‪ ،‬ﻭﺍﻟﺘﻲ ﺗﺴﺘﺨﺪﻡ ﻓﻲ ﺍﻟﻤﺨﺘﺒﺮﺍﺕ‬
‫ﻹﺟﺮﺍءﺍﻟﺘﺠﺎﺭﺏ ]‪ .[27 ،26‬ﺃﺛﺒﺘﺖ ﺍﻟﺪﺭﺍﺳﺎﺕ ﺃﻥ ﺍﻟﻨﺘﺮﺍﺕ ﻭﺍﻟﻨﺘﺮﻳﺖ‬
‫ﺍﻟﻤﻮﺟﻮﺩﺓﻓﻲ ﺍﻟﻠﺤﻮﻡ ﺍﻟﻤﻌﺎﻟﺠﺔ ﻭﺩﺧﺎﻥ ﺍﻟﺴﺠﺎﺉﺮ ﻭﻣﺴﺘﺤﻀﺮﺍﺕ‬
‫ﺍﻟﺘﺠﻤﻴﻞﻳﻤﻜﻦ ﺃﻥ ﺗﺆﺩﻱ ﺇﻟﻰ ﺳﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ ]‪ .[31-28‬ﻭﻣﻊ ﺫﻟﻚ‪ ،‬ﻓﺈﻥ‬
‫ﻫﺬﻩﺍﻟﻤﻮﺍﺩ ﺍﻟﻤﺴﺮﻃﻨﺔ ﻻ ﺗﻠﻌﺐ ﺩﻭﺭﺍً ﻣﻬﻤﺎً ﻓﻲ ﺍﻟﺘﺴﺒﺐ ﻓﻲ ﺳﺮﻃﺎﻥ‬
‫ﻣﻦﺍﻷﺑﺤﺎﺙ ﻟﻠﺘﻮﺻﻞ ﺇﻟﻰ ﺑﻴﺎﻥ ﻗﺎﻃﻊ‪.‬‬
‫‪.2.3‬ﺍﻟﺴﺠﻞ ﺍﻟﻄﺒﻲ‬
‫ﻛﺸﻒﻓﺤﺺ ﺍﻟﻌﺪﻭﻯ ﺍﻟﻔﻴﺮﻭﺳﻴﺔ ﻭﺍﺭﺗﺒﺎﻃﻬﺎ ﺑﺴﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ ﺃﻥ‬
‫ﻋﺪﺩﻛﺮﻳﺎﺕ ﺍﻟﺪﻡ ﺍﻟﺒﻴﻀﺎء ﻳﺰﻳﺪ ﻣﻦ ﺧﻄﺮ ﺍﻹﺻﺎﺑﺔ ﺑﺴﺮﻃﺎﻥ ﺍﻟﻐﺪﺩ‬
‫ﺍﻟﻠﻴﻤﻔﺎﻭﻳﺔﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺮﻛﺰﻱ‪ ،‬ﻓﻲ ﺣﻴﻦ ﻟﻮﺣﻆ ﺃﻥ ﺟﺪﺭﻱ ﺍﻟﻤﺎء‬
‫ﺍﻟﻌﻮﺍﻣﻞﺍﻟﻔﻴﺮﻭﺳﻴﺔ ﻋﻠﻰ ﺗﻄﻮﺭ ﺳﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ ﻳﺨﺘﻠﻒ ﻣﻦ ﺣﺎﻟﺔ ﺇﻟﻰ‬
‫ﺃﺧﺮﻯ‪.‬‬
‫‪.2.4‬ﺍﻟﺘﻌﺮﺽ ﻟﻺﺷﻌﺎﻋﺎﺕ‬
‫ﺍﻹﺷﻌﺎﻋﺎﺕﻫﻲ ﺍﻟﻌﺎﻣﻞ ﺍﻟﻮﺣﻴﺪ ﺍﻟﻤﺆﻛﺪ ﻟﻺﺻﺎﺑﺔ ﺑﺴﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ‪،‬‬
‫ﺣﺘﻰﻟﻮ ﻛﺎﻧﺖ ﻣﺴﺆﻭﻟﺔ ﻋﻦ ﻧﺴﺒﺔ ﺻﻐﻴﺮﺓ ﻣﻦ ﺍﻟﺤﺎﻻﺕ ]‪.[38-36‬‬
‫ﺍﻋﺘﺮﻓﺖﻣﻨﻈﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ )‪ (WHO‬ﺑﺄﻥ ﺍﻹﺷﻌﺎﻋﺎﺕ ﺍﻟﻤﺆﻳﻨﺔ ﻫﻲ‬
‫ﺭﺍﺟﺎﻓﺎﺑﻮﺩﻱﻭﺁﺧﺮﻭﻥ‪.‬‬ ‫‪4‬ﺍﻟﺘﺼﻮﻳﺮ ﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ‪ ،2021،‬ﺭﺣﻠﺔ ﺟﻮﻳﺔ‪ ،17 .‬ﻻ‪00 .‬‬

‫ﺍﻟﺠﺪﻭﻝ‪ .1‬ﺃﻧﻮﺍﻉ ﺃﻭﺭﺍﻡ ﺍﻟﻤﺦ ﻣﻊ ﺧﻴﺎﺭﺍﺕ ﺍﻟﻌﻼﺝ ﺍﻟﻤﺘﺎﺣﺔ ﻟﻜﻞ ﻣﻨﻬﺎ‪.‬‬

‫ﻣﺮﺟﻊ‬ ‫ﺧﻴﺎﺭﺍﺕﺍﻟﻌﻼﺝ ﺍﻟﻤﺘﺎﺣﺔ‬ ‫ﻧﻮﻉﻭﺭﻡ ﺍﻟﺪﻣﺎﻍ‬

‫]‪[123‬‬ ‫ﺍﻟﺠﺮﺍﺣﺔﺍﻟﻤﺠﻬﺮﻳﺔ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﺘﻘﻠﻴﺪﻱ‬ ‫ﺍﻟﻌﺼﺐﺍﻟﺴﻤﻌﻲ‬
‫ﺍﻟﺠﺮﺍﺣﺔ‪،‬ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﺴﺎﻋﺪ ﺑﺠﺮﻋﺔ ﻋﺎﻟﻴﺔ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻗﺒﻞ ﺍﻟﺠﺮﺍﺣﺔ‪ ،‬ﺍﻟﻌﻼﺝ‬
‫]‪[124‬‬ ‫ﻭﺭﻡﺣﺒﻠﻲ‬
‫ﺍﻹﺷﻌﺎﻋﻲﺍﻟﻤﺠﺰﺃ ]ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﻮﺟﻪ ﺑﺎﻟﺼﻮﺭ ﻭﺍﻟﻤﺠﺴﻢ ﺍﻟﻤﺠﺴﻢ[‬
‫]‪[125‬‬ ‫ﺍﻻﺳﺘﺉﺼﺎﻝﺍﻟﺠﺮﺍﺣﻲ ﺍﻟﻜﺎﻣﻞ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻟﻤﺴﺎﻋﺪ ]ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﻭﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﺘﻘﻠﻴﺪﻱ[‬ ‫ﺍﻷﻭﺭﺍﻡﺍﻟﻨﺠﻤﻴﺔ ﺍﻟﺸﻌﺮﻳﺔ‬
‫]‪[126‬‬ ‫ﺍﺳﺘﺉﺼﺎﻝﺍﻟﻮﺭﻡ ﺍﻟﺠﺬﺭﻱ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻟﻤﺴﺎﻋﺪ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺑﻌﺪ ﺍﻟﻌﻤﻠﻴﺔ ﺍﻟﺠﺮﺍﺣﻴﺔ‬ ‫ﻭﺭﻡﻧﺠﻤﻲ ﻣﻨﺨﻔﺾ ﺍﻟﺪﺭﺟﺔ‬
‫]‪[127‬‬ ‫ﺍﻻﺳﺘﺉﺼﺎﻝﺍﻟﺠﺮﺍﺣﻲ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﺑﻌﺪ ﺍﻟﻌﻤﻠﻴﺔ ﺍﻟﺠﺮﺍﺣﻴﺔ‬ ‫ﻭﺭﻡﻧﺠﻤﻲ ﻛﺸﻤﻲ‬
‫ﺍﻻﺳﺘﺉﺼﺎﻝﺍﻟﺠﺮﺍﺣﻲ ﻳﻠﻴﻪ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻭﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﺑﻌﺪ ﺍﻟﻌﻤﻠﻴﺔ ﺍﻟﺠﺮﺍﺣﻴﺔ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻟﻤﺴﺎﻋﺪ‬
‫]‪[128‬‬ ‫ﻭﺭﻡﺃﺭﻭﻣﻲ ﺩﺑﻘﻲ‬
‫‪com.apy‬‬

‫]‪[129‬‬ ‫ﺍﻟﻌﻼﺝﺍﻟﻜﻴﻤﻴﺎﺉﻲ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻟﻜﺎﻣﻞ ﺍﻟﺪﻣﺎﻍ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‬ ‫ﺳﺮﻃﺎﻥﺍﻟﻐﺪﺩ ﺍﻟﻠﻴﻤﻔﺎﻭﻳﺔ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺮﻛﺰﻱ‬

‫]‪[130‬‬ ‫ﺍﻻﺳﺘﺉﺼﺎﻝﺍﻟﺠﺮﺍﺣﻲ‪ ،‬ﺍﻟﺠﺮﺍﺣﺔ ﺍﻹﺷﻌﺎﻋﻴﺔ ﺑﺴﻜﻴﻦ ﺟﺎﻣﺎ‬ ‫ﺍﻟﻮﺭﻡﺍﻟﺸﻔﺎﻧﻲ‬

‫]‪[131‬‬ ‫ﺍﻟﺠﺮﺍﺣﺔﻭﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻭﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﺴﺎﻋﺪ ﻭﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‬ ‫ﺍﻷﻭﺭﺍﻡﺍﻟﻘﺤﻔﻴﺔ ﺍﻟﺒﻠﻌﻮﻣﻴﺔ‬
‫]‪[132‬‬ ‫ﺍﻻﺳﺘﺉﺼﺎﻝﺍﻟﺠﺮﺍﺣﻲ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﺍﻟﻤﺴﺎﻋﺪ‬ ‫ﺍﻟﺠﻠﺪﺍﻟﻌﺼﺒﻲ ﺍﻟﺒﺪﺍﺉﻲ ]‪[PNET‬‬
‫]‪[133‬‬ ‫ﺍﻟﺠﺮﺍﺣﺔ‪،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﺠﺴﻢ‪ ،‬ﺍﻟﺠﺮﺍﺣﺔ ﺍﻹﺷﻌﺎﻋﻴﺔ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‬ ‫ﻭﺭﻡﺍﻟﻐﺪﺓ ﺍﻟﻨﺨﺎﻣﻴﺔ‬
‫]‪[134‬‬ ‫ﺍﻟﺠﺮﺍﺣﺔﺍﻟﻤﻮﺟﻬﺔ ﺑﺎﻟﻔﻠﻮﺭﺳﻨﺖ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‬ ‫ﻭﺭﻡﺍﻟﺪﺑﻘﻴﺎﺕ ﻗﻠﻴﻠﺔ ﺍﻟﺘﻐﺼﻦ‬

‫ﺍﻻﺳﺘﺉﺼﺎﻝﺍﻟﺠﺮﺍﺣﻲ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﻄﺎﺑﻖ ﺛﻼﺛﻲ ﺍﻷﺑﻌﺎﺩ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﺠﺰﺃ‪ ،‬ﺗﺸﻲ‪-‬‬
‫]‪[135‬‬ ‫ﻭﺭﻡﺟﺬﻉ ﺍﻟﺪﻣﺎﻍ ﺍﻟﺪﺑﻘﻲ‬
‫‪com.motherapy‬‬

‫]‪[136‬‬ ‫ﺍﻻﺳﺘﺉﺼﺎﻝﺍﻟﺠﺮﺍﺣﻲ ﻳﻠﻴﻪ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺑﻌﺪ ﺍﻟﻌﻤﻠﻴﺔ ﺍﻟﺠﺮﺍﺣﻴﺔ‪ ،‬ﻭﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻟﻜﺎﻣﻞ ﺍﻟﺪﻣﺎﻍ‬ ‫ﺃﻭﺭﺍﻡﺍﻟﺪﻣﺎﻍ ﺍﻟﻨﻘﻴﻠﻴﺔ‬
‫]‪[137‬‬ ‫ﺍﻟﻌﻼﺝﺍﻟﺠﺮﺍﺣﻲ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻟﻜﺎﻣﻞ ﺍﻟﺪﻣﺎﻍ‬ ‫ﻭﺭﻡﺑﻄﺎﻧﻲ ﻋﺼﺒﻲ‬
‫]‪[138‬‬ ‫ﺍﺳﺘﺉﺼﺎﻝﺍﻟﺠﺮﺍﺣﻲ‬ ‫ﻭﺭﻡﺑﻄﺎﻧﻲ ﻓﺮﻋﻲ‬
‫]‪[139‬‬ ‫ﺍﻟﻌﻼﺝﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﺠﺴﻢ ﺍﻟﻤﺠﺰﺃ‪ ،‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﻮﺟﻪ ﺑﺎﻟﺼﻮﺭ‬ ‫ﻭﺭﻡﺍﻟﻌﺼﺐ ﺍﻟﺒﺼﺮﻱ‬
‫]‪[140‬‬ ‫ﺍﺳﺘﺉﺼﺎﻝﺍﻟﺠﺮﺍﺣﻲ‬ ‫ﻭﺭﻡﺃﺭﻭﻣﻲ ﻧﺨﺎﻋﻲ‬
‫]‪[141‬‬ ‫ﺍﻟﻌﻼﺝﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﺠﺮﺍﺣﻲ ﺍﻟﻤﺴﺎﻋﺪ‬ ‫ﺍﻟﻮﺭﻡﺍﻟﺴﺤﺎﺉﻲ‬

‫ﻣﻊﺍﻟﺤﻔﺎﻅ ﻋﻠﻰ ﺍﻟﺨﻼﻳﺎ ﺍﻟﺴﻠﻴﻤﺔ‪ ،‬ﺣﻴﺚ ﺗﺴﺘﻬﺪﻑ ﺍﻟﻤﻤﺎﺭﺳﺔ ﺍﻟﺘﻘﻠﻴﺪﻳﺔ‬
‫ﻋﺎﺩﺓ ًﻣﺮﺣﻠﺔ ﻣﻦ ﺩﻭﺭﺓ ﺍﻟﺨﻠﻴﺔ‪ ،‬ﻭﻫﻲ ﺍﻟﻤﺴﺆﻭﻟﺔ ﻋﻦ ﺍﻟﻬﺠﻮﻡ ﻋﻠﻰ ﺍﻟﺨﻼﻳﺎ‬
‫ﺍﻟﺴﺮﻃﺎﻧﻴﺔﻭﻛﺬﻟﻚ ﺍﻟﺴﻠﻴﻤﺔ ]‪ .[77-75‬ﺗﻌﺪ ﺍﻟﻌﻼﺟﺎﺕ ﺍﻟﻤﺴﺘﻬﺪﻓﺔ‬
‫ﻭﺍﻟﻌﻮﺍﻣﻞﺍﻟﻤﻤﻴﺰﺓ ﻭﺍﻟﻌﻼﺝ ﺍﻟﻬﺮﻣﻮﻧﻲ ﻭﺍﻟﻌﻼﺝ ﺍﻟﻤﻨﺎﻋﻲ ﺑﻌﻀﺎً ﻣﻦ‬
‫ﺍﻟﺒﺪﺍﺉﻞﺍﻟﻤﻘﺪﻣﺔ ﺟﻨﺒﺎً ﺇﻟﻰ ﺟﻨﺐ ﻣﻊ ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﻟﺘﻘﻠﻴﻞ ﺁﺛﺎﺭﻩ‬
‫ﻋﻠﻰﺍﻷﻧﺴﺠﺔ ﺍﻟﺴﻠﻴﻤﺔ ]‪ .[78‬ﻓﻲ ﺣﻴﻦ ﺃﻥ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻮﺟﻪ ﻳﻘﺘﻞ ﺍﻟﺨﻼﻳﺎ‬
‫ﺍﻟﺴﺮﻃﺎﻧﻴﺔﺑﺸﻜﻞ ﺻﺮﻳﺢ‪ ،‬ﻓﺈﻥ ﻋﻮﺍﻣﻞ ﺍﻟﺘﻤﻴﻴﺰ ﺗﻤﻴﻞ ﺇﻟﻰ ﺗﻄﻮﻳﺮ ﺍﻟﺨﻼﻳﺎ‬
‫ﺍﻟﺴﺮﻃﺎﻧﻴﺔﺇﻟﻰ ﺧﻼﻳﺎ ﻃﺒﻴﻌﻴﺔ‪ .‬ﻳﺆﺛﺮ ﺍﻟﻌﻼﺝ ﺍﻟﻬﺮﻣﻮﻧﻲ ﻋﻠﻰ ﺗﻮﺍﻓﺮ‬
‫ﻫﺮﻣﻮﻧﺎﺕﻧﻤﻮ ﻣﻌﻴﻨﺔ ﻟﻠﺨﻼﻳﺎ ﺍﻟﺴﺮﻃﺎﻧﻴﺔ‪ ،‬ﺑﻴﻨﻤﺎ ﻳﻘﺘﺮﺏ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻨﺎﻋﻲ‬
‫ﻋﺒﺮﺗﻌﺰﻳﺰ ﺍﻻﺳﺘﺠﺎﺑﺎﺕ ﺍﻟﻤﻨﺎﻋﻴﺔ ﺗﺠﺎﻩ ﺍﻟﺨﻼﻳﺎ ﺍﻟﺴﺮﻃﺎﻧﻴﺔ ]‪.[80 ،79‬‬
‫ﺍﻟﺘﺤﺪﻱﺍﻟﺮﺉﻴﺴﻲ ﺍﻟﺬﻱ ﻳﻮﺍﺟﻪ ﺃﺛﻨﺎء ﺗﻄﺒﻴﻖ ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‬
‫ﻭﻣﺠﻤﻮﻋﺎﺗﻪﻟﺤﺎﻻﺕ ﺳﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ ﻫﻮ ﺻﻌﻮﺑﺔ ﺍﺧﺘﺮﺍﻕ ﺣﺎﺟﺰ ﺍﻟﺪﻡ ﻓﻲ‬
‫ﺍﻟﺪﻣﺎﻍﺑﻮﺍﺳﻄﺔ ﺍﻟﺪﻭﺍء ]‪.[81‬‬
‫ﻣﻊﻧﺴﺒﺔ ﻧﺠﺎﺡ ﻋﺎﻟﻴﺔ‪ ،‬ﻳﻜﻮﻥ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺃﻛﺜﺮ ﻭﺿﻮﺣﺎً ﻣﻦ‬
‫ﺍﻟﺠﺮﺍﺣﺔﻟﻌﻼﺝ ﺍﻟﺴﺮﻃﺎﻥ‪ .‬ﻳﻌﻤﻞ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻋﻠﻰ ﻣﺒﺪﺃ ﺗﻠﻒ‬
‫ﺍﻟﺤﻤﺾﺍﻟﻨﻮﻭﻱ ﻋﻦ ﻃﺮﻳﻖ ﺇﺣﺪﺍﺙ ﻓﻮﺍﺻﻞ ﺻﻐﻴﺮﺓ ﻓﻲ ﺍﻟﺘﺴﻠﺴﻞ‬
‫ﺍﻟﺠﻴﻨﻲ‪،‬ﻭﺑﺎﻟﺘﺎﻟﻲ ﻗﺘﻞ ﺍﻟﺨﻼﻳﺎ ﻭﺗﺜﺒﻴﻂ ﺗﻜﺎﺛﺮﻫﺎ ]‪ .[82‬ﻓﻲ ﺍﻷﺳﺎﺱ‪،‬‬
‫ﻳﻨﻘﺴﻢﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺇﻟﻰ ﺛﻼﺙ ﻓﺉﺎﺕ ﺭﺉﻴﺴﻴﺔ‪ :‬ﺧﺎﺭﺟﻲ‪ ،‬ﻭﺩﺍﺧﻠﻲ‪،‬‬
‫ﻭﻧﻈﺎﻣﻲ‪.‬ﺑﻴﻨﻤﺎ ﻓﻲ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻨﻈﺎﻣﻲ‪ ،‬ﺗﺼﻞ ﺍﻟﻤﻮﺍﺩ ﺍﻟﻤﺸﻌﺔ‬
‫ﺇﻟﻰﻣﻮﻗﻊ ﺍﻟﻮﺭﻡ ﻣﻦ ﺧﻼﻝ ﺃﻭﺭﺩﺓ ﺍﻟﻤﺮﻳﺾ‪ ،‬ﻓﻲ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‬
‫ﺍﻟﺪﺍﺧﻠﻲ]ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﻮﺿﻌﻲ[‪ ،‬ﻳﺘﻢ ﺣﻘﻦ ﻣﺼﺪﺭ ﻣﺸﻊ ﻓﻲ‪/‬‬
‫ﺑﺎﻟﻘﺮﺏﻣﻦ ﻣﻮﻗﻊ ﺍﻟﻮﺭﻡ ]‪ .[84 ،83‬ﻳﺘﻀﻤﻦ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﺨﺎﺭﺟﻲ‬
‫ﺗﺸﻌﻴﻊﺍﻟﻮﺭﻡ ﺑﺎﺳﺘﺨﺪﺍﻡ ﺣﺰﻡ ﻋﺎﻟﻴﺔ ﺍﻟﻄﺎﻗﺔ ﻣﻦ ﺍﻟﻔﻮﺗﻮﻧﺎﺕ ﺃﻭ‬
‫ﺍﻟﺠﺴﻴﻤﺎﺕﺍﻟﻤﺸﺤﻮﻧﺔ ]‪ .[84‬ﺗﺴُﺘﺨﺪﻡ ﻫﺬﻩ ﺍﻟﻌﻼﺟﺎﺕ ﻗﺒﻞ ﺍﻟﺠﺮﺍﺣﺔ ]‬
‫ﺍﻟﻌﻼﺝﺍﻟﻤﺴﺎﻋﺪ ﺍﻟﺠﺪﻳﺪ[ ﻟﺘﻘﻠﻴﺺ ﺍﻟﻮﺭﻡ ﻭﺑﻌﺪ ﺍﻟﻌﻤﻞ ﺍﻟﺠﺮﺍﺣﻲ ]ﺍﻟﻌﻼﺝ‬
‫ﺍﻟﻤﺴﺎﻋﺪ[ ﻟﺘﺠﻨﺐ ﺗﻜﺮﺍﺭ ﺍﻟﻮﺭﻡ ]‪ .[85‬ﺍﻟﺘﻄﺒﻴﻖ ﺍﻟﺴﺎﺉﺪ‪-‬‬
‫ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‪.‬ﻳﺴﻌﻰ ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﺇﻟﻰ ﺇﻳﺠﺎﺩ ﺍﻟﺘﻮﺍﺯﻥ ﺑﻴﻦ ﺍﻟﻘﻀﺎء‬
‫ﺗﺘﻮﻓﺮﺑﺪﺍﺉﻞ ﺍﻟﻌﻼﺝ‪ ،‬ﻭﻳﻔﻀﻞ ﺃﻥ ﺗﻜﻮﻥ ﺍﻟﺠﺮﺍﺣﺔ ﻫﻲ ﺍﻟﺨﻄﻮﺓ ﺍﻷﻭﻟﻴﺔ‬
‫ﻹﺯﺍﻟﺔﺍﻟﻮﺭﻡ ﻭﻏﺎﻟﺒﺎ ﻣﺎ ﺗﻜﻮﻥ ﻋﻼﺟﻴﺔ ]‪ .[70 ،69‬ﻭﻣﻊ ﺫﻟﻚ‪ ،‬ﺇﺫﺍ ﺍﺳﺘﻤﺮ‬
‫ﺍﻟﻮﺭﻡﻓﻲ ﺍﻻﻧﺘﺸﺎﺭ‪ ،‬ﻓﺘﺘﺒﻌﻪ ﻣﺠﻤﻮﻋﺔ ﻣﻦ ﺗﻘﻨﻴﺎﺕ ﺍﻟﻌﻼﺝ ﻣﺜﻞ ﺍﻟﻌﻼﺝ‬
‫ﺍﻹﺷﻌﺎﻋﻲﺃﻭ ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﺃﻭ ﺍﻟﺠﺮﺍﺣﺔ ﺍﻟﻤﻮﺟﻬﺔ ﺑﺎﻟﺼﻮﺭ ﺃﻭ ﺍﻟﻌﻼﺝ‬
‫ﺍﻟﻤﻮﺟﻪﺑﻴﻮﻟﻮﺟﻴﺎً ]‪.[71‬‬
‫ﺳﻴﺤﺪﺩﺗﻌﻘﻴﺪ ﺍﻟﺨﻼﻳﺎ ﺍﻟﻌﺼﺒﻴﺔ ﺍﻹﺯﺍﻟﺔ ﺍﻟﺠﺰﺉﻴﺔ ﺃﻭ ﺍﻟﻜﺎﻣﻠﺔ ﻟﻠﻮﺭﻡ‪.‬‬
‫ﺗﺘﻀﻤﻦﺍﻟﺠﺮﺍﺣﺔ ﺍﻟﻤﺘﻄﻮﺭﺓ ﺍﻟﻤﻮﺟﻬﺔ ﺑﺎﻟﺼﻮﺭ ﺗﻄﻮﻳﺮ ﺗﺸﺮﻳﺢ ﺑﺸﺮﻱ‬
‫ﺍﻓﺘﺮﺍﺿﻲﻳﻮﺟﻪ ﺍﻟﺠﺮﺍﺡ ﻓﻲ ﺧﻄﻮﺍﺕ ﻣﺨﺘﻠﻔﺔ ﻃﻮﺍﻝ ﻋﻤﻠﻴﺔ ﺇﺯﺍﻟﺔ ﺍﻟﻮﺭﻡ ]‬
‫‪ .[73،72‬ﻭﻣﻊ ﺫﻟﻚ‪ ،‬ﻭﺑﺴﺒﺐ ﺍﻟﺘﻌﻘﻴﺪ ﺍﻟﻤﻔﺮﻁ ﻟﻠﺨﻼﻳﺎ ﺍﻟﻌﺼﺒﻴﺔ‪ ،‬ﻓﺈﻥ‬
‫ﺍﻻﺳﺘﺉﺼﺎﻝﺍﻟﺠﺮﺍﺣﻲ ﻟﻠﻮﺭﻡ ﻳﻌﺮﺽ ﺍﻟﻤﺮﻳﺾ ﻟﺨﻄﺮ ﺃﻛﺒﺮ ﻟﻺﺻﺎﺑﺔ‬
‫ﺑﺄﻣﺮﺍﺽﺍﻟﺘﻨﻜﺲ ﺍﻟﻌﺼﺒﻲ ﻭﺍﻷﻭﺭﺍﻡ ﺍﻟﺨﺒﻴﺜﺔ ﺍﻟﺜﺎﻧﻮﻳﺔ‪ .‬ﺇﻟﻰ ﺟﺎﻧﺐ ﺍﻟﺘﻌﻘﻴﺪ‬
‫ﺍﻟﻌﺼﺒﻲﻟﻠﻮﺭﻡ‪ ،‬ﻳﻌﺪ ﻭﺟﻮﺩ ﺍﻟﺤﺎﺟﺰ ﺍﻟﺪﻣﻮﻱ ﺍﻟﺪﻣﺎﻏﻲ ﺃﻳﻀﺎً ﻋﺎﻣﻼ ًﺣﺎﺳﻤﺎً‬
‫ﻳﺠﺐﺃﺧﺬﻩ ﻓﻲ ﺍﻻﻋﺘﺒﺎﺭ ﻷﻧﻪ ﻳﻌﺰﻝ ﺍﻟﺪﻣﺎﻍ ﺟﺴﺪﻳﺎً ﻭﻭﻇﻴﻔﻴﺎً ﻋﻦ ﺍﻟﺠﻬﺎﺯ‬
‫ﺍﻟﻤﻨﺎﻋﻲﻟﻠﺠﺴﻢ‪ ،‬ﺑﺤﻴﺚ ﻻ ﻳﻜﻮﻥ ﻟﺪﻳﻬﻢ ﺫﺍﻛﺮﺓ ﻟﻠﻮﺭﻡ‪ .‬ﺧﻼﻳﺎ ﺍﻟﺪﻣﺎﻍ‬
‫ﻛﺨﻼﻳﺎﺩﺍﺧﻠﻴﺔ‪ .‬ﻭﺃﻱ ﺿﺮﺭ ﻟﻬﺬﺍ ﺍﻟﺤﺎﺟﺰ‪ ،‬ﺑﺴﺒﺐ ﺳﻮء ﺗﺸﺨﻴﺺ ﺍﻟﺪﻣﺎﻍ‬
‫ﻭﺍﻷﻧﺴﺠﺔﺍﻟﻤﺠﺎﻭﺭﺓ‪ ،‬ﻳﺆﺩﻱ ﺇﻟﻰ ﺗﻌﺮﺽ ﺧﻼﻳﺎ ﺍﻟﺪﻣﺎﻍ ﻟﻠﺪﻡ‪ ،‬ﺍﻟﺬﻱ ﻳﻌﻤﻞ‬
‫ﻛﺤﺎﻣﻞﻟﺠﻤﻴﻊ ﺍﻻﺳﺘﺠﺎﺑﺎﺕ ﺍﻟﻤﻨﺎﻋﻴﺔ ﺍﻟﺨﻠﻄﻴﺔ ﻭﺍﻟﺨﻠﻮﻳﺔ‪ .‬ﺗﻬﺎﺟﻢ ﻫﺬﻩ‬
‫ﺍﻟﺨﻼﻳﺎﺍﻟﻤﻨﺎﻋﻴﺔ ﺧﻼﻳﺎ ﺍﻟﺪﻣﺎﻍ‪ ،‬ﻭﺗﻌﺎﻣﻠﻬﺎ ﻛﻤﺴﺘﻀﺪﺍﺕ‪ ،‬ﻣﻤﺎ ﻳﺆﺩﻱ ﺇﻟﻰ‬
‫ﺍﺿﻄﺮﺍﺑﺎﺕﺍﻟﻤﻨﺎﻋﺔ ﺍﻟﺬﺍﺗﻴﺔ‪ .‬ﻓﻲ ﻣﺜﻞ ﻫﺬﻩ ﺍﻟﻈﺮﻭﻑ‪ ،‬ﻳﻌﺪ ﺍﻟﻌﻼﺝ‬
‫ﺍﻟﻜﻴﻤﻴﺎﺉﻲﻭﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻋﻼﺟﺎً ﻣﻮﺛﻮﻗﺎً ﺑﻪ‪.‬‬
‫ﻳﺘﻀﻤﻦﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﺗﻨﺎﻭﻝ ﺍﻷﺩﻭﻳﺔ ﺍﻟﻤﻀﺎﺩﺓ ﻟﻠﺴﺮﻃﺎﻥ‬
‫ﻭﺍﻟﻤﻮﺍﺩﺍﻟﻜﻴﻤﻴﺎﺉﻴﺔ ﺍﻟﻤﻮﺟﻬﺔ ﻟﻘﺘﻞ ﺍﻟﺨﻼﻳﺎ ﺍﻟﺴﺮﻃﺎﻧﻴﺔ ]‪ .[74‬ﺇﻥ ﻃﺒﻴﻌﺔ‬
‫ﺍﻟﺨﻼﻳﺎﺍﻟﺴﺮﻃﺎﻧﻴﺔ ﺍﻟﻤﺘﻜﺎﺛﺮﺓ ﺑﺴﺮﻋﺔ ﺗﺠﻌﻠﻬﺎ ﻫﺪﻓﺎً ﺃﻓﻀﻞ ﻟﻌﻮﺍﻣﻞ ﺍﻟﻌﻼﺝ‬
‫ﻋﻠﻰﺍﻟﺨﻼﻳﺎ ﺍﻟﺴﺮﻃﺎﻧﻴﺔ ﻭ‬
 ‫ﺍﻟﺘﺼﻮﻳﺮﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ‪ ،2021،‬ﺭﺣﻠﺔ ﺟﻮﻳﺔ‪ ،17 .‬ﻻ‪500 .‬‬ ‫ﻭﺭﻡﺍﻟﺪﻣﺎﻍ ﺍﻷﺳﺒﺎﺏ ﻭﺍﻷﻋﺮﺍﺽ ﻭﺍﻟﺘﺸﺨﻴﺺ‬

‫ﻗﻤﺔﺍﻟﺘﻔﺎﺧﺮ‪ .‬ﺍﻟﺨﺎﺻﻴﺔ ﺍﻟﻔﻴﺰﻳﺎﺉﻴﺔ ﻟﺘﻨﺎﻗﺺ ﺍﻟﺠﺮﻋﺔ ﺇﻟﻰ ﻣﺎ ﺑﻌﺪ ﺫﺭﻭﺓ‬
‫ﺑﺮﺍﻍﺗﺠﻌﻞ ﺍﻟﺠﺴﻴﻤﺎﺕ ﺍﻟﻤﺸﺤﻮﻧﺔ ﺧﻴﺎﺭﺍً ﺃﻓﻀﻞ ﻟﻼﺳﺘﺨﺪﺍﻡ ﻓﻲ ﺣﺎﻟﺔ‬
‫ﺃﻭﺭﺍﻡﺍﻟﻤﺦ )ﺍﻟﺸﻜﻞ ‪ 1‬ﺃ(‪.(2.‬‬
‫ﺗﺸﻤﻞﺧﻴﺎﺭﺍﺕ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻌﻼﺝ ﺍﻟﺪﻳﻨﺎﻣﻴﻜﻲ ﺍﻟﻀﻮﺉﻲ‪ ،‬ﻭﺍﻟﺬﻱ‬
‫ﻳﺘﻀﻤﻦﺍﺳﺘﺨﺪﺍﻡ ﺍﻟﻤﺤﺴﺴﺎﺕ ﺍﻹﺷﻌﺎﻋﻴﺔ‪ ،‬ﻭﺑﺎﻟﺘﺎﻟﻲ ﻳﻌﻤﻞ ﻛﻤﺰﻳﺞ ﻣﻦ‬
‫ﺍﻟﻌﻼﺝﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﻭﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ]‪ .[87 ،86‬ﻳﺴﺘﺨﺪﻡ ﺍﻟﻌﻼﺝ‬
‫ﺍﻟﺘﻠﻄﻴﻔﻲﻟﻤﻮﺍﺟﻬﺔ ﻭﺗﺨﻔﻴﻒ ﺍﻷﻟﻢ ﻭﺍﻧﺴﺪﺍﺩ ﺍﻷﻣﻌﺎء ﻭﺍﻟﻤﻀﺎﻋﻔﺎﺕ‬
‫ﺍﻟﻤﻤﺎﺛﻠﺔﺍﻷﺧﺮﻯ ﺍﻟﻨﺎﺟﻤﺔ ﻋﻦ ﺍﻟﺴﺮﻃﺎﻥ ﺍﻟﻤﺘﻘﺪﻡ ]‪.[88‬‬

‫ﻳﺸﻤﻞﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﺳﺘﺨﺪﺍﻡ ﺍﻹﺷﻌﺎﻋﺎﺕ ﺍﻟﻤﺆﻳﻨﺔ‪ ،‬ﻭﺍﻟﺘﻲ‬

‫ﺗﺘﻀﻤﻦﺍﻟﻤﻮﺟﺎﺕ ﺍﻟﻜﻬﺮﻭﻣﻐﻨﺎﻃﻴﺴﻴﺔ ﻭﺇﺷﻌﺎﻉ ﺍﻟﺠﺴﻴﻤﺎﺕ ﻟﻠﻌﻼﺝ‪.‬‬
‫ﺗﺘﻜﻮﻥﺍﻟﻤﻮﺟﺎﺕ ﺍﻟﻜﻬﺮﻭﻣﻐﻨﺎﻃﻴﺴﻴﺔ ﻣﻦ ﺍﻷﺷﻌﺔ ﺍﻟﺴﻴﻨﻴﺔ‪ ،‬ﻭﺃﺷﻌﺔ‬
‫ﺍﻟﻤﻴﻜﺮﻭﻭﻳﻒ‪،‬ﻭﻣﻮﺟﺎﺕ ﺍﻟﺮﺍﺩﻳﻮ‪ ،‬ﻭﺃﺷﻌﺔ ﺟﺎﻣﺎ‪ ،‬ﺑﻴﻨﻤﺎ ﻳﺸﻤﻞ ﺇﺷﻌﺎﻉ‬
‫ﺍﻟﺠﺴﻴﻤﺎﺕﺍﺳﺘﺨﺪﺍﻡ ﺍﻟﺠﺴﻴﻤﺎﺕ ﺩﻭﻥ ﺍﻟﺬﺭﻳﺔ ﻭﺍﻷﻳﻮﻧﺎﺕ ﺍﻟﺜﻘﻴﻠﺔ‪.‬‬
‫ﻳﺴﺘﺨﺪﻡﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﺘﻘﻠﻴﺪﻱ ﻋﻠﻰ ﻧﻄﺎﻕ ﻭﺍﺳﻊ ﺃﺷﻌﺔ ﺳﻴﻨﻴﺔ‬
‫ﻣﻨﺨﻔﻀﺔ‪) LET‬ﻧﻘﻞ ﺍﻟﻄﺎﻗﺔ ﺍﻟﺨﻄﻴﺔ( ﻭﺃﺷﻌﺔ ﺟﺎﻣﺎ ﺍﻟﻨﺎﺗﺠﺔ ﻋﻦ ﻣﺴﺮﻉ‬
‫ﺧﻄﻲﻭﺍﺿﻤﺤﻼﻝ ﺇﺷﻌﺎﻋﻲ‪ ،‬ﻋﻠﻰ ﺍﻟﺘﻮﺍﻟﻲ‪ .‬ﻣﺠﻤﻮﻋﺔ ﻣﻦ ﺍﻟﻌﻼﺟﺎﺕ‬
‫ﺍﻹﺷﻌﺎﻋﻴﺔﺍﻟﺨﺎﺭﺟﻴﺔ ﻣﺜﻞ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺑﺤﺰﻣﺔ ﺍﻟﻔﻮﺗﻮﻥ‪ ،‬ﻭﺍﻟﻌﻼﺝ‬
‫ﺍﻹﺷﻌﺎﻋﻲﺍﻟﻤﻄﺎﺑﻖ ﺛﻼﺛﻲ ﺍﻷﺑﻌﺎﺩ )‪ ،(3D-CRT‬ﻭﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‬
‫ﺍﻟﻤﻌﺪﻝﺍﻟﻜﺜﺎﻓﺔ )‪ ،(IMRT‬ﻭﺍﻟﻌﻼﺝ ﺍﻟﻤﻘﻄﻌﻲ ﺍﻟﺤﻠﺰﻭﻧﻲ‪ ،‬ﻭﺍﻟﻌﻼﺝ‬
‫ﺍﻹﺷﻌﺎﻋﻲﺍﻟﻤﻮﺟﻪ ﺑﺎﻟﺼﻮﺭ )‪ ،(IGRT‬ﻭﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﺠﺴﻢ ) ‪(SRT‬‬
‫ﻭﺍﻟﻌﻼﺝﺍﻹﺷﻌﺎﻋﻲ ﺃﺛﻨﺎء ﺍﻟﻌﻤﻠﻴﺔ )‪ (IORT‬ﻳﺘﻀﻤﻦ ﺍﺳﺘﺨﺪﺍﻡ ﺍﻷﺷﻌﺔ‬
‫ﺍﻟﺴﻴﻨﻴﺔﻭﺃﺷﻌﺔ ﺟﺎﻣﺎ ﻟﺘﺸﻌﻴﻊ ﺍﻟﻮﺭﻡ‪ .‬ﻳﻌﺘﺒﺮ ‪ 3D CRT‬ﺃﻛﺜﺮ ﺩﻗﺔ ﻓﻲ ﻋﻼﺝ‬
‫ﺍﻷﻭﺭﺍﻡﺑﺎﻟﻤﻘﺎﺭﻧﺔ ﻣﻊ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺑﺎﻟﺤﺰﻣﺔ ﺍﻟﺨﺎﺭﺟﻴﺔ ﺑﻤﺘﻮﺳﻂ‬
‫ﻣﻌﺪﻝﺑﻘﺎء ﻳﺒﻠﻎ ‪ ٪47.2‬ﻷﻧﻪ ﻳﻤﺜﻞ ﺻﻮﺭﺓ ﺍﻓﺘﺮﺍﺿﻴﺔ ﺛﻼﺛﻴﺔ ﺍﻷﺑﻌﺎﺩ‬
‫ﻟﻠﻤﻨﻄﻘﺔﺍﻟﻤﺮﺍﺩ ﺗﺸﻌﻴﻌﻬﺎ ﻣﻤﺎ ﻳﺴﺎﻋﺪ ﻓﻲ ﺗﺼﻤﻴﻢ ﺟﺮﻋﺔ ﺍﻹﺷﻌﺎﻉ ]‪.[89‬‬
‫‪ IGRT‬ﻫﻮ ﺃﺣﺪ ﺃﺳﺎﻟﻴﺐ ‪ CRT‬ﺛﻼﺛﻴﺔ ﺍﻷﺑﻌﺎﺩ ﺣﻴﺚ ﻳﺘﻢ ﺍﺳﺘﺨﺪﺍﻡ‬
‫ﺍﻟﺘﺼﻮﻳﺮﺍﻟﻤﻘﻄﻌﻲ ﻹﻋﺎﺩﺓ ﺗﺮﻛﻴﺰ ﺍﻟﺤﺰﻡ ﻋﻠﻰ ﺍﻟﻮﺭﻡ‪ .‬ﻳﺴﺘﺨﺪﻡ ‪IMRT‬‬
‫ﻣﺴﺮﻋﺎﺕﺧﻄﻴﺔ ﺁﻟﻴﺔ‪ ،‬ﻭﺍﻟﺘﻲ ﺗﺼﻤﻢ ﺳﻠﺴﻠﺔ ﻣﻦ ﺟﺮﻋﺎﺕ ﺍﻹﺷﻌﺎﻉ ﺫﺍﺕ‬
‫ﺍﻟﺼﻮﺭﺓ‪.(2‬ﺗﻮﺯﻳﻊ ﻗﻨﻮﺍﺕ ﺍﻟﻄﺎﻗﺔ]ﺃ[ﺍﻷﺷﻌﺔ ﺍﻟﺴﻴﻨﻴﺔ ﻭ]ﺏ[ﺷﻌﺎﻉ ﺍﻟﺒﺮﻭﺗﻮﻥ‪OAR .‬‬ ‫ﺍﻟﻜﺜﺎﻓﺔﺍﻟﻤﻌﺪﻟﺔ ﻷﺣﺠﺎﻡ ﺻﻐﻴﺮﺓ ﻣﻦ ﺍﻟﺨﻼﻳﺎ ﺍﻟﺴﺮﻃﺎﻧﻴﺔ‪ ،‬ﻭﺑﺎﻟﺘﺎﻟﻲ ﺗﻘﻠﻞ‬
‫‪:‬ﺍﻷﻋﻀﺎء ﺍﻟﻤﻌﺮﺿﺔ ﻟﻠﺨﻄﺮ‪) .‬ﻳﺘﻮﻓﺮ ﺇﺻﺪﺍﺭ ﺃﻋﻠﻰ ﺩﻗﺔ‪/‬ﻟﻮﻥ ﻟﻬﺬﺍ ﺍﻟﺮﻗﻢ ﻓﻲ‬ ‫ﻣﻦﺗﻠﻒ ﺍﻷﻧﺴﺠﺔ ﺍﻟﺴﻠﻴﻤﺔ ]‪ .[90‬ﻫﻨﺎﻙ ﻧﺴﺨﺔ ﺃﻛﺜﺮ ﺩﻗﺔ ﻣﻦ ‪IMRT‬‬
‫ﺍﻟﻨﺴﺨﺔﺍﻹﻟﻜﺘﺮﻭﻧﻴﺔ ﻣﻦ ﺍﻟﻤﻘﺎﻟﺔ(‪.‬‬
‫ﻭﻫﻮﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﺤﻠﺰﻭﻧﻲ ﺣﻴﺚ ﺗﻘﻮﻡ ﻛﻤﻴﺎﺕ ﺻﻐﻴﺮﺓ ﻣﻦ ﺍﻟﺤﺰﻡ‬
‫ﺍﻟﺨﺎﺭﺟﻴﺔﺑﺘﺸﻌﻴﻊ ﺍﻟﺠﺴﻢ ﻣﻦ ﺯﻭﺍﻳﺎ ﻣﺨﺘﻠﻔﺔ ]‪ .[91‬ﻳﻌﺪ ‪ SRT‬ﺃﻛﺜﺮ ﺩﻗﺔ‬
‫‪.4.1‬ﺍﻟﻌﻼﺝ ﺑﺎﻟﺒﺮﻭﺗﻮﻥ‬ ‫ﻧﺴﺒﻴﺎًﻣﻦ ﺍﻟﻌﻼﺟﺎﺕ ﺍﻷﺧﺮﻯ ﻷﻧﻪ ﻳﺘﻀﻤﻦ ﺗﺸﻌﻴﻌﺎً ﻣﺮﻛﺰّﺍً ﻟﻠﻮﺭﻡ ﺑﺠﺮﻋﺎﺕ‬
‫ﺃﺛﺒﺖﺍﺳﺘﺨﺪﺍﻡ ﺍﻟﺒﺮﻭﺗﻮﻧﺎﺕ ﻓﻲ ﻋﻼﺝ ﺍﻟﺠﺴﻴﻤﺎﺕ ﺍﻟﻤﺸﺤﻮﻧﺔ ﺃﻧﻪ‬ ‫ﻋﺎﻟﻴﺔﻣﻦ ﺃﺷﻌﺔ ﺭﻓﻴﻌﺔ ﻣﺜﻞ ﻗﻠﻢ ﺍﻟﺮﺻﺎﺹ‪ ،‬ﻭﺑﺎﻟﺘﺎﻟﻲ ﻻ ﻳﺴﺒﺐ ﺿﺮﺭﺍً‬
‫ﺃﻓﻀﻞﻣﻦ ﺍﻟﻔﻮﺗﻮﻧﺎﺕ ﻣﻊ ﺍﻧﺨﻔﺎﺽ ﻣﻠﺤﻮﻅ ﻓﻲ ﺧﻄﺮ ﺍﻹﺻﺎﺑﺔ ﺑﺎﻷﻭﺭﺍﻡ‬ ‫ﻛﺒﻴﺮﺍًﻟﻠﺨﻼﻳﺎ ﺍﻟﺼﺤﻴﺔ‪ .‬ﻳﺸﺒﻪ ‪ IORT‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺑﺤﺰﻣﺔ ﺍﻟﻔﻮﺗﻮﻥ‬
‫ﺍﻟﺨﺒﻴﺜﺔﺍﻟﺜﺎﻧﻴﺔ ]‪ .[95‬ﻭﺃﺩﻯ ﺫﻟﻚ ﺇﻟﻰ ﺍﺳﺘﺒﺪﺍﻝ ﺍﻟﻔﻮﺗﻮﻧﺎﺕ ﺑﺎﻟﺒﺮﻭﺗﻮﻧﺎﺕ‬ ‫ﻭﻳﺴﺘﺨﺪﻡﺟﺪﺭﺍﻥ ﺍﻟﺤﻤﺎﻳﺔ ﻣﻦ ﺍﻹﺷﻌﺎﻉ ﻟﺘﻘﻠﻴﻞ ﺍﻟﺘﺄﺛﻴﺮ ﻋﻠﻰ ﺍﻟﺨﻼﻳﺎ‬
‫ﻓﻲﺍﻟﻌﻼﺟﺎﺕ ﺍﻹﺷﻌﺎﻋﻴﺔ ﺷﺎﺉﻌﺔ ﺍﻻﺳﺘﺨﺪﺍﻡ ﻣﺜﻞ ‪ IMRT‬ﻭ‪ .SRT‬ﻳﺆﺩﻱ‬ ‫ﺍﻟﻤﺠﺎﻭﺭﺓ]‪ .[92‬ﻭﺗﺸﺎﺭﻙ ﺑﺸﻜﻞ ﺭﺉﻴﺴﻲ ﻓﻲ ﻋﻼﺝ ﺍﻷﻭﺭﺍﻡ ﺫﺍﺕ‬
‫ﺍﻟﻤﺨﺎﻃﺮﺍﻟﻌﺎﻟﻴﺔ ﻟﻺﺻﺎﺑﺔ ﺑﺎﻷﻭﺭﺍﻡ ﺍﻟﺨﺒﻴﺜﺔ‪ .‬ﻛﺎﻧﺖ ﻓﻌﺎﻟﻴﺔ ﺍﻟﻌﻼﺟﺎﺕ‬
‫ﺍﻟﺘﺸﺘﺖﺍﻟﺴﻠﺒﻲ ﻟﻠﺒﺮﻭﺗﻮﻧﺎﺕ ﺑﺴﺒﺐ ﺍﻻﺻﻄﺪﺍﻣﺎﺕ ﺑﺎﻟﻨﺤﺎﺱ ﺍﻟﺼﻠﺐ‬
‫ﺍﻟﻤﺬﻛﻮﺭﺓﻛﺒﻴﺮﺓ ﻓﻲ ﻋﻼﺝ ﺳﺮﻃﺎﻧﺎﺕ ﺍﻟﺒﺮﻭﺳﺘﺎﺗﺎ ﻭﺍﻟﺮﺉﺔ ﻭﺍﻟﺜﺪﻱ‪ ،‬ﻟﻜﻦ‬
‫ﺇﻟﻰﺗﻮﻟﻴﺪ ﺟﺰء ﻏﻴﺮ ﻣﻘﺒﻮﻝ ﻣﻦ ﺍﻟﻨﻴﻮﺗﺮﻭﻧﺎﺕ )ﺳﻤﻴﺔ ﺍﻟﻨﻴﻮﺗﺮﻭﻧﺎﺕ( ﻋﻨﺪ‬
‫ﺗﻄﺒﻴﻘﻬﺎﻋﻠﻰ ﺳﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ ﻗﻴﺪ ﺍﻟﺘﻘﺪﻡ ﺑﺴﺒﺐ ﺍﻟﻄﺒﻴﻌﺔ ﺍﻟﻤﻌﻘﺪﺓ‬
‫ﻣﻘﺎﺭﻧﺘﻬﺎﺑﻤﺴﺢ ﺷﻌﺎﻉ ﺍﻟﻘﻠﻢ ﺍﻟﺮﺻﺎﺹ‪ ،‬ﻭﺍﻟﺬﻱ ﻳﺤﺘﻮﻱ ﻋﻠﻰ ﺍﺣﺘﻤﺎﻻﺕ‬
‫ﻭﺍﻟﻬﺸﺔﻟﻠﺪﻣﺎﻍ‪ .‬ﻭﻣﻊ ﺫﻟﻚ‪ ،‬ﻳﺘﻢ ﺍﺳﺘﺨﺪﺍﻡ ﺍﻟﻌﻼﺝ ﺍﻟﻮﻗﺎﺉﻲ ﻟﻤﻨﻊ ﺍﻧﺘﺸﺎﺭ‬
‫ﺃﻗﻞﺑﻨﺴﺒﺔ ‪ ٪50‬ﻟﺴﻤﻴﺔ ﺍﻟﻨﻴﻮﺗﺮﻭﻧﺎﺕ ]‪ .[97 ،96‬ﺣﺘﻰ ﺍﻟﺠﺮﻋﺔ‬
‫ﺍﻟﺴﺮﻃﺎﻥﻣﻦ ﺍﻟﺮﺉﺘﻴﻦ ﺇﻟﻰ ﺍﻟﺪﻣﺎﻍ‪ ،‬ﻭﺍﻟﺬﻱ ﻟﻮﺣﻆ ﺃﻧﻪ ﺷﺎﺉﻊ ﺟﺪﺍً ]‪.[93‬‬
‫ﺍﻟﻤﻨﺨﻔﻀﺔﻣﻦ ﺍﻟﻨﻴﻮﺗﺮﻭﻧﺎﺕ ﺗﺤﺪﺙ ﺗﺄﺛﻴﺮﺍً ﻛﺒﻴﺮﺍً ﻋﻠﻰ ﺍﻟﺨﻼﻳﺎ ﻧﻈﺮﺍً‬
‫ﻟﻔﻌﺎﻟﻴﺘﻬﺎﺍﻟﺒﻴﻮﻟﻮﺟﻴﺔ ﺍﻟﻌﺎﻟﻴﺔ‪ ،‬ﻣﻤﺎ ﻳﺆﺩﻱ ﻏﺎﻟﺒﺎً ﺇﻟﻰ ﺍﻹﺻﺎﺑﺔ ﺑﺄﻭﺭﺍﻡ ﺧﺒﻴﺜﺔ‬
‫ﺛﺎﻧﻮﻳﺔ‪.‬ﺃﺩﻯ ﺍﺳﺘﺨﺪﺍﻡ ﺍﻟﻤﻮﺻﻼﺕ ﺍﻟﻔﺎﺉﻘﺔ ﻓﻲ ﺍﻟﻘﻨﻄﺮﺓ ﻟﺘﻮﺻﻴﻞ‬
‫ﺍﻟﺠﺮﻋﺔﺇﻟﻰ ﺯﻳﺎﺩﺓ ﺩﻗﺔ ﻣﺴﺢ ﺷﻌﺎﻉ ﺍﻟﻘﻠﻢ ﺍﻟﺮﺻﺎﺹ ﻭﺗﻘﻠﻴﻞ ﺧﻄﺮ‬
‫ﺗﻮﺻﻴﻞﺍﻟﺠﺮﻋﺔ ﺇﻟﻰ ﺍﻷﻋﻀﺎء ﺍﻟﻤﺠﺎﻭﺭﺓ ]‪ .[98‬ﺍﻟﺪﺭﺍﺳﺎﺕ ﺍﻟﺤﺪﻳﺜﺔ ﻋﺒﺮ‬
‫ﺃﺑﻠﻎﻣﻄﻴﺎﻑ ﺭﺍﻣﺎﻥ ﺃﻳﻀﺎً ﻋﻦ ﺍﻟﻄﺒﻴﻌﺔ ﺍﻟﺤﺴﺎﺳﺔ ﻟﻠﻐﺎﻳﺔ ﻟﻤﺠﻤﻮﻋﺔ‬
‫ﺍﻟﻔﻮﺳﻔﺎﺕﺍﻟﻤﻤﺘﺪﺓ ﻓﻲ ﺍﻟﺤﻤﺾ ﺍﻟﻨﻮﻭﻱ‪ ،‬ﻣﻤﺎ ﺷﺠﻊ ﻋﻠﻰ ﺍﺳﺘﺨﺪﺍﻡ‬
‫ﻣﻄﻴﺎﻑﺭﺍﻣﺎﻥ ﻟﺘﺤﺴﻴﻦ ﺗﻘﻴﻴﻢ ﺍﻟﻤﺨﺎﻃﺮ ﺃﺛﻨﺎء ﺃﺑﺤﺎﺙ ﺍﻟﺒﻴﻮﻟﻮﺟﻴﺎ‬ ‫ﺗﺆﺩﻱﺍﻟﻔﻮﺗﻮﻧﺎﺕ ﺇﻟﻰ ﺯﻳﺎﺩﺓ ﺧﻄﺮ ﺗﻠﻒ ﺍﻷﻧﺴﺠﺔ ﻏﻴﺮ ﺍﻟﺨﺒﻴﺜﺔ‬
‫ﺍﻹﺷﻌﺎﻋﻴﺔ]‪.[99‬‬ ‫ﺍﻟﻤﺤﻴﻄﺔﺑﻬﺎ ﺑﺴﺒﺐ ﺫﺭﻭﺗﻬﺎ ﺍﻟﺤﺎﺩﺓ‪ ،‬ﻭﺍﻟﺘﻲ ﻳﺠﺐ ﺃﻥ ﺗﻜﻮﻥ ﺃﻭﺳﻊ ﻣﻦ‬
‫ﺃﺟﻞﻋﻼﺝ ﺃﻛﺜﺮ ﺩﻗﺔ‪ .‬ﺗﺤﺪﺩ ﺫﺭﻭﺓ ﺑﺮﺍﻍ ﻋﻤﻖ ﺗﺮﺳﻴﺐ ﺍﻟﻄﺎﻗﺔ ﺍﻟﺬﻱ‬
‫ﻳﺨﺘﻠﻒﺑﺎﺧﺘﻼﻑ ﺍﻟﺠﺮﻋﺔ‪ ،‬ﻭﺍﻟﺬﻱ ﻳﺘﻢ ﺗﺤﺪﻳﺪﻩ ﺑﻮﺍﺳﻄﺔ ﺍﻟﻄﺎﻗﺔ ﺍﻷﻭﻟﻴﺔ‬
‫ﻭﺷﺪﺓﺍﻟﺸﻌﺎﻉ ]‪ .[94‬ﻭﻗﺪ ﺣﺜﺖ ﺍﻟﻨﺘﺎﺉﺞ ﺍﻟﻤﻤﻴﺘﺔ ﻟﺘﻌﺮﺽ ﺍﻟﺨﻼﻳﺎ‬
‫ﺍﻟﺴﻠﻴﻤﺔﻟﻺﺷﻌﺎﻉ ﻋﻠﻰ ﺍﻟﺤﺎﺟﺔ ﺇﻟﻰ ﺗﺤﺴﻴﻦ ﺍﻟﻨﺴﺒﺔ ﺍﻟﻌﻼﺟﻴﺔﻋﺒﺮﺗﻌﻈﻴﻢ‬
‫ﺗﻢﺍﻟﻌﺜﻮﺭ ﻋﻠﻰ ﺍﻷﺑﺤﺎﺙ ﺍﻟﺘﻲ ﺃﺟﺮﻳﺖ ﻋﻠﻰ ﺍﺣﺘﻤﺎﻟﻴﺔ ﺣﺪﻭﺙ ﻣﻀﺎﻋﻔﺎﺕ‬
‫ﺍﻟﺠﺮﻋﺔﻭﺗﻘﻠﻴﻞ ﺗﺸﻌﻴﻊ ﺍﻷﻧﺴﺠﺔ ﺍﻟﻄﺒﻴﻌﻴﺔ‪ .‬ﻳﻌﺎﻟﺞ ﻋﻼﺝ ﺍﻟﺠﺴﻴﻤﺎﺕ‬
‫ﺍﻷﻧﺴﺠﺔﺍﻟﻄﺒﻴﻌﻴﺔ )‪ (NTCP‬ﻟﻠﻌﻼﺝ ﺑﺎﻟﺒﺮﻭﺗﻮﻧﺎﺕ ﺃﻗﻞ ﻣﻦ ﺗﻠﻚ ﺍﻟﺨﺎﺻﺔ ﺑـ‬
‫ﺍﻟﻤﺸﺤﻮﻧﺔﻫﺬﻩ ﺍﻟﻤﺸﻜﻠﺔ ﺑﺎﺳﺘﺨﺪﺍﻡ ﺍﻟﺠﺴﻴﻤﺎﺕ ﺩﻭﻥ ﺍﻟﺬﺭﻳﺔ ﻣﺜﻞ‬
‫‪ IMRT‬ﻋﻨﺪ ﺍﺧﺘﺒﺎﺭﻫﺎ ﻋﻠﻰ ﺳﺮﻃﺎﻥ ﺍﻟﻔﻢ ﻭﺍﻟﺒﻠﻌﻮﻡ ]‪.[100‬‬
‫ﺍﻟﺒﺮﻭﺗﻮﻧﺎﺕﻭﺍﻟﻨﻴﻮﺗﺮﻭﻧﺎﺕ ﻭﺍﻟﺪﻳﻮﺗﺮﻭﻧﺎﺕ‪ ،‬ﻭﺍﻷﻳﻮﻧﺎﺕ ﺍﻟﺜﻘﻴﻠﺔ ﻣﺜﻞ‬
‫ﺃﺛﺒﺘﺖﻧﺘﺎﺉﺞ ﺣﺴﺎﺏ ‪ NTCP‬ﺃﻳﻀﺎً ﻛﻔﺎءﺓ ﺍﻟﻌﻼﺝ ﺑﺎﻟﺒﺮﻭﺗﻮﻥ ﻓﻲ‬ ‫ﺍﻟﻬﻴﻠﻴﻮﻡﻭﺍﻟﻨﻴﻮﻥ ﻭﺍﻟﻜﺮﺑﻮﻥ‪ ،‬ﻭﺍﻟﺘﻲ ﻣﻦ ﺍﻟﻤﻌﺮﻭﻑ ﺃﻥ ﻟﻬﺎ ﺗﺄﺛﻴﺮﺍً ﺃﻭﺳﻊ‪.‬‬
‫ﻋﻼﺝﺃﻭﺭﺍﻡ ﺍﻟﻤﺦ‪ .‬ﻳﻘﺎﺭﻥ ‪ RBE‬ﻓﻌﺎﻟﻴﺔ ﺃﻱ ﺷﻌﺎﻉ ﺟﺴﻴﻢ ﻋﻠﻰ ﺃ‬
 ‫ﺭﺍﺟﺎﻓﺎﺑﻮﺩﻱﻭﺁﺧﺮﻭﻥ‪.‬‬ ‫‪6‬ﺍﻟﺘﺼﻮﻳﺮ ﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ‪ ،2021،‬ﺭﺣﻠﺔ ﺟﻮﻳﺔ‪ ،17 .‬ﻻ‪00 .‬‬

‫ﻭﺭﻡﺇﻟﻰ ﺷﻌﺎﻉ ﻓﻮﺗﻮﻥ ﺑﻨﻔﺲ ﺍﻟﺸﺪﺓ‪ .‬ﻳﻮﺍﺟﻪ ﻋﻼﺝ ﺳﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ‬

‫ﻋﻦﻃﺮﻳﻖ ﺍﻟﻌﻼﺝ ﺑﺎﻟﺒﺮﻭﺗﻮﻧﺎﺕ ﺍﻟﻤﻌﺪﻟﺔ ﺍﻟﻜﺜﺎﻓﺔ )‪ (IMPT‬ﺍﻟﻤﻤﺎﺭﺳﺔ‬
‫ﺍﻟﺸﺎﺉﻌﺔﺍﻟﻤﺘﻤﺜﻠﺔ ﻓﻲ ﺍﺳﺘﺨﺪﺍﻡ ﺇﺷﻌﺎﻋﺎﺕ ﺍﻟﺒﺮﻭﺗﻮﻥ )‪(RBE 1.1‬‬
‫ﻋﻦﻃﺮﻳﻖ ﺗﻐﻴﻴﺮ ‪ LET‬ﻟﻠﺠﺮﻋﺔ ﻭﺇﻧﺘﺎﺝ ‪ RBE‬ﺑﺤﺪ ﺃﻗﺼﻰ ‪ .1.4‬ﻳﻌﺪ‬
‫ﺍﻟﻌﻼﺝﺑﺸﻌﺎﻉ ﺍﻟﺒﺮﻭﺗﻮﻥ ﻣﻤﺎﺭﺳﺔ ﺷﺎﺉﻌﺔ ﻓﻲ ﻋﻼﺝ ﺳﺮﻃﺎﻧﺎﺕ‬
‫ﺍﻷﻃﻔﺎﻝﻭﺃﻭﺭﺍﻡ ﺍﻟﻤﺦ ﻭﺍﻟﺴﺮﻃﺎﻧﺎﺕ ﺍﻟﻤﺮﺗﺒﻄﺔ ﺑﺎﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ‬
‫ﺍﻟﻤﺮﻛﺰﻱﻭﻣﺮﺽ ﻫﻮﺩﺟﻜﻴﻦ ﻭﺍﻷﻭﺭﺍﻡ ﺍﻟﻠﺤﻤﻴﺔ ﻭﺍﻟﻮﺭﻡ ﺍﻷﺭﻭﻣﻲ‬
‫ﺍﻟﻌﺼﺒﻲ‪.‬ﻭﻣﻊ ﺫﻟﻚ‪ ،‬ﻧﻈﺮﺍً ﻟﻔﻌﺎﻟﻴﺘﻪ ﺍﻟﻌﺎﻟﻴﺔ‪ ،‬ﻳﺤﺘﺎﺝ ﺃﻃﺒﺎء ﻋﻼﺝ‬
‫ﺍﻷﻭﺭﺍﻡﺑﺎﻹﺷﻌﺎﻉ ﺍﻟﺬﻳﻦ ﻳﺴﺘﺨﺪﻣﻮﻥ ﺍﻟﻌﻼﺝ ﺑﺎﻟﺒﺮﻭﺗﻮﻧﺎﺕ ﺇﻟﻰ ﺃﻥ‬
‫ﻳﻜﻮﻧﻮﺍﺫﻭﻱ ﺧﺒﺮﺓ ﻋﺎﻟﻴﺔ ﻭﺩﻗﻴﻘﻴﻦ ﻓﻲ ﺗﺤﺪﻳﺪ ﻣﻮﻗﻊ ﺍﻟﻮﺭﻡ ﻭﻧﻤﻂ‬
‫ﺍﻟﻌﻼﺝ)ﺍﻟﺸﻜﻞ ‪(3.(1‬‬

‫ﺷﻜﻞ)‪.(4‬ﺍﻟﺘﻤﺜﻴﻞ ﺍﻟﻨﺴﺒﻲ ﻟﻠﻔﻌﺎﻟﻴﺔ ﺍﻟﺒﻴﻮﻟﻮﺟﻴﺔ ﺍﻟﻨﺴﺒﻴﺔ ﻭﻧﺴﺒﺔ ﺗﻌﺰﻳﺰ‬

‫ﺍﻷﻛﺴﺠﻴﻦﻟﺤﺰﻣﺔ ﺍﻟﻔﻮﺗﻮﻥ‪ ،‬ﻭﺣﺰﻣﺔ ﺍﻟﺒﺮﻭﺗﻮﻥ‪ ،‬ﻭﺣﺰﻣﺔ ﺃﻳﻮﻥ ﺍﻟﻬﻴﻠﻴﻮﻡ‪ ،‬ﻭﺣﺰﻣﺔ‬
‫ﺃﻳﻮﻥﺍﻟﻜﺮﺑﻮﻥ‪ ،‬ﻭﺣﺰﻣﺔ ﺍﻟﻨﻴﻮﻥ‪ ،‬ﻭﺣﺰﻣﺔ ﺍﻷﺭﺟﻮﻥ‪.‬‬

‫ﻳﺤﺘﻮﻱﺃﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ ﺃﻳﻀﺎً ﻋﻠﻰ ‪ LET‬ﻭﺗﺠﺰﺉﺔ ﻧﻮﻭﻳﺔ ﺃﻋﻠﻰ ﺑـ ‪36‬‬

‫ﻣﺮﺓﻣﻦ ﺫﺭﻭﺓ ﺍﻟﺘﻔﺎﺧﺮ ﻣﻘﺎﺭﻧﺔ ًﺑﺎﻟﺒﺪﺍﺉﻞ ﺍﻷﺧﺮﻯ ﻟﻨﻔﺲ ﺳﺮﻋﺔ ﺍﻟﺸﻌﺎﻉ ]‬
‫ﺗﻴﻦ‪.(3.‬ﺫﺭﻭﺓ ﺍﻟﺘﻔﺎﺧﺮ ﺍﻟﻤﻤﻴﺰﺓ ﺃﻭ ﺗﻮﺯﻳﻊ ﺍﻟﻄﺎﻗﺔ ﻟﻸﺷﻌﺔ ﺍﻟﺴﻴﻨﻴﺔ ﻭﺍﻟﺒﺮﻭﺗﻮﻥ‬
‫‪ .[101‬ﺇﻧﻪ ﻳﻀﻤﻦ ﻛﺴﺮ ﺍﻟﺤﻤﺾ ﺍﻟﻨﻮﻭﻱ ﺍﻟﻤﺰﺩﻭﺝ ﺑﻀﺮﺑﺔ ﻭﺍﺣﺪﺓ‪ ،‬ﻭﻫﻮ‬
‫ﻭﺃﻳﻮﻥﺍﻟﻜﺮﺑﻮﻥ ﻣﻊ ﺗﻘﺮﻳﺐ ﻟﻔﻌﺎﻟﻴﺘﻬﺎ ﻋﻠﻰ ﺍﻟﻮﺭﻡ‪.‬‬
‫ﺃﻣﺮﻏﻴﺮ ﻣﻤﻜﻦ ﻓﻲ ﺣﺎﻟﺔ ﺍﻟﺒﺮﻭﺗﻮﻧﺎﺕ ﺃﻭ ﺍﻟﻔﻮﺗﻮﻧﺎﺕ )ﺍﻟﺸﻜﻞ ‪ .(5.(1‬ﻭﻣﻊ‬
‫ﺫﻟﻚ‪،‬ﻧﻈﺮﺍً ﻟﻼﺳﺘﺮﺍﺗﻴﺠﻴﺎﺕ ﻏﻴﺮ ﺍﻟﻤﺘﻄﻮﺭﺓ ﻓﻲ ﻣﺠﺎﻝ ‪ ،CIRT‬ﻓﺈﻥ ﺍﻟﻌﻼﺝ‬
‫ﺍﻟﻤﺨﺼﺺﻫﻮ ﺍﻟﻨﻬﺞ ﺍﻟﻤﻘﺘﺮﺡ ﻟﻌﻼﺝ ﺃﻭﺭﺍﻡ ﺍﻟﻤﺦ‪.‬‬
‫‪.4.2‬ﻳﻤﻴﻦ‬
‫ﺷﻬﺪﻋﺎﻡ ‪ 1957‬ﺇﻧﺸﺎء ﺃﻭﻝ ﻣﻌﺠﻞ ﻟﻸﻳﻮﻧﺎﺕ ﺍﻟﺜﻘﻴﻠﺔ ﻓﻲ ﺍﻟﻤﻌﻬﺪ‬
‫ﺍﻟﻮﻃﻨﻲﻟﻠﻌﻠﻮﻡ ﺍﻹﺷﻌﺎﻋﻴﺔ )‪ (NIRS‬ﻓﻲ ﺍﻟﻴﺎﺑﺎﻥ ﻟﻠﺒﺤﺚ ﺍﻟﺴﺮﻳﺮﻱ‬
‫ﺣﻮﻝﺍﺳﺘﺨﺪﺍﻣﻪ ﺍﻟﻌﻼﺟﻲ‪ .‬ﺃﺩﺕ ﺍﻟﺘﺠﺎﺭﺏ ﺍﻟﺘﻲ ﺃﺟﺮﺗﻬﺎ ﺇﻟﻴﺎﻧﻮﺭ ﺑﻼﻛﻠﻲ‬
‫ﻓﻲﻣﺨﺘﺒﺮ ﻟﻮﺭﺍﻧﺲ ﺑﻴﺮﻛﻠﻲ ﺍﻟﻮﻃﻨﻲ ﻋﻠﻰ ﺍﻟﻜﺮﺑﻮﻥ ﻭﺍﻟﻨﻴﻮﻥ ﻭﺍﻷﺭﺟﻮﻥ‬
‫ﻟﻔﻌﺎﻟﻴﺘﻬﺎﻓﻲ ﻋﻼﺝ ﺍﻟﺴﺮﻃﺎﻥ ﺇﻟﻰ ﻇﻬﻮﺭ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻜﺮﺑﻮﻧﻲ‬
‫ﻓﻲﻋﺎﻡ ‪ .1979‬ﻭﻗﺪ ﺃﺩﺕ ﺍﻟﻨﺘﺎﺉﺞ ﺍﻟﻤﺴﺘﺨﻠﺼﺔ ﻣﻦ ﻫﺬﻩ ﺍﻟﺘﺠﺎﺭﺏ‬
‫ﺇﻟﻰﺍﺳﺘﺨﺪﺍﻡ ﺍﻷﻳﻮﻧﺎﺕ ﺍﻟﺜﻘﻴﻠﺔ ﻟﻠﻌﻼﺝ‪ .‬ﻣﻦ ﻭﺭﻡ‪ .‬ﺃﺩﻯ ﺑﻨﺎء ﺍﻟﻤﺴﺮﻉ‬
‫ﺍﻟﻄﺒﻲﻟﻸﻳﻮﻧﺎﺕ ﺍﻟﺜﻘﻴﻠﺔ ﻓﻲ ﻋﺎﻡ ‪ 1984‬ﻓﻲ ‪ ،NIRS‬ﻭﺍﻟﺬﻱ ﺃﻋﻘﺒﻪ‬
‫ﺃﻭﻝﻋﻼﺝ ﺇﺷﻌﺎﻋﻲ ﻟﻸﻳﻮﻧﺎﺕ ﺍﻟﺜﻘﻴﻠﺔ ﻓﻲ ﻋﺎﻡ ‪ ،1994‬ﺇﻟﻰ ﺗﻮﻓﺮ‬
‫ﺍﻟﻌﻼﺝﺑﺎﻟﺠﺴﻴﻤﺎﺕ ﺍﻟﻤﺸﺤﻮﻧﺔ ﻟﻠﺠﻤﻬﻮﺭ ﻣﻨﺬ ﻋﺎﻡ ‪ .1996‬ﻭﺍﻓﻘﺖ‬
‫ﻭﺯﺍﺭﺓﺍﻟﺼﺤﺔ ﻭﺍﻟﺮﻋﺎﻳﺔ ﺍﻻﺟﺘﻤﺎﻋﻴﺔ ﻭﺍﻟﻌﻤﻞ ﺑﺎﻟﺤﻜﻮﻣﺔ ﺍﻟﻴﺎﺑﺎﻧﻴﺔ ﻋﻠﻰ‬
‫ﺍﻟﻜﺮﺑﻮﻥﺍﻷﻭﻟﻲ‪ .‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻷﻳﻮﻧﻲ )‪ (CIRT‬ﺍﻟﺬﻱ ﺳﻴﺘﻢ‬
‫ﺇﻧﺸﺎﺅﻩﺑﻮﺍﺳﻄﺔ ‪ NIRS‬ﻓﻲ ﻋﺎﻡ ‪ ،2003‬ﻭﺍﻟﺬﻱ ﻃﻮﺭ ﻭﺑﺪﺃ ﺍﻟﻌﻼﺝ‬
‫ﺑﺎﻟﻤﺴﺢﺍﻟﻨﺸﻂ ﻓﻲ ﻣﺎﻳﻮ ‪ .[10] 2011‬ﻭﻇﻬﺮ ﺍﺳﺘﺨﺪﺍﻡ ﺍﻟﻜﺮﺑﻮﻥ ﻓﻲ‬
‫ﺍﻟﻌﻼﺝﺍﻹﺷﻌﺎﻋﻲ ﺑﻔﻌﺎﻟﻴﺘﻪ ﺍﻟﻌﺎﻟﻴﺔ ﻭﻓﻌﺎﻟﻴﺘﻪ ﻓﻲ ﻋﻼﺝ ﺍﻷﻭﺭﺍﻡ‬
‫ﺍﻟﻤﻘﺎﻭﻣﺔﻟﻠﻔﻮﺗﻮﻥ ﻭﺍﻟﺒﺮﻭﺗﻮﻥ‪ .‬ﺗﻌﺪ ﺫﺭﻭﺓ ‪ Bragg‬ﺍﻷﻭﺳﻊ ﻷﻳﻮﻥ‬
‫ﺍﻟﻜﺮﺑﻮﻥﺧﺎﺻﻴﺔ ﺭﺉﻴﺴﻴﺔ ﺫﺍﺕ ﺃﻫﻤﻴﺔ ﻟﺘﻄﺒﻴﻘﻬﺎ‪ ،‬ﻭﺗﺴﺘﺨﺪﻡ ﻛﻤﻌﻴﺎﺭ‬
‫ﺷﻜﻞ)‪.(5‬ﺇﻣﻜﺎﻧﻴﺔ ﻛﺴﺮ ﺍﻟﺠﺪﻳﻠﺔ ﺍﻟﻤﺰﺩﻭﺟﺔ ﻷﻳﻮﻧﺎﺕ ﺍﻟﻜﺮﺑﻮﻥ ﻣﻘﺎﺭﻧﺔ ﺑﺈﻣﻜﺎﻧﻴﺔ‬ ‫ﻟﺘﺤﺪﻳﺪﺍﻟﺠﺮﻋﺔ ﺍﻟﺪﻗﻴﻘﺔ‪ .‬ﻣﻊ ﺗﺤﺪﻳﺪ ﻧﺴﺒﺔ ﺗﻌﺰﻳﺰ ﺍﻷﻛﺴﺠﻴﻦ )‪(OER‬‬
‫ﻛﺴﺮﺍﻟﺠﺪﻳﻠﺔ ﺍﻟﻤﻔﺮﺩﺓ ﻟﻠﺒﺮﻭﺗﻮﻥ ﻭﺍﻟﻔﻮﺗﻮﻥ‪.‬‬ ‫ﺍﻟﺤﺴﺎﺳﻴﺔﺍﻹﺷﻌﺎﻋﻴﺔ ﻟﻠﺨﻼﻳﺎ ﻓﻲ ﻭﺟﻮﺩ ﺍﻷﻛﺴﺠﻴﻦ‪ ،‬ﻭﺟﺪ ﺃﻥ ﺃﻳﻮﻥ‬
‫ﺍﻟﻜﺮﺑﻮﻥﻟﺪﻳﻪ ﺗﻮﺍﺯﻥ ﻣﺜﺎﻟﻲ ﺑﻴﻦ ‪ OER‬ﻭ‪) RBE‬ﺍﻟﺸﻜﻞ ‪ 1‬ﺃ(‪.(4.‬‬
‫ﺇﻥﺗﻮﻓﺮ ﻣﺠﻤﻮﻋﺔ ﻭﺍﺳﻌﺔ ﻣﻦ ﺧﻴﺎﺭﺍﺕ ﺍﻟﻌﻼﺝ ﻳﻀﻤﻦ ﺣﺼﻮﻝ‬
‫ﺍﻟﻤﺮﻳﺾﻋﻠﻰ ﻋﻼﺝ ﻣﺨﺼﺺ ﺧﺎﺹ ﺑﺎﻟﻮﺭﻡ ﺍﻟﺬﻱ ﻳﻌﺎﻧﻲ ﻣﻨﻪ‪ .‬ﻟﻮﺣﻆ ﺃﻥ‬
‫ﺍﻟﻌﻼﺝﺍﻹﺷﻌﺎﻋﻲ ﺑﻤﺴﺎﻋﺪﺓ ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﻣﺜﻞ ﺍﻟﻌﻼﺝ ﺍﻟﺪﻳﻨﺎﻣﻴﻜﻲ‬
‫ﺍﻟﻀﻮﺉﻲﻓﻌﺎﻝ ﻓﻲ‬
 ‫ﺍﻟﺘﺼﻮﻳﺮﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ‪ ،2021،‬ﺭﺣﻠﺔ ﺟﻮﻳﺔ‪ ،17 .‬ﻻ‪700 .‬‬
‫ﺗﺸﺘﻤﻞﺍﻟﻌﻮﺍﻣﻞ ﺍﻟﻮﺍﻗﻴﺔ ﻟﻠﺜﻨﺎﺉﻲ ﻋﻠﻰ ﺍﻟﺜﻴﻮﻝ ﻭﺍﻟﻌﻮﺍﻣﻞ ﺍﻟﺪﻭﺍﺉﻴﺔ ﻣﺜﻞ‬
‫ﺍﻟﻜﺤﻮﻝﻭﺍﻟﻤﻮﺭﻓﻴﻦ ﻭﺍﻟﻬﻴﺮﻭﻳﻦ ﻭﺍﻟﺪﻭﺑﺎﻣﻴﻦ ﻭﺍﻟﺴﻴﺮﻭﺗﻮﻧﻴﻦ ﻭﺍﻟﻬﺮﻣﻮﻧﺎﺕ ]‬
‫‪ .[109‬ﺇﻥ ﺗﻜﻮﻳﻦ ﺍﻟﻜﺒﺮﻳﺘﻴﺪﺍﺕ ﻭﺯﺑﺎﻝ ﺍﻟﺠﺬﻭﺭ ﺍﻟﺤﺮﺓ ﻫﻮ ﻋﺪﺩ ﻗﻠﻴﻞ ﻣﻦ‬
‫ﺁﻟﻴﺎﺕﺍﻟﺤﻤﺎﻳﺔ ﺍﻹﺷﻌﺎﻋﻴﺔ ﺍﻟﻌﺪﻳﺪﺓ ﺍﻟﻤﻘﺘﺮﺣﺔ ﻟﺸﺮﺡ ﻋﻤﻞ ﻫﺬﻩ ﺍﻷﺩﻭﻳﺔ ]‬
‫‪.[110‬‬
‫ﺧﺎﺗﻤﺔ‬
‫ﻣﻨﺬﺍﻛﺘﺸﺎﻑ ﺍﻷﺷﻌﺔ ﺍﻟﺴﻴﻨﻴﺔ ﻋﺎﻡ ‪ ،1896‬ﻭﻣﻦ ﺛﻢ ﺍﺳﺘﺨﺪﺍﻣﻬﺎ ﻓﻲ‬
‫ﺗﺸﺨﻴﺺﺍﻷﻭﺭﺍﻡ‪ ،‬ﺃﺻﺒﺤﺖ ﺍﻷﺷﻌﺔ ﺑﺪﻳﻼ ًﺃﻓﻀﻞ ﻟﻌﻼﺝ ﺃﻭﺭﺍﻡ ﺍﻟﻤﺦ‪ .‬ﺃﺩﺕ‬
‫ﺍﻟﻄﺒﻴﻌﺔﺍﻟﻤﺮﻧﺔ ﻟﻸﺷﻌﺔ ﺍﻟﺴﻴﻨﻴﺔ ﺇﻟﻰ ﺍﺳﺘﺨﺪﺍﻣﻬﺎ ﻓﻲ ‪ IGRT‬ﻭ‪ SRT‬ﻭ[‬
‫‪ .IMRT ]111،84‬ﺃﺩﻯ ﻣﻔﻬﻮﻡ ﺫﺭﻭﺓ ﺑﺮﺍﻍ ﺍﻷﻭﺳﻊ ﻭ‪ RBE‬ﺍﻷﻣﺜﻞ ﺇﻟﻰ‬
‫ﺇﺟﺮﺍءﺍﻟﺘﺠﺎﺭﺏ ﻋﻠﻰ ﺍﻷﻳﻮﻧﺎﺕ ﺍﻟﺜﻘﻴﻠﺔ ﻭﺍﻟﺠﺴﻴﻤﺎﺕ ﺩﻭﻥ ﺍﻟﺬﺭﻳﺔ ﻭﺑﺎﻟﺘﺎﻟﻲ‬
‫ﺗﻘﺪﻳﻢﺍﻟﺒﺮﻭﺗﻮﻥ ﻭﺃﻳﻮﻧﺎﺕ ﺍﻟﻜﺮﺑﻮﻥ ﻛﺒﺪﺍﺉﻞ ﺩﻗﻴﻘﺔ ﻭﻓﻌﺎﻟﺔ ﻟﻸﺷﻌﺔ‬
‫ﺍﻟﺴﻴﻨﻴﺔ‪.‬ﻓﻲ ﺣﻴﻦ ﺃﺛﺒﺖ ﺃﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ ﺃﻥ ﻟﺪﻳﻪ ‪ RBE‬ﻗﺪﺭﻩ ‪ ،3.0‬ﻭﻳﻘﻠﻞ‬
‫ﻣﻦﺍﻟﺘﺸﺘﺖ ﺍﻟﺠﺎﻧﺒﻲ‪ ،‬ﻻ ﻳﻤﻜﻦ ﻷﻃﺒﺎء ﺍﻷﻭﺭﺍﻡ ﺗﺠﺎﻫﻞ ﺍﻟﻤﺨﺎﻃﺮ ﺍﻷﻋﻠﻰ‬
‫ﻋﻠﻰﺍﻷﻋﻀﺎء ﺍﻟﻤﻌﺮﺿﺔ ﻟﻠﺨﻄﺮ )‪ ،(OAR‬ﻭﺫﻟﻚ ﺑﺴﺒﺐ ﺍﻟﻤﺮﺍﻓﻖ ﺍﻟﺤﺎﻟﻴﺔ‬
‫ﻭﺍﻟﺠﺪﻭﻯﺍﻟﻤﺎﻟﻴﺔ ﻟﻤﻌﻈﻢ ﻣﺮﺍﻛﺰ ﻋﻼﺝ ﺍﻟﺴﺮﻃﺎﻥ ]‪ .[112‬ﺗﺘﻀﻤﻦ‬
‫ﺍﺳﺘﺮﺍﺗﻴﺠﻴﺎﺕﺍﻟﻌﻼﺝ ﺍﻟﻤﺨﻄﻄﺔ ﻟﻤﻮﺍﺟﻬﺔ ﻭﺭﻡ ﺍﻟﺪﻣﺎﻍ ﺍﻹﺯﺍﻟﺔ ﺍﻟﺠﺮﺍﺣﻴﺔ‬
‫ﻣﻊﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﺃﻭ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‪ .‬ﺑﺎﻟﻤﻘﺎﺭﻧﺔ ﻣﻊ ﺍﻟﻌﻼﺝ‬
‫ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‪،‬ﺃﺛﺒﺖ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺃﻧﻪ ﺃﻛﺜﺮ ﻛﻔﺎءﺓ ﻣﻊ ﺍﺭﺗﻔﺎﻉ ﻧﺴﺒﺔ‬
‫ﺍﻟﻨﺠﺎﺓﻣﻦ ﺍﻟﺴﺮﻃﺎﻥ ]‪ .[84‬ﺃﺛﺒﺘﺖ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﺜﻠﻰ ﻟـ ‪ RBE‬ﻭ ‪ OER‬ﻷﻳﻮﻥ‬
‫ﺍﻟﻜﺮﺑﻮﻥﺍﺳﺘﺨﺪﺍﻣﻬﺎ ﺍﻟﻌﻼﺟﻲ ﻓﻲ ﻋﻼﺝ ﺍﻟﺴﺮﻃﺎﻥ‪ .‬ﻋﻨﺪ ﺗﺤﻠﻴﻠﻪ ﻋﻠﻰ‬
‫ﻧﻤﻮﺫﺝﺍﻟﻔﺄﺭ‪ ،‬ﻟﻮﺣﻆ ﺃﻥ ‪ RBE‬ﻷﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ ﻳﺨﺘﻠﻒ ﻣﻦ ‪ 3.2‬ﺇﻟﻰ ‪1.5‬‬
‫ﺑﺴﺒﺐﻃﺒﻴﻌﺘﻪ ﺍﻟﺤﺴﺎﺳﺔ ﺗﺠﺎﻩ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺤﻴﻄﻲ‪ ،‬ﻭﻫﻮ ﻣﺎ‬
‫ﻳﻮﺣﻲﺃﻳﻀﺎً ﺑﺎﻻﺧﺘﺒﺎﺭ ﻓﻲ ﺣﺎﻟﺔ ﺍﻟﻨﻤﻮﺫﺝ ﺍﻟﺒﺸﺮﻱ ]‪.[113‬‬
‫ﺍﻟﻤﺘﺄﺧﺮﺇﻟﻰ ﻣﺒﻜﺮ )‪ 3-1‬ﺃﺷﻬﺮ( ﻭﻣﺘﺄﺧﺮ )‪ 3‬ﺃﺷﻬﺮ ‪ -‬ﺳﻨﺔ ﻭﺍﺣﺪﺓ(‪ .‬ﻓﻲ ﺣﻴﻦ‬
‫ﻳﺘﻢﺗﺼﻨﻴﻒ ﺍﻋﺘﻼﻝ ﺍﻟﻨﺨﺎﻉ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻌﺎﺑﺮ ﻋﻠﻰ ﺃﻧﻪ ﺗﺄﺛﻴﺮ ﻣﺒﻜﺮ ﻣﺘﺄﺧﺮ‬
‫ﺃﺩﺕﺍﻷﺑﺤﺎﺙ ﺃﻳﻀﺎً ﺇﻟﻰ ﻓﻬﻢ ﺍﻹﺷﻌﺎﻉ ﻛﺴﺒﺐ ﻣﻬﻢ ﻟﺴﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ‬
‫ﺇﻟﻰﺟﺎﻧﺐ ﺍﻟﻮﺭﺍﺛﺔ ﻭﺍﻟﺘﻌﺮﺽ ﻟﻠﻤﻮﺍﺩ ﺍﻟﻤﺴﺮﻃﻨﺔ ﻭﺍﻷﻭﺭﺍﻡ ﺍﻟﺨﺒﻴﺜﺔ‬
‫ﺍﻟﺜﺎﻧﻮﻳﺔ‪.‬ﺃﺩﺕ ﺍﻟﻤﻼﺣﻈﺎﺕ ﺇﻟﻰ ﺗﻔﺴﻴﺮ ﺍﻻﺿﻄﺮﺍﺑﺎﺕ ﺍﻟﻌﺼﺒﻴﺔ ﺍﻟﻨﺎﺟﻤﺔ‬
‫ﻋﻦﺍﺳﺘﺨﺪﺍﻡ ﺟﺮﻋﺎﺕ ﻣﺆﻳﻨﺔ ﻣﻨﺨﻔﻀﺔ )>‪ (2Gy‬ﻭﻋﺎﻟﻴﺔ )< ‪114] (45Gy‬‬
‫[‪ .‬ﻳﻌﺪ ﺍﻻﻓﺘﻘﺎﺭ ﺇﻟﻰ ﺍﻟﻤﻬﻨﻴﻴﻦ ﺫﻭﻱ ﺍﻟﻤﻬﺎﺭﺍﺕ ﺍﻟﻌﺎﻟﻴﺔ ﻫﺪﻓﺎً ﺿﺮﻭﺭﻳﺎً‬
‫ﻳﺠﺐﻣﻌﺎﻟﺠﺘﻪ ﺟﻨﺒﺎً ﺇﻟﻰ ﺟﻨﺐ ﻣﻊ ﻓﻜﺮﺓ ﺇﻋﺪﺍﺩ ﻧﻤﻮﺫﺝ ﻣﺪﻣﺞ ﻭﺳﻬﻞ‬
‫ﺍﻟﻮﺻﻮﻝﺇﻟﻴﻪ ﻭﻣﻤﻜﻦ ﻭﺃﻛﺜﺮ ﺩﻗﺔ ﻟﺘﻮﺻﻴﻞ ﺍﻟﺠﺮﻋﺔ ﻟـ ‪ .CIRT‬ﻭﻣﻊ ﺍﻟﺘﻘﺪﻡ‬
‫ﺍﻟﺘﻜﻨﻮﻟﻮﺟﻲﻭﺍﻟﻤﻬﻨﻴﻴﻦ ﺍﻟﻤﻬﺮﺓ‪ ،‬ﻓﺈﻥ ﺍﻟﻔﻌﺎﻟﻴﺔ ﺍﻟﻤﻤﺘﺎﺯﺓ ﺍﻟﺘﻲ ﺃﺛﺒﺘﺘﻬﺎ‬
‫ﺃﻳﻮﻧﺎﺕﺍﻟﻜﺮﺑﻮﻥ ﻓﻲ ﺍﻟﻨﻄﺎﻕ ﺍﻟﻌﻼﺟﻲ )‪ 45 - 2‬ﻏﺮﺍﻱ( ﺗﺠﻌﻠﻬﺎ ﺑﺪﻳﻼ ًﻣﺜﺎﻟﻴﺎً‬
‫ﻟﻼﺳﺘﺨﺪﺍﻡﺍﻟﺤﺎﻟﻲ ﻟﻠﻔﻮﺗﻮﻧﺎﺕ ﻭﺍﻟﺒﺮﻭﺗﻮﻧﺎﺕ ﻓﻲ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ]‪[114‬‬
‫‪.‬‬
‫ﻭﻳﻼﺣﻆﻭﺭﻡ ﺧﺒﻴﺚ ﺑﻌﺪ ﻭﺭﻡ ﻓﻲ ﺍﻟﻤﺦ ﺑﺴﺒﺐ ﺍﻟﻤﻮﻗﻊ ﺍﻟﻤﻌﺰﻭﻝ ﻟﻠﺪﻣﺎﻍ‪.‬‬
‫ﺗﻌﻤﻞﺍﻟﺘﻄﻮﺭﺍﺕ ﺍﻟﺤﺪﻳﺜﺔ ﻓﻲ ﻣﺠﺎﻝ ﺍﻟﻤﻮﺻﻼﺕ ﺍﻟﻔﺎﺉﻘﺔ ﻭﺗﻄﺒﻴﻘﻬﺎ‬
‫ﻓﻲﺍﻟﻘﻨﻄﺮﻳﺔ ﻋﻠﻰ ﺗﺤﺴﻴﻦ ﻛﻔﺎءﺓ ﺗﻮﺻﻴﻞ ﺍﻟﺠﺮﻋﺔ ﻓﻲ ﺇﺟﺮﺍءﺍﺕ ﺍﻟﻌﻼﺝ ]‬
‫‪ .[115‬ﺳﻴﺴﺒﻼﺗﻴﻦ )ﺩﻭﺍء ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ( ‪ -‬ﺃﻇﻬﺮ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‬
‫ﺑﻤﺴﺎﻋﺪﺓﺃﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ ﻧﺘﺎﺉﺞ ﺟﻴﺪﺓ ﻋﻠﻰ ﺳﺮﻃﺎﻥ ﺍﻟﺨﻼﻳﺎ ﺍﻟﺤﺮﺷﻔﻴﺔ‬
‫ﻓﻲﻋﻨﻖ ﺍﻟﺮﺣﻢ ﺍﻟﻤﺘﻘﺪﻡ ﻣﺘﻮﺳﻂ ﺍﻟﺤﺠﻢ‪ ،‬ﻓﻲ ﺣﻴﻦ ﺃﻥ ﺍﻟﺒﺤﺚ ﻋﻦ‬
‫ﺍﻟﻌﻼﺝﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﺨﺎﺭﺟﻲ ﺑﺄﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ ﻣﻊ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‬
‫ﺍﻟﻤﻮﺿﻌﻲﻳﻤﻜﻦ ﺃﻥ ﻳﺴﺎﻋﺪ ﻓﻲ ﺍﻟﺤﺪ ﻣﻦ ﺍﻟﺘﺄﺛﻴﺮﺍﺕ ﺍﻟﺸﺪﻳﺪﺓ ﺑﻌﺪ‬
‫ﺍﻹﺷﻌﺎﻉ]‪ . [116‬ﻳﻤﻜﻦ ﺃﻥ ﻳﻜﻮﻥ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺑﺄﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ‬
‫ﺍﻟﺤﺠﻤﻲﺍﻟﻤﻮﺟﻪ ﺑﺎﻟﺼﻮﺭ ﻃﺮﻳﻘﺔ ﻣﻨﻬﺠﻴﺔ ﻟﺘﺠﻨﺐ ﺍﻟﺘﻮﺯﻳﻊ ﻏﻴﺮ ﺍﻟﻤﻨﺘﻈﻢ‬
‫ﻟﻠﺠﺮﻋﺔﻭﺗﺤﺴﻴﻦ ﺩﻗﺔ ﺍﻟﻌﻼﺝ ﻷﻧﻪ ﺣﺴﺎﺱ ﻟﻠﺘﻐﻴﺮﺍﺕ ﺍﻟﺘﺸﺮﻳﺤﻴﺔ‬
‫ﺍﻟﺼﻐﻴﺮﺓﻓﻲ ﺍﻟﻮﺭﻡ‪ ،‬ﻣﻤﺎ ﻳﺆﺩﻱ ﺇﻟﻰ ﺍﻟﺤﺪ ﺍﻷﺩﻧﻰ ﻣﻦ ﺍﻟﺨﻄﺄ ]‪.[117‬‬
‫ﺍﺳﺘﻜﺸﺎﻑﺁﻓﺎﻕ ﺍﺳﺘﺨﺪﺍﻡ ﺃﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ ﻓﻲ ﺍﻟﺼﻨﺎﻋﺎﺕ ﺍﻟﺘﻘﻠﻴﺪﻳﺔ‬
‫ﻭﺭﻡﺍﻟﺪﻣﺎﻍ ﺍﻷﺳﺒﺎﺏ ﻭﺍﻷﻋﺮﺍﺽ ﻭﺍﻟﺘﺸﺨﻴﺺ‬
‫ﺣﺎﻟﺔﺍﻹﺻﺎﺑﺔ ﺑﺴﺮﻃﺎﻥ ﺍﻟﺮﺉﺔ ﺻﻐﻴﺮ ﺍﻟﺨﻼﻳﺎ‪ ،‬ﻣﻤﺎ ﻳﺰﻳﺪ ﻣﻦ ﻓﺮﺹ‬
‫ﺗﺄﺛﻴﺮﺍﺗﻪﺍﻹﻳﺠﺎﺑﻴﺔ ﻋﻠﻰ ﺳﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ ]‪ .[102‬ﺇﻧﻪ ﻳﻘﺪﻡ ﺟﺎﻧﺒﺎً ﻭﺍﻋﺪﺍً ﻣﻦ‬
‫ﺍﻟﻌﻼﺝﺍﻹﺷﻌﺎﻋﻲ ﻭﺩﻣﺠﻪ ﻣﻊ ﻋﻼﺟﺎﺕ ﺃﺧﺮﻯ ﻟﺘﺤﺴﻴﻦ ﻧﺴﺒﺔ ﺍﻟﺪﻗﺔ‬
‫ﻭﺍﻟﻨﺠﺎﺡ‪.‬‬
‫‪.5‬ﺁﺛﺎﺭ ﻣﺎ ﺑﻌﺪ ﺍﻟﻌﻼﺝ‬
‫ﺑﻐﺾﺍﻟﻨﻈﺮ ﻋﻦ ﻓﻌﺎﻟﻴﺘﻪ‪ ،‬ﻳﺆﺩﻱ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻟﻠﺪﻣﺎﻍ ﺇﻟﻰ ﺁﺛﺎﺭ‬
‫ﻻﺣﻘﺔﺗﺘﺮﺍﻭﺡ ﻣﻦ ﺍﻟﻀﻌﻒ ﺍﻹﺩﺭﺍﻛﻲ ﺍﻟﺨﻔﻴﻒ ﺇﻟﻰ ﻧﺨﺮ ﺍﻟﺪﻣﺎﻍ ﺍﻟﻌﻠﻨﻲ‪.‬‬
‫ﺗﺆﺛﺮﻫﺬﻩ ﺍﻟﻌﻮﺍﻣﻞ ﻋﻠﻰ ﺟﻮﻫﺮ ﺍﻟﺤﻴﺎﺓ ﻭﻣﺪﺓ ﺍﻟﺒﻘﺎء ﻋﻠﻰ ﻗﻴﺪ ﺍﻟﺤﻴﺎﺓ ﺑﻌﺪ‬
‫ﺍﻟﻌﻼﺝ‪،‬ﺍﻋﺘﻤﺎﺩﺍً ﻋﻠﻰ ﻋﻮﺍﻣﻞ ﻣﺨﺘﻠﻔﺔ ﻣﺜﻞ ﺣﺠﻢ ﺍﻟﻮﺭﻡ ﻭﻣﻮﻗﻌﻪ ﻭﻋﻤﺮ‬
‫ﺍﻟﻤﺮﻳﺾ‪.‬ﺗﺤﺪﺩ ﻫﺬﻩ ﺍﻟﻌﻮﺍﻣﻞ ﻃﺒﻴﻌﺔ ﺍﻵﺛﺎﺭ ﺍﻟﺠﺎﻧﺒﻴﺔ ﺍﻟﺘﻲ ﻳﻌﺎﻧﻲ ﻣﻨﻬﺎ‬
‫ﺍﻟﻤﺮﺿﻰﺍﻋﺘﻤﺎﺩﺍً ﻋﻠﻰ ﻭﻗﺖ ﺗﻄﻮﺭﻫﻢ؛ ﺍﻵﺛﺎﺭ ﺍﻟﺠﺎﻧﺒﻴﺔ ﺍﻟﻤﺒﻜﺮﺓ ﺃﻭ‬
‫ﺍﻟﻤﺘﺄﺧﺮﺓ]‪.[103‬‬
‫ﺗﻈﻬﺮﺍﻵﺛﺎﺭ ﺍﻟﺠﺎﻧﺒﻴﺔ ﺍﻟﻤﺒﻜﺮﺓ ﻋﻠﻰ ﺍﻷﻋﻀﺎء ﺍﻟﻤﺠﺎﻭﺭﺓ ﻓﻲ ﺍﻟﻤﻨﻄﻘﺔ‬
‫ﺍﻟﻤﻌﺮﺿﺔﻟﻺﺷﻌﺎﻋﺎﺕ‪ ،‬ﻭﻳﻼﺣﻆ ﺃﻧﻬﺎ ﺗﺘﻄﻮﺭ ﺃﺛﻨﺎء ﺍﻟﻌﻼﺝ ﺃﻭ ﺑﻌﺪ ﺑﻀﻌﺔ‬
‫ﺃﻳﺎﻡ‪.‬ﻭﻓﻲ ﺣﺎﻟﺔ ﺃﻭﺭﺍﻡ ﺍﻟﻤﺦ ﻗﺪ ﻳﺆﺩﻱ ﺇﻟﻰ ﺗﻮﺭﻡ ﻳﺆﺩﻱ ﺇﻟﻰ ﻗﺼﺮ ﻣﺘﻮﺳﻂ‬
‫‪-‬ﺍﻵﺛﺎﺭ ﺍﻟﺠﺎﻧﺒﻴﺔ ﺍﻟﻤﺪﻯ ﻣﺜﻞ ﺍﻟﺘﻌﺐ‪ ،‬ﻭﺍﻟﻨﻮﺑﺎﺕ‪ ،‬ﻭﺍﻟﻐﺜﻴﺎﻥ‪ ،‬ﻭﺗﺴﺎﻗﻂ‬
‫ﺍﻟﺸﻌﺮ‪،‬ﻭﺗﻐﻴﺮﺍﺕ ﺍﻟﺠﻠﺪ‪ ،‬ﻭﺍﻟﺘﻲ ﻳﻤﻜﻦ ﻋﻼﺟﻬﺎ ﺑﺎﻷﺩﻭﻳﺔ ]‪.[104‬‬
‫ﺗﺆﺛﺮﺍﻟﺠﺮﻋﺎﺕ ﺍﻹﺷﻌﺎﻋﻴﺔ ﺍﻟﻌﺎﻟﻴﺔ ﻋﻠﻰ ﺍﻷﻧﺴﺠﺔ ﺍﻟﺨﺒﻴﺜﺔ ﻭﺍﻟﺴﻠﻴﻤﺔ‬
‫ﻋﻠﻰﺣﺪ ﺳﻮﺍء ﻭﺗﺴﺒﺐ ﺍﻹﺻﺎﺑﺔ ﺍﻹﺷﻌﺎﻋﻴﺔ ﺍﻟﻤﺘﺄﺧﺮﺓ‪ .‬ﻟﻮﺣﻆ ﺃﻥ‬
‫ﺍﻟﻤﺮﺿﻰﺍﻟﺬﻳﻦ ﺧﻀﻌﻮﺍ ﻟﻠﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻓﻲ ﻣﻨﻄﻘﺔ ﺍﻟﺮﺃﺱ ﻭﺍﻟﺮﻗﺒﺔ‬
‫ﻳﻌﺎﻧﻮﻥﻣﻦ ﺍﻋﺘﻼﻝ ﺍﻟﻨﺨﺎﻉ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻌﺎﺑﺮ )ﺻﺪﻣﺔ ﻛﻬﺮﺑﺎﺉﻴﺔ ‪ -‬ﻣﺜﻞ‬
‫ﺍﻷﺣﺎﺳﻴﺲﺃﺳﻔﻞ ﺍﻟﺮﻗﺒﺔ( ﺑﺴﺒﺐ ﺇﺯﺍﻟﺔ ﺍﻟﻤﻴﺎﻟﻴﻦ ﺍﻟﻤﺆﻗﺘﺔ ﻟﻠﺨﻼﻳﺎ‬
‫ﺍﻟﻌﺼﺒﻴﺔﺍﻟﺤﺴﻴﺔ ]‪ .[105‬ﻟﻢ ﻳﺘﻢ ﺍﻟﺘﻌﺮﻑ ﻋﻠﻰ ﻫﺬﻩ ﺍﻷﺣﺎﺳﻴﺲ ﻋﻠﻰ‬
‫ﺍﻟﻔﻮﺭﻋﻠﻰ ﺃﻧﻬﺎ ﺗﺄﺛﻴﺮ ﻣﺒﻜﺮ‪ ،‬ﻭﻻ ﺗﻢ ﺍﻟﺘﻌﺮﻑ ﻋﻠﻴﻬﺎ ﺑﻌﺪ ﻓﻮﺍﺕ ﺍﻷﻭﺍﻥ‬
‫ﻟﺘﻜﻮﻥﺗﺄﺛﻴﺮﺍً ﻣﺘﺄﺧﺮﺍً‪ .‬ﻭﺃﺩﻯ ﺫﻟﻚ ﺇﻟﻰ ﻣﺰﻳﺪ ﻣﻦ ﺗﻘﺴﻴﻢ ﺗﺄﺛﻴﺮ ﺍﻹﺷﻌﺎﻉ‬
‫ﺑﻌﺪﺍﻟﻌﻼﺝ‪ ،‬ﻓﺈﻥ ﺗﺄﺛﻴﺮﺍﺕ ﻣﺎ ﺑﻌﺪ ﺍﻟﻌﻼﺝ ﺍﻟﻤﺘﺄﺧﺮﺓ ﻋﺎﺩﺓ ﻣﺎ ﺗﻨﻄﻮﻱ ﻋﻠﻰ‬
‫ﺧﻠﻞﻓﻲ ﺍﻟﻐﺪﺓ ﺍﻟﻨﺨﺎﻣﻴﺔ ﻭﺗﺤﺖ ﺍﻟﻤﻬﺎﺩ ﻭﺗﺨﻔﻴﻒ ﺍﻟﻘﺪﺭﺓ ﺍﻟﻔﻜﺮﻳﺔ‪ .‬ﺗﻈﻬﺮ‬
‫ﺍﻷﻋﺮﺍﺽﺗﺤﺖ ﺗﺄﺛﻴﺮﺍﺕ ﻣﺎ ﺑﻌﺪ ﺍﻟﻌﻼﺝ ﺍﻟﻤﺘﺄﺧﺮﺓ ﺑﻌﺪ ﻋﺪﺓ ﺃﺷﻬﺮ ﺇﻟﻰ‬
‫ﺳﻨﻮﺍﺕﺑﻌﺪ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻭﻫﻲ ﺃﻛﺜﺮ ﺍﻟﻤﺨﺎﻭﻑ ﺧﻄﻮﺭﺓ ﺍﻟﻤﺮﺗﺒﻄﺔ‬
‫ﺑﺎﻟﺘﻌﺮﺽﻟﻺﺷﻌﺎﻉ ﻓﻲ ﺍﻟﺪﻣﺎﻍ‪ ،‬ﻣﻤﺎ ﻳﺆﺩﻱ ﻋﺎﺩﺓ ﺇﻟﻰ ﺍﻟﻨﺨﺮ‪ .‬ﻭﻳﻌﺘﻤﺪ‬
‫ﺍﻟﺘﻌﺒﻴﺮﻋﻦ ﻫﺬﻩ ﺍﻟﺘﺄﺛﻴﺮﺍﺕ ﻋﻠﻰ ﺗﻮﺍﺗﺮ ﻭﺟﺮﻋﺔ ﻭﺣﺠﻢ ﺍﻟﺪﻣﺎﻍ ﺍﻟﻤﺸﻌﻊ‬
‫ﻭﻫﻮﺳﺎﺉﺪ ﻓﻲ ﺍﻟﻤﺎﺩﺓ ﺍﻟﺒﻴﻀﺎء‪ ،‬ﻭﺧﺎﺻﺔ ﻓﻲ ﺍﻟﺨﻼﻳﺎ ﺍﻟﺪﺑﻘﻴﺔ ]‪.[106‬‬
‫ﻳﺤﺪﺙﻣﻮﺕ ﺍﻟﺨﻼﻳﺎ ﺍﻟﻤﺒﺮﻣﺞ ﻟﺨﻼﻳﺎ ﺍﻟﺪﻣﺎﻍ ﺑﺴﺒﺐ ﺍﻹﺟﻬﺎﺩ ﺍﻟﺘﺄﻛﺴﺪﻱ‪،‬‬
‫ﻭﺧﻠﻞﺍﻟﻤﻴﺘﻮﻛﻮﻧﺪﺭﻳﺎ‪ ،‬ﻭﺗﺪﻫﻮﺭ ﺍﻟﺒﺮﻭﺗﻴﻦ‪ ،‬ﻣﻤﺎ ﻳﺴﺒﺐ ﻏﺎﻟﺒﺎً ﺃﻣﺮﺍﺽ‬
‫ﺗﻨﻜﺲﻋﺼﺒﻲ ]‪ .[107‬ﺗﻜﻮﻥ ﺍﺣﺘﻤﺎﻟﻴﺔ ﺍﻹﺻﺎﺑﺔ ﺑﺄﻭﺭﺍﻡ ﺧﺒﻴﺜﺔ ﺛﺎﻧﻮﻳﺔ‬
‫ﺃﻋﻠﻰﻓﻲ ﺣﺎﻟﺔ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‪ ،‬ﻭﺫﻟﻚ ﺑﺴﺒﺐ ﺍﻟﺘﺮﻛﻴﺐ ﺍﻟﺠﻴﻨﻲ ﻭﻧﻤﻂ‬
‫ﺍﻟﺤﻴﺎﺓﻭﺍﻻﺳﺘﺠﺎﺑﺎﺕ ﺍﻟﺨﻄﻴﺔ ﻟﻠﺠﺮﻋﺎﺕ ﻣﻦ ‪ 0.2‬ﺇﻟﻰ ‪ 2‬ﺳﻴﻔﺮﺕ‪.‬‬
‫ﻭﻣﻦﺍﻟﻤﻌﺮﻭﻑ ﺃﻥ ﺍﻟﺠﺮﻋﺎﺕ ﺍﻟﻤﻨﺨﻔﻀﺔ ﺍﻟﻤﺰﻣﻨﺔ ﻣﻦ ﺍﻹﺷﻌﺎﻋﺎﺕ‬
‫ﺍﻟﻤﺆﻳﻨﺔﺗﺴﺒﺐ ﺳﺮﻃﺎﻥ ﺍﻟﺪﻡ‪ ،‬ﻭﺳﺮﻃﺎﻥ ﺍﻟﺜﺪﻱ‪ ،‬ﻭﺃﻣﺮﺍﺽ ﺍﻟﻌﻴﻮﻥ‪،‬‬
‫ﻭﺃﻣﺮﺍﺽﺍﻟﻘﻠﺐ ﻭﺍﻷﻭﻋﻴﺔ ﺍﻟﺪﻣﻮﻳﺔ ﻭﺍﻟﺪﻣﺎﻏﻴﺔ‪ ،‬ﻭﻣﺨﺘﻠﻒ ﺍﻵﺛﺎﺭ ﺍﻟﺼﺤﻴﺔ‬
‫ﺍﻟﻌﻘﻠﻴﺔﻭﺍﻟﻨﻔﺴﻴﺔ ]‪ .[108‬ﺗﻘﻠﻞ ﻫﺬﻩ ﺍﻟﺘﺄﺛﻴﺮﺍﺕ ﻣﻦ ﺟﻮﺩﺓ ﺍﻟﺤﻴﺎﺓ ﺑﺪﺭﺟﺔ‬
‫ﻛﺒﻴﺮﺓ‪،‬ﻭﺑﺎﻟﺘﺎﻟﻲ ﻓﻬﻲ ﺃﺣﺪ ﺍﻟﻘﻴﻮﺩ ﺍﻟﺮﺉﻴﺴﻴﺔ ﻟﻠﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‪.‬‬
‫ﺗﺘﻮﻓﺮﻣﺠﻤﻮﻋﺔ ﻣﻦ ﺍﻟﻌﻮﺍﻣﻞ ﻭﺍﻷﺩﻭﻳﺔ ﺍﻟﻮﺍﻗﻴﺔ ﻣﻦ ﺍﻹﺷﻌﺎﻉ ﻟﺘﻘﻠﻴﻞ‬
‫ﺍﻵﺛﺎﺭﺍﻟﻀﺎﺭﺓ ﺑﻌﺪ ﺍﻟﻌﻼﺝ ﺑﺴﺒﺐ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺩﻭﻥ ﺃﻱ ﺗﻌﻮﻳﺾ ﻓﻲ‬
‫ﺍﻟﺠﺮﻋﺎﺕ‪.‬ﻫﺬﻩ ﺭﺍ‪-‬‬
 ‫ﺭﺍﺟﺎﻓﺎﺑﻮﺩﻱﻭﺁﺧﺮﻭﻥ‪.‬‬
‫‪http://dx.doi.org/10.14338/IJPT-15-00013‬‬
‫]‪ [10‬ﺇﺑﻨﺮ ﺩﻱ ﻛﻴﻪ‪ ،‬ﻛﺎﻣﺎﺩﺍ ﺗﻲ‪ .‬ﺍﻟﺪﻭﺭ ﺍﻟﻨﺎﺷﺊ ﻟﻠﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺑﺄﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ‪ .‬ﺟﺒﻬﺔ‬
‫ﺃﻭﻧﻜﻮﻝ‪2016‬؛ ‪.140 :6‬‬
‫‪http://dx.doi.org/10.3389/fonc.2016.00140 PMID: 27376030‬‬
‫]‪ [11‬ﺭ‪ .‬ﻛﺎﺳﺘﺮﻭ ﺝ‪ .‬ﺍﻟﻌﻼﺝ ﺑﺎﻷﻳﻮﻧﺎﺕ ﺍﻟﺜﻘﻴﻠﺔ‪ .‬ﺑﻴﺮﻛﻠﻲ‪ ،‬ﻛﺎﻟﻴﻔﻮﺭﻧﻴﺎ‪ :‬ﻟﻮﺭﺍﻧﺲ ﺑﻴﺮﻛﻲ‪-‬‬
‫ﻣﺨﺘﺒﺮﻟﻲ ﺍﻟﻮﻃﻨﻲ ‪.1993‬‬
‫‪.‬ﺍﻟﻔﻴﺰﻳﺎءﺍﻟﻨﻮﻭﻳﺔ ﻓﻲ ﺍﻟﻌﻼﺝ ﺑﺎﻟﺠﺴﻴﻤﺎﺕ‪ :‬ﻣﺮﺍﺟﻌﺔ‪ .‬ﻣﻨﺪﻭﺏ ﺑﺮﻭﻍ ﻓﻴﺰ ‪2016‬؛‬
‫‪]12[ Durante M, Paganetti H. 096702:(9)79‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1088/0034-4885/79/9/09670227540827‬‬
‫‪http://dx.doi.org‬‬
‫]‪ [13‬ﺑﺎﻭﻣﺎﻥ ﺇﻡ‪ ،‬ﻛﺮﺍﻭﺱ ﺇﻡ‪ ،‬ﺃﻭﻓﺮﺟﺎﺭﺩ ﺟﻲ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﻋﻼﺝ ﺍﻷﻭﺭﺍﻡ ﺑﺎﻹﺷﻌﺎﻉ ﻓﻲ ﻋﺼﺮ‬
‫ﺍﻟﻄﺐﺍﻟﺪﻗﻴﻖ‪ .‬ﻧﺎﺕ ﺭﻳﻒ ﺍﻟﺴﺮﻃﺎﻥ ‪2016‬؛ ‪.49-234 :(4)16‬‬
‫‪http://dx.doi.org/10.1038/nrc.2016.18 PMID: 27009394‬‬
‫]‪ [14‬ﺩﻭﺭﺍﻧﺘﻲ ﺇﻡ‪ ،‬ﻟﻮﻓﻠﺮ ﺟﻲ ﺇﺱ‪ .‬ﺍﻟﺠﺴﻴﻤﺎﺕ ﺍﻟﻤﺸﺤﻮﻧﺔ ﻓﻲ ﻋﻼﺝ ﺍﻷﻭﺭﺍﻡ ﺑﺎﻹﺷﻌﺎﻉ‪.‬‬
‫ﻧﺎﺕﺭﻳﻒ ﻛﻠﻴﻦ ﺃﻭﻧﻜﻮﻝ ‪2010‬؛ ‪.43-37 :(1)7‬‬
‫‪http://dx.doi.org/10.1038/nrclinonc.2009.183 PMID: 19949433‬‬
‫]‪ [15‬ﻛﻮﻣﺰ ﺇﺱ ﺇﻱ‪ ،‬ﺑﻮﻫﻞ ﺟﻴﻪ‪ ،‬ﺍﻟﺴﺎﺳﺮ ﺗﻲ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﻟﺘﻘﻴﻴﻢ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﺒﻴﻮﻟﻮﺟﻲ‬
‫ﻭﺍﻻﺭﺗﺒﺎﻁﻣﻊ ﻧﻤﻮﺫﺝ ﺍﻟﺘﺄﺛﻴﺮ ﺍﻟﻤﺤﻠﻲ )‪ (LEM‬ﻟﻠﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺑﺄﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ‬
‫ﻭﺍﻟﺘﻴﻤﻮﺯﻭﻟﻮﻣﻴﺪﻓﻲ ﺧﻄﻮﻁ ﺧﻼﻳﺎ ﺍﻟﻮﺭﻡ ﺍﻷﺭﻭﻣﻲ ﺍﻟﺪﺑﻘﻲ‪ .‬ﺇﻧﺖ ﺝ‬
‫ﺭﺍﺩﻳﺎﺕﺑﻴﻮﻝ ‪2009‬؛ ‪/10.1080/09553000802641151 .37-126 :(2)85‬‬
‫‪ http://dx.doi.org‬ﺑﻤﻴﺪ‪19280465 :‬‬
‫]‪ [16‬ﺑﺎﻟﻨﺴﺒﺔ ﺇﻟﻰ ‪،SL، Lebesque JV، Theuws JC‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﻻﻟﺘﻬﺎﺏ ﺍﻟﺮﺉﻮﻱ‬
‫ﺍﻹﺷﻌﺎﻋﻲﻛﺪﺍﻟﺔ ﻟﻤﺘﻮﺳﻂ ﺟﺮﻋﺔ ﺍﻟﺮﺉﺔ‪ :‬ﺗﺤﻠﻴﻞ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺠﻤﻌﺔ ﻟـ ‪540‬‬
‫ﻣﺠﻠﺲﺃﺑﺤﺎﺙ ﺍﻟﻌﻠﻮﻡ ﻭﺍﻟﻬﻨﺪﺳﺔ‪ ،‬ﺣﻜﻮﻣﺔ ﺍﻟﻬﻨﺪ )‪/2017/000466‬‬
‫ﻣﺮﻳﻀﺎ‪ً.‬ﺇﻧﺖ ‪ J‬ﺭﺍﺩﻳﺎﺕ ﺃﻭﻧﻜﻮﻝ ﺑﻴﻮﻝ ﻓﻴﺰ ‪1998‬؛ ‪.9-1 :(1)42‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1016/S0360-3016)98(00196-59747813‬‬
‫‪http://dx.doi.org‬‬
‫]‪ [17‬ﻣﺎﺳﻴﻨﺠﻴﻞ ﺏ‪ .‬ﺍﻟﺘﻨﺒﺆ ﺑﻜﺸﻒ ﺍﻟﺠﺮﻋﺔ ﺍﻟﻤﻤﺘﺼﺔ ﻣﻦ ﺍﻟﺒﺮﻭﺗﻮﻥ ﻭﺍﻟﻨﻴﻮﺗﺮﻭﻥ‪.‬‬
‫ﺍﻟﻤﺴﺎﻫﻤﺎﺕﻓﻲ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺑﺤﺰﻣﺔ ﺍﻟﺒﺮﻭﺗﻮﻥ ﺑﺎﺳﺘﺨﺪﺍﻡ ﻣﻮﻧﺖ ﻛﺎﺭﻟﻮ ‪- N‬‬
‫ﻛﻮﺩﻧﻘﻞ ﺍﻟﺠﺴﻴﻤﺎﺕ ]‪ .[MCNPX‬ﻛﻮﻟﻴﺞ ﺳﺘﻴﺸﻦ‪ ،‬ﺗﻜﺴﺎﺱ‪ :‬ﺟﺎﻣﻌﺔ ﺗﻜﺴﺎﺱ‬
‫ﺇﻳﻪﺁﻧﺪ ﺇﻡ ‪.2010‬‬
‫‪.‬ﺍﻟﺠﺪﻝﺍﻻﻗﺘﺼﺎﺩﻱ ﺍﻟﺼﺤﻲ ﻭﻓﻌﺎﻟﻴﺔ ﺗﻜﻠﻔﺔ ﺍﻟﻌﻼﺝ ﺑﺎﻟﺒﺮﻭﺗﻮﻥ‪ .‬ﺳﻴﻤﻴﻦ ﺭﺍﺩﻳﺎﺕ ﺃﻭﻧﻜﻮﻝ‬
‫‪2013‬؛‪]18[ Lievens Y, Pijls-Johannesma M. 41-134 :(2)23‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1016/j.semradonc.2012.11.00523473691‬‬
‫‪http://dx.doi.org‬‬
‫]‪ [19‬ﺑﺎﺟﺎﻧﻴﺘﻲ ﺇﺗﺶ‪ ،‬ﺯﻳﺘﻤﺎﻥ ﺃ‪ .‬ﻟﻤﺎﺫﺍ ﻳﻌﺘﺒﺮ ﺍﻟﻌﻼﺝ ﺑﺤﺰﻣﺔ ﺍﻟﺒﺮﻭﺗﻮﻧﺎﺕ ﻣﺜﻴﺮﺍً ﻟﻠﺠﺪﻝ؟‬
‫ﻟﻠﺘﻜﻨﻮﻟﻮﺟﻴﺎﻭﺍﺭﺍﻧﺠﺎﻝ( ﺍﻟﺬﻱ ﻗﺪﻡ ﺍﻟﺒﺼﻴﺮﺓ ﻭﺍﻟﺨﺒﺮﺓ ﺍﻟﺘﻲ ﺳﺎﻋﺪﺕ ﺑﺸﻜﻞ‬
‫ﺳﻴﺎﻝ؟ﺟﻲ ﺁﻡ ﻛﻮﻝ ﺭﺍﺩﻳﻮﻝ ‪2015‬؛ ‪ 12)12‬ﻧﻘﻄﺔ ﺃ(‪PMID: 26653836 .9-1318 :‬‬
‫‪http://dx.doi.org/10.1016/j.jacr.2015.09.019‬‬
‫]‪ [20‬ﺍﻟﻤﻌﻬﺪ ﺍﻟﻮﻃﻨﻲ ﻟﻠﺴﺮﻃﺎﻥ‪ .‬ﻋﻠﻢ ﺍﻟﻮﺭﺍﺛﺔ‪-https://www.cancer.gov.2019 .‬‬
‫‪/‬ﺣﻮﻝ‪-‬ﺍﻟﺴﺮﻃﺎﻥ‪/‬ﺃﺳﺒﺎﺏ‪-‬ﺍﻟﻮﻗﺎﻳﺔ‪/‬ﻋﻠﻢ ﺍﻟﻮﺭﺍﺛﺔ‬
‫]‪ [21‬ﺭﺍﻳﻠﻲ ﻛﻴﻪ ﺇﻡ‪ .‬ﻗﺎﺑﻠﻴﺔ ﺍﻹﺻﺎﺑﺔ ﺑﻮﺭﻡ ﺍﻟﺪﻣﺎﻍ‪ :‬ﺩﻭﺭ ﺍﻟﻌﻮﺍﻣﻞ ﺍﻟﻮﺭﺍﺛﻴﺔ ﻭﺍﺳﺘﺨﺪﺍﻣﺎﺕ‬
‫ﻧﻤﺎﺫﺝﺍﻟﻔﺄﺭ ﻟﻜﺸﻒ ﺍﻟﻤﺨﺎﻃﺮ‪ .‬ﺑﺮﻳﻦ ﺑﺎﺛﻮﻝ ‪.31-121 :(1)19 ;2009‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1111/j.1750-3639.2008.00236.x19076777‬‬
‫‪http://dx.doi.org‬‬ ‫]‪ [2‬ﻓﺎﻥ ﺩﻥ ﺗﻮﻳﻞ ﺟﻲ ﺟﻲ‪ ،‬ﺗﺎﻳﻠﻮﺭ ﺳﻲ ﺁﺭ‪ .‬ﺗﺎﺭﻳﺦ ﻣﻮﺟﺰ ﻟﻌﻠﻢ ﺍﻷﻣﺮﺍﺽ‪ :‬ﻣﻘﺪﻣﺔ ﻟﺴﻠﺴﻠﺔ‬
‫]‪ [22‬ﻟﻮﺩﻳﺶ ﺇﺗﺶ‪ ،‬ﺑﻴﺮﻙ ﺇﻳﻪ‪ ،‬ﺯﻳﺒﻮﺭﺳﻜﻲ ﺇﺱ ﺇﻝ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺑﻴﻮﻟﻮﺟﻴﺎ ﺍﻟﺨﻼﻳﺎ ﺍﻟﺠﺰﻳﺉﻴﺔ‪.‬‬
‫)ﺍﻟﻄﺒﻌﺔ ﺍﻟﺮﺍﺑﻌﺔ(‪ ،‬ﻧﻴﻮﻳﻮﺭﻙ‪ :‬ﺩﺑﻠﻴﻮ ﺇﺗﺶ ﻓﺮﻳﻤﺎﻥ ‪.2000‬‬
‫]‪ [23‬ﺑﻠﻮﻣﻨﺜﺎﻝ ﺩﻱ ﺗﻲ‪ ،‬ﻛﺎﻧﻮﻥ ﺃﻭﻟﺒﺮﺍﻳﺖ ﻟﻮﺱ ﺃﻧﺠﻠﻮﺱ‪ .‬ﺍﻟﻌﺎﺉﻠﺔ ﻓﻲ ﻭﺭﻡ ﻓﻲ ﺍﻟﻤﺦ‪ .‬ﻋﻠﻢ‬
‫ﺍﻷﻋﺼﺎﺏ‪2008‬؛ ‪.20-1015 :(13)71‬‬
‫‪/10.1212/01.wnl.0000326597.60605.27 PMID: 18809838‬‬ ‫ﺑﻤﻴﺪ‪. http://dx.doi.org/10.1007/s13277-012-0389-0 22492238:‬ﺍﻟﻨﻤﺎﺫﺝ‬
‫‪http://dx.doi.org‬‬ ‫ﺍﻟﻤﺘﻄﻮﺭﺓﻷﺻﻞ ﺍﻟﻮﺭﻡ ﻭﺗﻄﻮﺭﻩ‪ .‬ﻭﺭﻡ ﺑﻴﻮﻝ ‪2012‬؛ ‪A, Szala S. 7-911 :(4)33‬‬
‫]‪ [24‬ﻓﺎﺭﻳﻞ ﺳﻲ ﺟﻴﻪ‪ ،‬ﺑﻠﻮﺗﻜﻴﻦ ﺇﺱ ﺁﺭ‪ .‬ﺍﻷﺳﺒﺎﺏ ﺍﻟﻮﺭﺍﺛﻴﺔ ﻟﻮﺭﻡ ﺍﻟﺪﻣﺎﻍ‪ :‬ﺍﻟﻮﺭﻡ ﺍﻟﻌﺼﺒﻲ‬
‫ﺍﻟﻠﻴﻔﻲ‪،‬ﺍﻟﺘﺼﻠﺐ ﺍﻟﺤﺪﺑﻲ‪ ،‬ﻓﻮﻥ ﻫﻴﺒﻞ ﻟﻴﻨﺪﺍﻭ‪ ،‬ﻭﻣﺘﻼﺯﻣﺎﺕ ﺃﺧﺮﻯ‪ .‬ﻧﻴﻮﺭﻭﻝ ﻛﻠﻴﻦ‬
‫‪2007‬؛‪ ،946-925 :(4)25‬ﺍﻟﺜﺎﻣﻦ‪.‬‬
‫‪http://dx.doi.org/10.1016/j.ncl.2007.07.008 PMID: 17964021‬‬ ‫‪: iv1-iv86.‬ﺗﺸﺨﻴﺺ ﺃﻭﺭﺍﻡ ﺍﻟﺪﻣﺎﻍ ﺍﻷﻭﻟﻴﺔ ﻭﺃﻭﺭﺍﻡ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺮﻛﺰﻱ ﺍﻷﺧﺮﻯ ﻓﻲ‬
‫]‪ [25‬ﺍﻟﺘﻤﻴﻤﻲ ﺃ‪ ،‬ﺟﻮﻳﺪ ﻡ‪ .‬ﻋﻠﻢ ﺍﻷﻭﺑﺉﺔ ﻭﻧﺘﺎﺉﺞ ﺍﻟﻮﺭﻡ ﺍﻷﺭﻭﻣﻲ ﺍﻟﺪﺑﻘﻲ‪ .‬ﻭﺭﻡ ﺃﺭﻭﻣﻲ ﺩﺑﻘﻲ‬
‫‪2017‬؛ﺹ ‪.53-143‬‬
‫‪http://dx.doi.org/10.15586/codon.glioblastoma.2017.ch8‬‬
‫]‪ [26‬ﻛﺎﺭﺑﻨﺘﺮ ﺩﻭ‪ ،‬ﺑﻮﺷﻜﻴﻦ ﺑﻴﺪﻳﻨﺖ ﺇﺱ‪ .‬ﺍﻟﺘﻌﺮﺽ ﻟﻠﻤﻮﺍﺩ ﺍﻟﻜﻴﻤﻴﺎﺉﻴﺔ ﻭﺍﻹﺷﻌﺎﻉ ﺃﺛﻨﺎء‬
‫ﺍﻟﻄﻔﻮﻟﺔﻭﺧﻄﺮ ﺍﻹﺻﺎﺑﺔ ﺑﺎﻟﺴﺮﻃﺎﻥ ﻓﻲ ﻭﻗﺖ ﻻﺣﻖ ﻣﻦ ﺍﻟﺤﻴﺎﺓ‪ .‬ﻱ ﺃﺩﻭﻟﻴﺴﻚ‬
‫ﺍﻟﺼﺤﺔ‪2013‬؛ ‪) (5)52‬ﻣﻠﺤﻖ(‪23601608 :‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪http://dx.doi.org/10.1016/j.jadohealth.2013.01.027‬‬
‫‪S21-9.‬‬
‫]‪ [27‬ﻧﻴﺘﺎ ﺟﻲ‪ ،‬ﺳﺘﻴﻮﺍﺭﺕ ﺑﻲ ﺇﻳﻪ‪ ،‬ﺭﺍﺟﺎﺭﺍﻣﺎﻥ ﺑﻲ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﻟﺘﻌﺮﺽ ﺍﻟﻤﻬﻨﻲ ﻟﻠﻤﺬﻳﺒﺎﺕ‬
‫ﺍﻟﻤﻜﻠﻮﺭﺓﻭﻣﺨﺎﻃﺮ ﺍﻟﻮﺭﻡ ﺍﻟﺪﺑﻘﻲ ﻭﺍﻟﻮﺭﻡ ﺍﻟﺴﺤﺎﺉﻲ ﻟﺪﻯ ﺍﻟﺒﺎﻟﻐﻴﻦ‪ .‬ﻭﺍﺣﺘﻼﻝ‬
‫ﺍﻟﺒﻴﺉﺔﻓﻲ ﺍﻟﺒﺤﺮ ﺍﻷﺑﻴﺾ ﺍﻟﻤﺘﻮﺳﻂ ‪ 2012‬؛ ‪.801-793 :(11)69‬‬
‫‪http://dx.doi.org/10.1136/oemed-2012-100742 PMID: 22864249‬‬
‫]‪ [28‬ﺍﻟﻮﻛﺎﻟﺔ ﺍﻟﺪﻭﻟﻴﺔ ﻷﺑﺤﺎﺙ ﺍﻟﺴﺮﻃﺎﻥ‪ .‬ﺗﻘﻮﻡ ﺩﺭﺍﺳﺎﺕ ﺍﻟﻮﻛﺎﻟﺔ ﺍﻟﺪﻭﻟﻴﺔ ﻟﺒﺤﻮﺙ ﺍﻟﺴﺮﻃﺎﻥ‬
‫)‪ (IARC‬ﺑﺘﻘﻴﻴﻢ ﺍﺳﺘﻬﻼﻙ ﺍﻟﻠﺤﻮﻡ ﺍﻟﺤﻤﺮﺍء ﻭﺍﻟﻠﺤﻮﻡ ﺍﻟﻤﺼﻨﻌﺔ ﻟﻌﺎﻡ ‪.2015‬‬
‫]‪ [29‬ﻛﺎﻓﻮ ﺇﻡ‪ ،‬ﻛﺎﺭﻭﺳﻮ ﺟﻲ‪ ،‬ﻓﺎﺗﺎ ﺟﻲ ﺇﻝ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﻟﻤﻌﺎﺩﻥ ﺍﻟﺜﻘﻴﻠﺔ ﻭﺍﻟﺘﻐﻴﺮﺍﺕ ﺍﻟﻼﺟﻴﻨﻴﺔ‬
‫ﻓﻲﻭﺭﻡ ﺍﻟﻤﺦ‪ .‬ﻋﻠﻢ ﺍﻟﺠﻴﻨﻮﻡ ﺑﺎﻟﻌﻤﻠﺔ ‪2014‬؛ ‪PMID .63-457 :(6)15‬‬
‫‪:http://dx.doi.org/10.2174/138920291506150106151847‬‬
‫‪8‬ﺍﻟﺘﺼﻮﻳﺮ ﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ‪ ،2021،‬ﺭﺣﻠﺔ ﺟﻮﻳﺔ‪ ،17 .‬ﻻ‪00 .‬‬
‫ﻳﻤﻜﻦﺃﻥ ﻳﺤﻞ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻣﺤﻞ ﺍﻟﻔﻮﺗﻮﻧﺎﺕ ﻭﺑﺎﻟﺘﺎﻟﻲ ﻳﺰﻳﺪ ﻣﻦ‬
‫ﺍﻟﺪﻗﺔﻭﻧﺴﺒﺔ ﺍﻟﺒﻘﺎء ﻋﻠﻰ ﻗﻴﺪ ﺍﻟﺤﻴﺎﺓ ]‪ .[118‬ﻟﻘﺪ ﺣﻔﺰﺕ ﺍﻟﻄﺒﻴﻌﺔ‬
‫ﺍﻟﻮﺍﻋﺪﺓﻷﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ ﺍﻟﻌﻠﻤﺎء ﻋﻠﻰ ﺗﺠﺮﺑﺔ ﺃﻳﻮﻧﺎﺕ ﺛﻘﻴﻠﺔ ﺃﺧﺮﻯ ﺫﺍﺕ‬
‫ﺧﺼﺎﺉﺺﻋﻼﺟﻴﺔ ﻣﻤﺘﺎﺯﺓ‪ .‬ﻗﺪﻣﺖ ﺍﻟﺘﺠﺎﺭﺏ ﺍﻟﺘﻲ ﺃﺟﺮﻳﺖ ﻋﻠﻰ ﺃﻋﻀﺎء‬
‫ﺃﻗﻞﺗﻌﻘﻴﺪﺍً ﻟﻠﻤﺘﻄﻮﻋﻴﻦ ﻧﺘﺎﺉﺞ ﻣﻘﻨﻌﺔ‪ ،‬ﻣﻤﺎ ﻳﺸﻴﺮ ﺇﻟﻰ ﻭﺟﻮﺩ ﻣﺠﺎﻝ‬
‫ﻟﻤﺰﻳﺪﻣﻦ ﺍﻟﺘﻌﺰﻳﺰ ﻣﻦ ﺃﺟﻞ ﻋﻼﺝ ﻓﻌﺎﻝ ﻟﺴﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ‪ .‬ﻳﻌﺪ ﺍﻻﻓﺘﻘﺎﺭ‬
‫ﺇﻟﻰﺍﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﻭﺍﻟﺤﺎﻻﺕ ﺑﻤﺜﺎﺑﺔ ﻋﻘﺒﺎﺕ ﺃﻣﺎﻡ ﺍﻟﻔﻬﻢ ﺍﻟﻜﺎﻣﻞ ﻟﻄﺮﻳﻘﺔ‬
‫ﻋﻤﻞﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻋﻠﻰ ﻭﺭﻡ ﺍﻟﺪﻣﺎﻍ‪ .‬ﻭﻣﻊ ﺫﻟﻚ‪ ،‬ﻓﺈﻥ ﺍﻟﺘﻘﺪﻡ ﻓﻲ‬
‫ﺍﻟﺒﺤﺚﻭﺍﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﻳﻤﻜﻦ ﺃﻥ ﻳﻀﻤﻦ ﺃﻥ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻟﺪﻳﻪ ﺍﻟﻘﺪﺭﺓ‬
‫ﻋﻠﻰﺃﻥ ﻳﺼﺒﺢ ﺧﻴﺎﺭ ﺍﻟﻌﻼﺝ ﺍﻟﺘﻘﻠﻴﺪﻱ ﻓﻲ ﺍﻟﻤﺴﺘﻘﺒﻞ ]‪.[122-119‬‬
‫ﺍﻟﻤﻮﺍﻓﻘﺔﻋﻠﻰ ﺍﻟﻨﺸﺮ‬
‫ﻏﻴﺮﻗﺎﺑﻞ ﻟﻠﺘﻄﺒﻴﻖ‪.‬‬
‫ﺍﻟﺘﻤﻮﻳﻞ‬
‫ﺗﻢﺩﻋﻢ ﺍﻟﻌﻤﻞ ﺍﻟﺤﺎﻟﻲ ﻣﻦ ﻗﺒﻞ ﻗﺴﻢ ﺍﻟﻌﻠﻮﻡ ﻭﺍﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ )‪،(DST‬‬
‫‪.(EEQ‬‬
‫ﺗﻀﺎﺭﺏﺍﻟﻤﺼﺎﻟﺢ‬
‫ﺍﻟﻜﺘﺎﺏﻟﻴﺲ ﻟﺪﻳﻬﻢ ﺗﻀﺎﺭﺏ ﻓﻲ ﺍﻟﻤﺼﺎﻟﺢ‪ ،‬ﻣﺎﻟﻴﺔ ﺃﻭ ﻏﻴﺮ ﺫﻟﻚ‪.‬‬
‫ﺷﻜﺮﻭﺗﻘﺪﻳﺮ‬
‫ﻧﺸﻜﺮﻗﺴﻤﻨﺎ )ﻗﺴﻢ ﺍﻟﺘﻜﻨﻮﻟﻮﺟﻴﺎ ﺍﻟﺤﻴﻮﻳﺔ‪ ،‬ﺍﻟﻤﻌﻬﺪ ﺍﻟﻮﻃﻨﻲ‬
‫ﻛﺒﻴﺮﻓﻲ ﻛﺘﺎﺑﺔ ﻭﺭﻗﺔ ﺍﻟﻤﺮﺍﺟﻌﺔ ﻫﺬﻩ‪.‬‬
‫ﻣﺮﺍﺟﻊ‬
‫]‪ [1‬ﺑﻮﺭﻧﺞ ﺇﻱ‪ ،‬ﻣﻴﺮﻓﻲ ﺟﻲ‪ .‬ﻣﻘﺪﻣﺔ ﺗﺎﺭﻳﺨﻴﺔ ﻟﻌﻠﻢ ﺍﻟﻨﻔﺲ ﺍﻟﺤﺪﻳﺚ‪ .‬ﺁﻡ ﺟﻲ ﺳﻴﻜﻮﻝ‬
‫‪1930‬؛‪.156 :(1)42‬‬
‫‪http://dx.doi.org/10.2307/1414440‬‬
‫ﻗﺎﺩﻣﺔﺗﺴﻠﻂ ﺍﻟﻀﻮء ﻋﻠﻰ ﺍﻟﻤﻌﺎﻟﻢ ﺍﻟﺒﺎﺭﺯﺓ ﻓﻲ ﺗﻄﻮﺭ ﻋﻠﻢ ﺍﻷﻣﺮﺍﺽ ﻛﻨﻈﺎﻡ‪.‬‬
‫ﻓﻴﺮﺷﻮﺱﺁﺭﺗﺶ ‪2010‬؛ ‪.10-3 :(1)457‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1007/s00428-010-0934-4 20499087:‬‬
‫‪]3[ Mitrus I, Bryndza E, Sochanik‬‬
‫]‪ [4‬ﻫﺎﻣﻴﻠﺘﻮﻥ ﺇﺱ‪ .‬ﻋﻠﻢ ﺍﻷﻣﺮﺍﺽ ﻭﻋﻠﻢ ﺍﻟﻮﺭﺍﺛﺔ ﻷﻭﺭﺍﻡ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻬﻀﻤﻲ‪ .‬ﻟﻴﻮﻥ‪ :‬ﻣﻄﺒﻌﺔ ﺍﻟﻮﻛﺎﻟﺔ‬
‫ﺍﻟﺪﻭﻟﻴﺔﻟﺒﺤﻮﺙ ﺍﻟﺴﺮﻃﺎﻥ ‪.2006‬‬
‫ﺍﻟﻮﻻﻳﺎﺕﺍﻟﻤﺘﺤﺪﺓ ﻓﻲ ‪ .2015-2011‬ﻋﻠﻢ ﺍﻷﻭﺭﺍﻡ ﺍﻟﻌﺼﺒﻴﺔ ‪2018‬؛ ‪)20‬ﻣﻠﺤﻖ‬
‫_‪ CBTRUS: (4‬ﺗﻘﺮﻳﺮ ﺇﺣﺼﺎﺉﻲ ‪A، Kruchko C، Barnholtz-Sloan J.‬‬
‫‪]5[ Ostrom Q، Gittleman H، Truitt G، Boscia‬‬
‫]‪ [6‬ﺛﺮﻳﺎﺕ ﺟﻲ‪ ،‬ﺣﻨﻮﻥ ﻟﻴﻔﻲ ﺟﻲ ﺇﻡ‪ ،‬ﺻﻦ ﻣﻴﻨﺖ ﺃ‪ ،‬ﻓﻮﻧﺞ ﺗﻲ‪ ،‬ﺟﻴﺮﺍﺭ ﺟﻲ ﺑﻲ‪ .‬ﺍﻟﻤﺎﺿﻲ‬
‫ﻭﺍﻟﺤﺎﺿﺮﻭﺍﻟﻤﺴﺘﻘﺒﻞ ﻟﻠﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻟﺼﺎﻟﺢ ﺍﻟﻤﺮﺿﻰ‪.‬‬
‫ﻧﺎﺕﺭﻳﻒ ﻛﻠﻴﻦ ﺃﻭﻧﻜﻮﻝ ‪2013‬؛ ‪PMID: 23183635 .60-52 :(1)10‬‬
‫‪http://dx.doi.org/10.1038/nrclinonc.2012.203‬‬
‫‪. http://dx.doi.org/10.1016/j.semradonc.2006.04.003‬ﺍﻟﺘﻘﻨﻴﺎﺕ ﺍﻟﻤﺒﺘﻜﺮﺓ ﻓﻲ‬
‫ﺍﻟﻌﻼﺝﺍﻹﺷﻌﺎﻋﻲ‪ :‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﻮﺿﻌﻲ‪ .‬ﺳﻴﻤﻴﻦ ﺭﺍﺩﻳﺎﺕ ﺃﻭﻧﻜﻮﻝ ‪2006‬؛ ‪)16‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪]7[ Hoskin PJ, Bownes P. 17-209 :(4‬‬
‫‪17010903‬‬
‫]‪ [8‬ﻓﻮﺭﻣﻴﻨﺘﻲ ﺇﺱ ﺳﻲ‪ ،‬ﺩﻳﻤﺎﺭﻳﺎ ﺇﺱ‪ .‬ﺍﻟﺘﺄﺛﻴﺮﺍﺕ ﺍﻟﺠﻬﺎﺯﻳﺔ ﻟﻠﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﺤﻠﻲ‪.‬‬
‫ﻻﻧﺴﻴﺖﺃﻭﻧﻜﻮﻝ ‪2009‬؛ ‪.26-718 :(7)10‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1016/S1470-2045)09(70082-819573801‬‬
‫‪http://dx.doi.org‬‬
‫]‪ [9‬ﺟﻴﺮﻣﺎﻥ ﻡ‪ .‬ﺇﺣﺼﺎﺉﻴﺎﺕ ﺍﻟﻌﻼﺝ ﺑﺎﻟﺠﺴﻴﻤﺎﺕ ﻓﻲ ﻋﺎﻡ ‪2015; 2)1(: 50-4 .2014‬‬
‫‪.Int J Part Ther‬‬
 ‫ﺍﻟﺘﺼﻮﻳﺮﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ‪ ،2021،‬ﺭﺣﻠﺔ ﺟﻮﻳﺔ‪ ،17 .‬ﻻ‪900 .‬‬ ‫ﻭﺭﻡﺍﻟﺪﻣﺎﻍ ﺍﻷﺳﺒﺎﺏ ﻭﺍﻷﻋﺮﺍﺽ ﻭﺍﻟﺘﺸﺨﻴﺺ‬

‫]‪ [47‬ﻗﺎﻋﺪﺓ ﺑﻴﺎﻧﺎﺕ ﻣﺪﺍﻡ ﻛﻮﺭﻱ ﻟﻠﻌﻠﻮﻡ ﺍﻟﺒﻴﻮﻟﻮﺟﻴﺔ ‪.2000‬‬ ‫‪25646073‬‬

‫]‪ [48‬ﺟﻴﻦ ﺇﻛﺲ‪ ،‬ﻣﻮ ﺑﻲ‪ .‬ﺍﺳﺘﻬﺪﺍﻑ ﻭﺭﻡ ﺧﺒﻴﺚ ﻓﻲ ﺳﺮﻃﺎﻥ ﺍﻟﺜﺪﻱ‪ .‬ﺳﺮﻃﺎﻥ ﺍﻟﺜﺪﻱ‬ ‫]‪ [30‬ﺩﻱ ﻻ ﻣﺎﻭﻧﺖ ﺇﺱ ﺇﻡ‪ ،‬ﻧﻮﺳﻨﺮ ﺇﻳﻪ‪ ،‬ﺗﺸﻮ ﺟﻲ‪ ،‬ﻟﻮﺗﻮﻥ ﺇﻡ‪ .‬ﺍﻟﻮﺑﺎﺉﻲ‬
‫)ﺃﻭﻛﻞ( ‪2015‬؛ ‪) 9‬ﻣﻠﺤﻖ ‪.34-23 :(1‬‬ ‫ﺗﺸﻴﺮﺍﻻﺗﺠﺎﻫﺎﺕ ﺑﻘﻮﺓ ﺇﻟﻰ ﺍﻟﺘﻌﺮﺽ ﻛﻌﻮﺍﻣﻞ ﻣﺴﺒﺒﺔ ﻟﻸﻣﺮﺍﺽ ﻓﻲ ﺍﻟﺘﺴﺒﺐ ﻓﻲ‬
‫ﺑﻤﻴﺪ‪26380552:‬‬ ‫ﻣﺮﺽﺍﻟﺰﻫﺎﻳﻤﺮ ﺍﻟﻤﺘﻘﻄﻊ‪ ،‬ﻭﻣﺮﺽ ﺍﻟﺴﻜﺮﻱ‪ ،‬ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺪ ﺍﻟﺪﻫﻨﻲ ﻏﻴﺮ‬
‫]‪ [49‬ﻓﺎﺑﻲ ﺃ‪ ،‬ﻓﻴﻠﻴﺴﻲ ﺃ‪ ،‬ﻣﺘﺮﻭ ﺟﻲ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﻧﻘﺎﺉﻞ ﺍﻟﺪﻣﺎﻍ ﻣﻦ ﺍﻟﻮﺭﻡ ﺍﻟﺼﻠﺐ‪ :‬ﻧﺘﺎﺉﺞ‬ ‫ﺍﻟﻜﺤﻮﻟﻲ‪ J.‬ﺍﻟﺰﻫﺎﻳﻤﺮ ﺩﻳﺲ ‪2009‬؛ ‪.29-519 :(3)17‬‬
‫ﺍﻟﻤﺮﺽﺣﺴﺐ ﻧﻮﻉ ﺍﻟﻌﻼﺝ ﻭﺍﻟﻤﻮﺍﺭﺩ ﺍﻟﻌﻼﺟﻴﺔ ﻟﻠﻤﺮﻛﺰ ﺍﻟﻌﻼﺟﻲ‪ J .‬ﺇﻛﺴﺐ ﻛﻠﻴﻦ‬
‫ﻛﺎﻧﺴﺮﺭﻳﺲ ‪2011‬؛‬ ‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.3233/JAD-2009-1070 19363256:‬‬
‫‪.10:30‬‬ ‫]‪ [31‬ﺭﻳﻨﺶ ﺇﻡ‪ ،‬ﻣﻴﻦ ﻭﺍﻱ‪ ،‬ﺗﺸﻴﻮ ﺗﻲ‪ ،‬ﺑﻮﻧﺪﻱ ﺇﻡ‪ ،‬ﺑﻴﺮﺟﺮ ﺇﻡ ﺇﺱ‪ .‬ﻭﺑﺎﺉﻴﺎﺕ ﻭﺭﻡ ﺍﻟﺪﻣﺎﻍ‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1186/1756-9966-30-10 21244695:‬‬ ‫ﺍﻷﻭﻟﻲ‪:‬ﺍﻟﻤﻔﺎﻫﻴﻢ ﺍﻟﺤﺎﻟﻴﺔ ﻭﻣﺮﺍﺟﻌﺔ ﺍﻷﺩﺑﻴﺎﺕ‪ .‬ﺍﻟﻌﺼﺒﻴﺔ ﺃﻭﻧﻜﻮﻝ ‪2002‬؛ ‪:(4)4‬‬
‫]‪ [50‬ﻧﻴﺪﺭ ﺳﻲ‪ ،‬ﻣﻴﻬﺘﺎ ﺇﻡ ﺑﻲ‪ ،‬ﺟﻴﻨﻴﺘﺰ ﺇﺗﺶ‪ ،‬ﺟﺮﻭﺳﻮ ﺁﻝ‪ .‬ﺍﻟﻨﺬﻳﺮ ﻭﺍﻟﺘﻨﺒﺆﻳﺔ‬ ‫‪.99-278‬‬
‫ﺍﻟﻌﻮﺍﻣﻞﺍﻟﻔﻌﺎﻟﺔ ﻓﻲ ﺍﻟﻤﺮﺿﻰ ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﻧﻘﺎﺉﻞ ﺍﻟﺪﻣﺎﻍ ﻣﻦ ﺍﻟﻮﺭﻡ ﺍﻟﺼﻠﺐ‪:‬‬ ‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1093/neuonc/4.4.278 12356358:‬‬
‫ﻣﺮﺍﺟﻌﺔﻟﻠﺮﺳﻮﻡ ﺍﻟﺒﻴﺎﻧﻴﺔ ﺍﻟﻤﻨﺸﻮﺭﺓ‪ .‬ﻛﺮﻳﺖ ﺭﻳﻒ ﺃﻭﻧﻜﻮﻝ ﻫﻴﻤﺎﺗﻮﻝ ‪2018‬؛ ‪:126‬‬ ‫]‪ [32‬ﺃﺧﺘﺎﺭ ﺇﺱ‪ ،‬ﻓﺮﺍﻧﻴﺘﺶ ﺇﺱ‪ ،‬ﺳﻴﺒﺮﻳﺎﻥ ﺇﻑ ﺇﺱ‪ ،‬ﺍﻟﻤﺼﻄﻔﻰ ﺇ‪ .‬ﻓﻴﺮﻭﺱ ﺍﺑﺸﺘﺎﻳﻦ ﺑﺎﺭ‬
‫‪.8-13‬‬ ‫ﻓﻲﺍﻷﻭﺭﺍﻡ ﺍﻟﺪﺑﻘﻴﺔ‪ :‬ﺳﺒﺐ ﺃﻡ ﺍﺭﺗﺒﺎﻁ ﺃﻡ ﻗﻄﻌﺔ ﺃﺛﺮﻳﺔ؟ ﺟﺒﻬﺔ ﺃﻭﻧﻜﻮﻝ ‪2018‬؛ ‪:8‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1016/j.critrevonc.2018.03.01829759555‬‬ ‫‪.123‬‬
‫‪http://dx.doi.org‬‬ ‫‪http://dx.doi.org/10.3389/fonc.2018.00123 PMID: 29732319‬‬
‫]‪ [51‬ﺃﻭﻭﻧﻴﻜﻮﻛﻮ ﺗﻲ ﻛﻴﻪ‪ ،‬ﺃﺭﺑﻴﺰﺭ ﺟﻴﻪ‪ ،‬ﺯﻳﻠﻨﺎﻙ ﺃ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﻟﻨﻬﺞ ﺍﻟﺤﺎﻟﻲ ﻟﻌﻼﺝ ﺃﻭﺭﺍﻡ ﺍﻟﺪﻣﺎﻍ‬ ‫‪.‬ﺍﻷﻭﺭﺍﻡﺍﻟﻤﺮﺗﺒﻄﺔ ﺑﺎﻟﻔﻴﺮﻭﺳﺎﺕ‪ :‬ﺗﺤﺪﻳﺚ ﻟﻌﻨﺎﻳﺔ ﺃﺧﺼﺎﺉﻲ ﻋﻠﻢ ﺍﻷﻣﺮﺍﺽ ﺍﻟﻌﺎﻣﻞ‪ .‬ﺟﻲ‬
‫ﺍﻟﻨﻘﻴﻠﻲ‪.‬ﻧﺎﺕ ﺭﻳﻒ ﻛﻠﻴﻦ ﺃﻭﻧﻜﻮﻝ ‪2014‬؛ ‪.22-203 :(4)11‬‬ ‫ﻛﻠﻴﻦﺑﺎﺛﻮﻝ ‪2007‬؛ ‪B, Taniere P. Epstein Barr 64-1358:(12)60‬‬
‫‪]33[ Delecluse HJ, Feederle R, O'Sullivan‬‬
‫‪http://dx.doi.org/10.1038/nrclinonc.2014.25 PMID: 24569448‬‬ ‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1136/jcp.2006.044586 17873116:‬‬
‫]‪ [52‬ﻫﺎﺭﺩﻳﺴﺘﻲ ﺩﻱ ﺇﻳﻪ‪ ،‬ﻧﺎﻛﺎﺟﻲ ﺑﻲ‪ .‬ﺍﻟﻌﻼﺝ ﺍﻟﺤﺎﻟﻲ ﻭﺍﻟﻤﺴﺘﻘﺒﻠﻲ ﻟﻠﻨﻘﺎﺉﻞ ﺍﻟﺪﻣﺎﻏﻴﺔ‪.‬‬ ‫]‪ [34‬ﺗﻴﺎﺟﻲ ﻑ‪ ،‬ﺛﻴﻮﺑﺎﻟﺪ ﺝ‪ ،‬ﺑﺎﺭﺟﺮ ﺝ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺇﺻﺎﺑﺎﺕ ﺍﻟﺪﻣﺎﻍ ﺍﻟﻤﺆﻟﻤﺔ ﻭﺗﻄﻮﺭ ﻭﺭﻡ ﺃﺭﻭﻣﻲ‬
‫ﻓﺮﻭﻧﺖﺳﻮﺭﺝ ‪2016‬؛ ‪.30 :3‬‬ ‫ﺩﺑﻘﻲﻻﺣﻖ‪ :‬ﻣﺮﺍﺟﻌﺔ ﺍﻷﺩﺑﻴﺎﺕ ﻭﺗﻘﺎﺭﻳﺮ ﺍﻟﺤﺎﻟﺔ‪ .‬ﺳﻮﺭﺝ ﻧﻴﻮﺭﻭﻝ ﺇﻧﺖ ‪2016‬؛ ‪(1)7‬‬
‫‪http://dx.doi.org/10.3389/fsurg.2016.00030 PMID: 27252942‬‬ ‫‪.78:‬‬
‫‪.‬ﺣﺪﻭﺙﻧﻘﺎﺉﻞ ﺍﻟﺪﻣﺎﻍ ﻓﻲ ﻣﺠﻤﻮﻋﺔ ﻣﻦ ﺍﻟﻤﺮﺿﻰ ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺳﺮﻃﺎﻥ ﺍﻟﺜﺪﻱ‬ ‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.4103/2152-7806.189296 27625888:‬‬
‫ﻭﺍﻟﻘﻮﻟﻮﻥﻭﺍﻟﻜﻠﻰ ﻭﺍﻟﺮﺉﺔ ﻭﺳﺮﻃﺎﻥ ﺍﻟﺠﻠﺪ‪ .‬ﺍﻟﺴﺮﻃﺎﻥ ‪2002‬؛ ‪:(10)94‬‬ ‫]‪ [35‬ﺃﻣﻴﺮﻳﺎﻥ ﺇﺱ‪ ،‬ﺷﻮﺭﻳﺮ ﺇﻡ ﺇﻱ‪ ،‬ﺗﺸﻮ ﺁﺭ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺗﺎﺭﻳﺦ ﺟﺪﺭﻱ ﺍﻟﻤﺎء ﻓﻲ ﺧﻄﺮ ﺍﻟﻮﺭﻡ‬
‫‪[ Schouten LJ، Rutten J، Huveneers HA، Twijnstra A. 705-2698‬‬ ‫ﺍﻟﺪﺑﻘﻲ‪:‬ﺗﻘﺮﻳﺮ ﻣﻦ ﺩﺭﺍﺳﺔ ﺍﻟﺤﺎﻻﺕ ﻭﺍﻟﺸﻮﺍﻫﺪ ﺍﻟﺪﻭﻟﻴﺔ ﻟﻠﻮﺭﻡ ﺍﻟﺪﺑﻘﻲ )‪.(GICC‬‬
‫‪]53‬‬ ‫ﺍﻟﺴﺮﻃﺎﻥﻣﻴﺪ ‪2016‬؛ ‪.8-1352 :(6)5‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1002/cncr.10541 12173339:‬‬ ‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1002/cam4.682 26972449:‬‬
‫]‪ [54‬ﺑﺎﺭﻧﻬﻮﻟﺘﺰ‪-‬ﺳﻠﻮﻥ ﺟﻲ ﺇﺱ‪ ،‬ﺳﻠﻮﻥ ﺇﻳﻪ ﺇﻱ‪ ،‬ﺩﻳﻔﻴﺲ ﺇﻑ ﺟﻲ‪ ،‬ﻓﻴﺠﻨﻮ ﺇﻑ ﺩﻱ‪ ،‬ﻻﻱ‬ ‫‪.‬ﺍﻹﺷﻌﺎﻉﺍﻟﻤﺆﻳﻦ ﻭﺧﻄﺮ ﺍﻹﺻﺎﺑﺔ ﺑﻮﺭﻡ ﻓﻲ ﺍﻟﻤﺦ ﻭﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺮﻛﺰﻱ‪ :‬ﻣﺮﺍﺟﻌﺔ‬
‫ﺑﻲ‪،‬ﺻﻮﺍﻳﺎ ﺁﺭ ﺇﻱ‪ .‬ﻧﺴﺐ ﺍﻹﺻﺎﺑﺔ ﺑﺎﻟﻨﻘﺎﺉﻞ ﺍﻟﺪﻣﺎﻏﻴﺔ ﻟﺪﻯ ﺍﻟﻤﺮﺿﻰ ﺍﻟﺬﻳﻦ ﺗﻢ‬ ‫ﻣﻨﻬﺠﻴﺔ‪.‬ﺍﻟﻌﺼﺒﻴﺔ ﺃﻭﻧﻜﻮﻝ ‪2012‬؛ ‪KJ، Rajaraman P. 24-1316 :(11)14‬‬
‫ﺗﺸﺨﻴﺼﻬﻢ)‪ 1973‬ﺇﻟﻰ ‪ (2001‬ﻓﻲ ﻧﻈﺎﻡ ﻣﺮﺍﻗﺒﺔ ﺍﻟﺴﺮﻃﺎﻥ ﻓﻲ ﻣﺘﺮﻭﺑﻮﻟﻴﺘﺎﻥ‬ ‫‪، Kitahara CM، Berrington de González A، Inskip PD، Johnson‬‬
‫ﺩﻳﺘﺮﻭﻳﺖ‪.‬ﺟﻲ ﻛﻠﻴﻦ ﺃﻭﻧﻜﻮﻝ ‪2004‬؛ ‪.72-2865 :(14)22‬‬ ‫‪]36[ Braganza MZ‬‬
‫‪http://dx.doi.org/10.1200/JCO.2004.12.149 PMID: 15254054‬‬ ‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1093/neuonc/nos208 22952197:‬‬
‫]‪ [55‬ﺳﻴﺰﻭ ﺇﻱ ﺇﻡ‪ ،‬ﺑﺮﺍﻡ ﺇﻝ‪ ،‬ﺑﻮﺳﺘﻤﺎ ﺗﻲ ﺟﻴﻪ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﻷﻋﺮﺍﺽ ﻭﺍﻟﻤﺸﺎﻛﻞ ﻓﻲ ﻣﺮﺣﻠﺔ‬ ‫]‪ [37‬ﻣﻌﻬﺪ ﺍﻟﻄﺐ ]ﺍﻟﻮﻻﻳﺎﺕ ﺍﻟﻤﺘﺤﺪﺓ[ ﻟﺠﻨﺔ ﻣﻜﺎﻓﺤﺔ ﺍﻟﺴﺮﻃﺎﻥ ﻓﻲ ﺍﻟﺒﻠﺪﺍﻥ ﺍﻟﻤﻨﺨﻔﻀﺔ ﺍﻟﺪﺧﻞ‬
‫ﻧﻬﺎﻳﺔﺍﻟﻌﻤﺮ ﻟﻤﺮﺿﻰ ﺍﻟﻮﺭﻡ ﺍﻟﺪﺑﻘﻲ ﻋﺎﻟﻲ ﺍﻟﺠﻮﺩﺓ‪ .‬ﺍﻟﻌﺼﺒﻴﺔ ﺃﻭﻧﻜﻮﻝ ‪2010‬؛ ‪)12‬‬ ‫ﻭﺍﻟﺒﻠﺪﺍﻥﺍﻟﻤﺘﻮﺳﻄﺔ ﺍﻟﺪﺧﻞ؛ ﺳﻠﻮﻥ ﺇﻑ ﺇﻳﻪ‪ ،‬ﺟﻴﻠﺒﺎﻧﺪ ﺇﺗﺶ‪ ،‬ﻣﺤﺮﺭﻭ ﻓﺮﺹ‬
‫‪.6-1162 :(11‬‬ ‫ﻣﻜﺎﻓﺤﺔﺍﻟﺴﺮﻃﺎﻥ ﻓﻲ ﺍﻟﺒﻠﺪﺍﻥ ﺍﻟﻤﻨﺨﻔﻀﺔ ﻭﺍﻟﻤﺘﻮﺳﻄﺔ ﺍﻟﺪﺧﻞ ‪.2007‬‬
‫‪http://dx.doi.org/10.1093/neuonc/nop045 PMID: 20511193‬‬
‫]‪ [56‬ﻭﻳﻠﻨﻲ ﺇﺱ ﺇﺗﺶ‪ ،‬ﻓﻴﺮﻳﺲ ﺁﺭ ﺳﻲ‪ ،‬ﻧﺎﺛﻮﺍﻧﻲ ﺃ‪ ،‬ﻛﻴﻨﻴﺪﻱ ﺳﻲ ﺁﺭ‪ .‬ﺍﻟﺴﻤﺎﺕ ﺍﻟﻤﻤﻴﺰﺓ‬ ‫]‪ [38‬ﺑﻮﻧﺪﻱ ﺇﻡ ﺇﻝ‪ ،‬ﺷﻮﺭﻳﺮ ﺇﻡ ﺇﻱ‪ ،‬ﻣﺎﻟﻤﺮ ﺑﻲ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﺗﺤﺎﺩ ﺃﻭﺭﺍﻡ ﺍﻟﺪﻣﺎﻍ ﺍﻟﻮﺑﺎﺉﻴﺔ‪.‬‬
‫ﻷﻭﺭﺍﻡﺍﻟﻤﺦ‪ :‬ﻣﺮﺍﺟﻌﺔ ‪ 200‬ﺣﺎﻟﺔ‪ .‬ﺁﺭﺗﺶ ﺩﻳﺲ ﺗﺸﺎﻳﻠﺪ ‪2006‬؛ ‪.6-502 :(6)91‬‬ ‫ﻭﺑﺎﺉﻴﺎﺕﻭﺭﻡ ﺍﻟﺪﻣﺎﻍ‪ :‬ﺇﺟﻤﺎﻉ ﻣﻦ‬
‫ﺍﺗﺤﺎﺩﺃﻭﺭﺍﻡ ﺍﻟﺪﻣﺎﻍ ﺍﻟﻮﺑﺎﺉﻴﺔ‪ .‬ﺍﻟﺴﺮﻃﺎﻥ ‪2008‬؛ ‪) (7) 113‬ﻣﻠﺤﻖ(‪.68-1953 :‬‬
‫‪http://dx.doi.org/10.1136/adc.2005.090266 PMID: 16547083‬‬
‫]‪ [57‬ﻣﺎﺩﻫﻮﺳﻮﺩﺍﻧﺎﻥ ﺇﺱ‪ ،‬ﺗﻴﻨﻎ ﺇﻡ ﺑﻲ‪ ،‬ﻓﺮﺡ ﺗﻲ‪ ،‬ﺃﻭﻏﻮﺭ ﻳﻮ‪ .‬ﺍﻟﺠﻮﺍﻧﺐ ﺍﻟﻨﻔﺴﻴﺔ ﻟﻮﺭﻡ‬ ‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1002/cncr.23741 18798534:‬‬
‫ﺍﻟﺪﻣﺎﻍ‪:‬ﻣﺮﺍﺟﻌﺔ‪ .‬ﺍﻟﻌﺎﻟﻢ ‪ J‬ﻟﻠﻄﺐ ﺍﻟﻨﻔﺴﻲ ‪2015‬؛ ‪.85-273 :(3)5‬‬ ‫]‪ [39‬ﻓﻴﺠﺎﻳﺎﻻﻛﺴﻤﻲ ﺇﺱ ﺇﻡ‪ ،‬ﺳﻜﺎﺭﻓﻲ ﺇﻡ ﺁﺭ‪ .‬ﺗﻘﻴﻴﻤﺎﺕ ﻓﺮﻳﻖ ﺍﻟﺨﺒﺮﺍء ﺍﻟﺪﻭﻟﻲ ﻭﺍﻟﻮﻃﻨﻲ‪:‬‬
‫ﺍﻵﺛﺎﺭﺍﻟﺒﻴﻮﻟﻮﺟﻴﺔ‪/‬ﺍﻟﺼﺤﻴﺔ ﻟﻤﺠﺎﻻﺕ ﺍﻟﺘﺮﺩﺩﺍﺕ ﺍﻟﺮﺍﺩﻳﻮﻳﺔ‪Int J Environ Res .‬‬
‫‪http://dx.doi.org/10.5498/wjp.v5.i3.273 PMID: 26425442‬‬ ‫ﺍﻟﺼﺤﺔﺍﻟﻌﺎﻣﺔ ‪2014‬؛ ‪/10.3390/ijerph110909376 .408-9376 :(9)11‬‬
‫]‪ [58‬ﺗﺮﻳﺒﻴﻞ ﻛﻲ ﺇﻝ‪ ،‬ﻣﺎﺭﺗﻦ ﺁﺭ ﺳﻲ‪ ،‬ﻧﺎﺑﻮﺭﺯ ﺇﻝ ﺑﻲ‪ ،‬ﻣﺎﺭﺳﻮﻥ ﺩﻱ ﺳﻲ‪ .‬ﺍﻟﻘﺮﺍﺭ ﺍﻟﻄﺒﻲ‬ ‫‪ http://dx.doi.org‬ﺑﻤﻴﺪ‪25211777 :‬‬
‫ﺍﻟﻘﺪﺭﺓﻋﻠﻰ ﺻﻨﻊ ﺳﻴﻮﻥ ﻓﻲ ﺍﻟﻤﺮﺿﻰ ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺍﻟﻮﺭﻡ ﺍﻟﺪﺑﻘﻲ ﺍﻟﺨﺒﻴﺚ‪ .‬ﻋﻠﻢ‬ ‫]‪ [40‬ﻫﺎﺭﺩﻝ ﺇﻝ‪ .‬ﻣﻨﻈﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ‪ ،‬ﺇﺷﻌﺎﻉ ﺍﻟﺘﺮﺩﺩﺍﺕ ﺍﻟﺮﺍﺩﻳﻮﻳﺔ ﻭﺍﻟﺼﺤﺔ – ﻣﺴﺄﻟﺔ‬
‫ﺍﻷﻋﺼﺎﺏ‪2009‬؛ ‪.92-2086 :(24)73‬‬ ‫ﻳﺼﻌﺐﺣﻠﻬﺎ )ﺇﻋﺎﺩﺓ ﺍﻟﻨﻈﺮ(‪ .‬ﺇﻧﺖ ﺟﻲ ﺃﻭﻧﻜﻮﻝ ‪2017‬؛ ‪.13-405 :(2)51‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1212/WNL.0b013e3181c67bce20018637‬‬
‫‪http://dx.doi.org‬‬ ‫‪http://dx.doi.org/10.3892/ijo.2017.4046 PMID: 28656257‬‬
‫]‪ [59‬ﺭﻳﺲ ﺝ‪.‬ﻩ‪ .‬ﺍﻟﺘﺸﺨﻴﺺ ﻭﺍﻟﻌﻼﺝ ﻓﻲ ﻃﺐ ﺍﻷﻭﺭﺍﻡ ﺍﻟﻌﺼﺒﻴﺔ‪ :‬ﻋﻠﻢ ﺍﻷﻭﺭﺍﻡ‬ ‫]‪ [41‬ﻛﻼﺏ ﺁﺭ ﺩﺑﻠﻴﻮ‪ ،‬ﺟﺎﻛﻮﺑﺲ ﺇﻡ ﺇﻡ‪ ،‬ﻟﻮﻳﺸﻠﺮ ﺇﻝ‪ .‬ﺍﻟﺒﻴﺉﻴﺔ ﻭﺍﻟﻮﻇﻴﻔﻴﺔ‬
‫ﻣﻨﻈﻮﺭﻛﺎﻝ‪ .‬ﺑﺮ ﺟﻲ ﺭﺍﺩﻳﻮﻝ ‪2011‬؛ ‪) 84‬ﺍﻟﻤﻮﺍﺻﻔﺎﺕ ﺭﻗﻢ ‪PMID: 22433832 :(2‬‬ ‫ﺍﻷﺳﺒﺎﺏﺍﻟﺘﻘﻠﻴﺪﻳﺔ ﻟﻠﺴﺮﻃﺎﻥ‪ :‬ﺃﺩﻟﺔ ﺟﺪﻳﺪﺓ ‪ .2007-2005‬ﺍﻟﻘﺲ ﺻﺤﺔ ﺍﻟﺒﻴﺉﺔ‬
‫‪S82-9. http://dx.doi.org/10.1259/bjr/18061999‬‬ ‫‪2008‬؛‪.37-1 :(1)23‬‬
‫]‪ [60‬ﻣﺎﺳﻜﻴﻮ ﻡ‪ .‬ﺍﻟﺼﺮﻉ ﺍﻟﻤﺮﺗﺒﻂ ﺑﻮﺭﻡ ﺍﻟﺪﻣﺎﻍ‪ .‬ﻛﻮﺭ ﻧﻴﻮﻓﺎﺭﻣﺎﻛﻮﻝ ‪2012‬؛ ‪:(2)10‬‬ ‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1515/REVEH.2008.23.1.1 18557596:‬‬
‫‪.33-124‬‬ ‫]‪ [42‬ﻟﻴﻮ ﺁﺭ‪ ،‬ﺑﻴﺞ ﺇﻡ‪ ،‬ﺳﻮﻟﻬﺎﻳﻢ ﻛﻴﻪ‪ ،‬ﻓﻮﻛﺲ ﺇﺱ‪ ،‬ﺗﺸﺎﻧﻎ ﺇﺱ ﺇﻡ‪ .‬ﻧﻮﻋﻴﺔ ﺍﻟﺤﻴﺎﺓ ﻟﺪﻯ‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.2174/157015912800604470 23204982:‬‬ ‫ﺍﻟﺒﺎﻟﻐﻴﻦﺍﻟﻤﺼﺎﺑﻴﻦ ﺑﻮﺭﻡ ﻓﻲ ﺍﻟﻤﺦ‪ :‬ﺍﻟﻤﻌﺮﻓﺔ ﺍﻟﺤﺎﻟﻴﺔ ﻭﺍﻻﺗﺠﺎﻫﺎﺕ ﺍﻟﻤﺴﺘﻘﺒﻠﻴﺔ‪.‬‬
‫‪. http://dx.doi.org/10.3390/brainsci7100122 PMID: 28946652‬ﺍﻟﺘﻐﻴﺮﺍﺕ‬ ‫ﺍﻟﻌﺼﺒﻴﺔﺃﻭﻧﻜﻮﻝ ‪2009‬؛ ‪.9-330 :(3)11‬‬
‫ﻓﻲﺍﻟﻘﺪﺭﺓ ﺍﻹﺩﺭﺍﻛﻴﺔ ﻭﺍﺗﺨﺎﺫ ﺍﻟﻘﺮﺍﺭ ﺑﻌﺪ ﺍﺳﺘﺉﺼﺎﻝ ﻭﺭﻡ ﺍﻟﺪﻣﺎﻍ‪ :‬ﻣﻮﺿﺤﺔ‬ ‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1215/15228517-2008-093 19001097:‬‬
‫ﺑﺤﺎﻟﺘﻴﻦ‪.‬ﻋﻠﻮﻡ ﺍﻟﺪﻣﺎﻍ ‪2017‬؛ ‪D, Biggs V, Robinson G. 122 :(10)7‬‬ ‫ﻧﻮﻋﻴﺔﺍﻟﺤﻴﺎﺓ ﻓﻲ ﺗﺠﺎﺭﺏ ﺍﻹﺷﻌﺎﻉ ﺍﻟﻨﻘﻴﻠﻲ ﻓﻲ ﺍﻟﺪﻣﺎﻍ‪ :‬ﻣﺮﺍﺟﻌﺔ ﺍﻷﺩﺑﻴﺎﺕ‪ .‬ﺍﻟﻌﻤﻠﺔ ‪E.‬‬
‫‪]61[ Veretennikoff K, Walker‬‬ ‫‪]43[ Wong J، Hird A، Kirou-Mauro A، Napolskikh J، Chow‬‬
‫‪.‬ﺍﻟﺘﺄﺛﻴﺮﺍﺕﺍﻟﺤﺎﺩﺓ ﻟﻠﺠﺮﺍﺣﺔ ﻋﻠﻰ ﺍﻟﻌﺎﻃﻔﺔ ﻭﺍﻟﺸﺨﺼﻴﺔ ﻟﺪﻯ ﻣﺮﺿﻰ ﺃﻭﺭﺍﻡ ﺍﻟﻤﺦ‪ :‬ﺗﺄﺛﻴﺮ‬ ‫ﺃﻭﻧﻜﻮﻝ‪.45-25 :(5)15 ;2008‬‬
‫ﺍﻟﺠﺮﺍﺣﺔﻭﺍﻟﺠﻮﺍﻧﺐ ﺍﻟﻨﺴﻴﺠﻴﺔ ﻭﺍﻟﺸﻔﺎء‪ .‬ﺍﻟﻌﺼﺒﻴﺔ ﺃﻭﻧﻜﻮﻝ ‪2015‬؛ ‪:(8)17‬‬ ‫ﺑﻤﻴﺪ‪19008990:‬‬
‫‪[ Campanella F، Fabbro F، Ius T، Shallice T، Skrap M. 31-1121‬‬ ‫]‪ [44‬ﻟﺠﻨﺔ ﺗﺤﻠﻴﻞ ﻣﺨﺎﻃﺮ ﺍﻟﺴﺮﻃﺎﻥ ﻟﺪﻯ ﺍﻟﺴﻜﺎﻥ ﺍﻟﻘﺮﻳﺒﻴﻦ ﻣﻦ ﺍﻟﻨﻮﺍﺓ‪.‬‬
‫‪]62‬‬ ‫ﻣﺮﺍﻓﻖﻭﺍﺿﺤﺔ ‪ -‬ﺍﻟﻤﺮﺣﻠﺔ ﺍﻷﻭﻟﻰ؛ ﻣﺠﻠﺲ ﺍﻟﺪﺭﺍﺳﺎﺕ ﺍﻟﻨﻮﻭﻳﺔ ﻭﺍﻹﺷﻌﺎﻋﻴﺔ؛ ﻗﺴﻢ‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1093/neuonc/nov065 25921022:‬‬ ‫ﺩﺭﺍﺳﺎﺕﺍﻷﺭﺽ ﻭﺍﻟﺤﻴﺎﺓ؛ ﺗﺤﻠﻴﻞ ﺍﻟﻤﺠﻠﺲ ﺍﻟﻮﻃﻨﻲ ﻟﻠﺒﺤﻮﺙ ﻟﻤﺨﺎﻃﺮ ﺍﻟﺴﺮﻃﺎﻥ‬
‫ﺍﻷﻋﺮﺍﺽﺍﻟﻨﻔﺴﻴﺔ ‪]63[ Boele FW, Rooney AG, Grant R, Klein M.‬‬ ‫ﻟﺪﻯﺍﻟﺴﻜﺎﻥ ﺑﺎﻟﻘﺮﺏ ﻣﻦ ﺍﻟﻤﻨﺸﺂﺕ ﺍﻟﻨﻮﻭﻳﺔ‪ :‬ﺍﻟﻤﺮﺣﻠﺔ ﺍﻷﻭﻟﻰ ‪.2012‬‬
‫ﻓﻲﻣﺮﺿﻰ ﺍﻟﻮﺭﻡ ﺍﻟﺪﺑﻘﻲ‪ :‬ﻣﻦ ﺍﻟﺘﺸﺨﻴﺺ ﺇﻟﻰ ﺍﻹﺩﺍﺭﺓ‪ .‬ﻋﻼﺝ ﺍﻟﻄﺐ ﺍﻟﻨﻔﺴﻲ‬
‫ﺍﻟﻌﺼﺒﻲ‪2015‬؛ ‪.20-1413 :11‬‬ ‫]‪ [45‬ﺁﻫﻦ ﻳﻮ‪ ،‬ﻟﻲ ﺯﺩ ﺇﻡ‪ .‬ﻣﺠﻤﻮﻋﺔ ﺩﺭﺍﺳﺔ ‪ .KREEC‬ﺧﻄﺮ ﺍﻹﺻﺎﺑﺔ ﺑﺎﻟﺴﺮﻃﺎﻥ ﻟﺪﻯ ﺍﻟﺴﻜﺎﻥ‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.2147/NDT.S65874 26089669:‬‬ ‫ﺍﻟﺒﺎﻟﻐﻴﻦﺑﺎﻟﻘﺮﺏ ﻣﻦ ﻣﺤﻄﺎﺕ ﺍﻟﻄﺎﻗﺔ ﺍﻟﻨﻮﻭﻳﺔ ﻓﻲ ﻛﻮﺭﻳﺎ ‪ -‬ﺩﺭﺍﺳﺔ ﺃﺗﺮﺍﺑﻴﺔ ﻟﻠﻔﺘﺮﺓ‬
‫]‪ [64‬ﻛﺎﻓﺮﺯ ﺩ‪ ،‬ﻫﺎﻛﻴﻨﺞ ﺑﻲ‪ ،‬ﺇﺭﻳﺪﺝ ﺇﺱ ﺇﻱ‪ ،‬ﻛﻴﻨﺪﺍﻝ ﺇﻡ‪ ،‬ﻣﻮﺭﻳﺲ ﺑﻲ ﺟﻲ‪ ،‬ﻣﻮﺭﺍﻱ ﺇﺱ ﺇﻳﻪ‪.‬‬ ‫‪ J.2010-1992‬ﺍﻟﻜﻮﺭﻳﺔ ﻣﻴﺪ ﺍﻟﻌﻠﻮﻡ ‪2012‬؛ ‪.1008-999 :(9)27‬‬
‫ﺍﻟﺮﻓﺎﻩﺍﻻﺟﺘﻤﺎﻋﻲ ﻭﺍﻟﻨﻔﺴﻲ ﻭﺍﻟﻮﺟﻮﺩﻱ ﻟﻠﻤﺮﺿﻰ ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺍﻟﻮﺭﻡ ﺍﻟﺪﺑﻘﻲ‬ ‫‪http://dx.doi.org/10.3346/jkms.2012.27.9.999 PMID: 22969244‬‬
‫ﻭﻣﻘﺪﻣﻲﺍﻟﺮﻋﺎﻳﺔ ﻟﻬﻢ‪ :‬ﺩﺭﺍﺳﺔ ﻧﻮﻋﻴﺔ‪ .‬ﻛﻤﺎﺝ ‪.E373-82:(7)184 ;2012‬‬ ‫‪.‬ﺍﻷﺳﺒﺎﺏﺍﻟﺠﺬﺭﻳﺔ ﻭﺗﺄﺛﻴﺮﺍﺕ ﺍﻟﺤﻮﺍﺩﺙ ﺍﻟﺨﻄﻴﺮﺓ ﻓﻲ ﻣﺤﻄﺎﺕ ﺍﻟﻄﺎﻗﺔ ﺍﻟﻨﻮﻭﻳﺔ ﺍﻟﻜﺒﻴﺮﺓ‪.‬‬
‫ﺃﻣﺒﻴﻮ‪]46[ Högberg L. 84-267 :(3)42 ;2013‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1503/cmaj.111622 22431898:‬‬ ‫‪http://dx.doi.org/10.1007/s13280-013-0382-x PMID: 23423737‬‬
 ‫ﺭﺍﺟﺎﻓﺎﺑﻮﺩﻱﻭﺁﺧﺮﻭﻥ‪.‬‬ ‫‪10‬ﺍﻟﺘﺼﻮﻳﺮ ﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ‪ ،2021،‬ﺭﺣﻠﺔ ﺟﻮﻳﺔ‪ ،17 .‬ﻻ‪00 .‬‬

‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.2217/fon.11.111 22044206:‬‬ ‫]‪ [65‬ﺍﻟﻌﻜﻴﻠﻲ ﺁﺭ ﺇﻥ‪ ،‬ﻛﺮﻳﺠﺰﺍ ﺟﻲ‪ ،‬ﻭﺍﻧﻎ ﺇﺱ‪ ،‬ﻭﻭ ﺟﻲ ﺇﺗﺶ‪ ،‬ﻣﻠﺤﻢ ﺇﻱ ﺁﺭ‪ .‬ﺗﻘﻨﻴﺎﺕ ﺍﻟﺘﺼﻮﻳﺮ‬
‫]‪ [83‬ﻣﻮﺭﺍﻱ ﺩ‪ ،‬ﻣﺎﻙ ﺇﻳﻮﺍﻥ ﺇﻳﻪ ﺟﻴﻪ‪ .‬ﻋﻠﻢ ﺍﻷﺣﻴﺎء ﺍﻹﺷﻌﺎﻋﻲ ﻟﻠﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻨﻈﺎﻣﻲ‪.‬‬
‫ﺍﻟﺴﺮﻃﺎﻥﺑﻴﻮﺗﺮ ﺭﺍﺩﻳﻮﻓﺎﺭﻡ ‪2007‬؛ ‪.23-1 :(1)22‬‬
‫‪http://dx.doi.org/10.1089/cbr.2006.531 PMID: 17627411‬‬
‫]‪ [84‬ﺻﺎﺩﻗﻲ ﻡ‪ ،‬ﺍﻧﻔﺮﺩﻱ ﻡ‪ ،‬ﺷﻴﺮﺍﺯﻱ ﺃ‪ .‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﺨﺎﺭﺟﻲ ﻭﺍﻟﺪﺍﺧﻠﻲ‪ :‬ﺍﻻﺗﺠﺎﻫﺎﺕ‬
‫ﺍﻟﻤﺎﺿﻴﺔﻭﺍﻟﻤﺴﺘﻘﺒﻠﻴﺔ‪ J .‬ﺍﻟﺴﺮﻃﺎﻥ ﺍﻟﺪﻗﺔ ﻫﻨﺎﻙ ‪2010‬؛ ‪.48-239 :(3)6‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.4103/0973-1482.73324 21119247:‬‬
‫]‪ [85‬ﺑﻴﻜﻠﺰ ﺇﻡ ﺩﻱ‪ ،‬ﺟﻴﺒﺲ ﺑﻲ‪ ،‬ﻟﻮﺭﻱ ﺇﻡ‪ ،‬ﺗﻴﺮﻧﺒﻮﻝ ﺇﻝ ﺩﺑﻠﻴﻮ‪ .‬ﺗﺴﺒﻖ ﺗﻐﻴﻴﺮﺍﺕ ﺍﻻﻧﺘﺸﺎﺭ‬
‫ﺗﻘﻠﻴﻞﺍﻟﺤﺠﻢ ﻓﻲ ﺍﻟﻌﻼﺝ ﺍﻟﻤﺴﺎﻋﺪ ﺍﻟﺠﺪﻳﺪ ﻟﺴﺮﻃﺎﻥ ﺍﻟﺜﺪﻱ‪.‬‬ ‫ﻭﻳﻠﺴﻮﻥﺳﻲ ﺑﻲ‪ .‬ﻣﻌﺎﻳﻴﺮ ﺗﻘﻴﻴﻢ ﺍﻟﻤﺮﺿﻰ ﺍﻟﺬﻳﻦ ﻳﺨﻀﻌﻮﻥ ﻟﻠﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‬
‫ﻣﺎﺟﻦﺭﻳﺴﻮﻥ ﺍﻟﺘﺼﻮﻳﺮ ‪2006‬؛ ‪PMID: 16916701 .7-843 :(7)24‬‬
‫‪http://dx.doi.org/10.1016/j.mri.2005.11.005‬‬
‫‪.‬ﺍﻟﻤﺤﺴﺴﺎﺕﺍﻹﺷﻌﺎﻋﻴﺔ ﺍﻟﻜﻴﻤﻴﺎﺉﻴﺔ ﺍﻟﻤﺴﺘﺨﺪﻣﺔ ﻓﻲ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ‪ .‬ﻛﻠﻴﻦ ﺃﻭﻧﻜﻮﻝ )ﺁﺭ ﻛﻮﻝ‬
‫ﺭﺍﺩﻳﻮﻝ( ‪2007‬؛ ‪]86[ Wardman P. 417-397 :(6)19‬‬
‫‪http://dx.doi.org/10.1016/j.clon.2007.03.010 PMID: 17478086‬‬
‫]‪ [87‬ﺃﻟﻴﺴﻮﻥ ﺁﺭ ﺁﺭ‪ ،‬ﺳﻴﺒﺎﺗﺎ ﺳﻲ ﺇﺗﺶ‪ .‬ﺍﻟﻌﻼﺝ ﺍﻟﻀﻮﺉﻲ ﺍﻟﺪﻳﻨﺎﻣﻴﻜﻲ ﻟﻸﻭﺭﺍﻡ‪-‬‬
‫ﺍﻟﻤﺤﺴﺴﺎﺕ‪:‬ﻣﺮﺍﺟﻌﺔ ﺳﺮﻳﺮﻳﺔ‪ .‬ﻓﻮﺗﻮ ﺩﻳﺎﺟﻦ ﻓﻮﺗﻮﺩﻳﻦ ﻫﻨﺎﻙ ‪2010‬؛ ‪:(2)7‬‬
‫‪.75-61‬‬
‫‪http://dx.doi.org/10.1016/j.pdpdt.2010.02.001 PMID: 20510301‬‬
‫‪.‬ﺗﺤﺪﻳﺚﺣﻮﻝ ﺍﻟﻤﺮﺍﺟﻌﺔ ﺍﻟﻤﻨﻬﺠﻴﺔ ﻟﺘﺠﺎﺭﺏ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻤﻠﻄﻒ ﻟﻠﻨﻘﺎﺉﻞ‬
‫ﺍﻟﻌﻈﻤﻴﺔ‪.‬ﻛﻠﻴﻦ ﺃﻭﻧﻜﻮﻝ )ﺁﺭ ﻛﻮﻝ ﺭﺍﺩﻳﻮﻝ( ‪2012‬؛ ‪M، Lutz S. 24-112 :(2)24‬‬
‫‪]88[ Chow E، Zeng L، Salvo N، Dennis K، Tsao‬‬
‫‪http://dx.doi.org/10.1016/j.clon.2011.11.004 PMID: 22130630‬‬
‫]‪ [89‬ﻓﺎﻳﻔﺎﺵ ﺟﻲ ﺑﻲ‪ ،‬ﻫﺎﻧﻜﺲ ﺟﻲ‪ ،‬ﺭﻭﺗﺶ ﺇﻡ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﻹﺷﻌﺎﻉ ﺍﻟﻤﻄﺎﺑﻖ ﺛﻼﺛﻲ ﺍﻷﺑﻌﺎﺩ‬
‫‪. http://dx.doi.org/10.1016/S0360-3016)00(00441-7‬ﺭﺍﺩﻳﺎﺕ‬
‫ﺃﻭﻧﻜﻮﻝﺑﻴﻮﻝ ﻓﻴﺰ ‪2000‬؛ ‪ J 42-335 :(2)47‬ﻟﺴﺮﻃﺎﻥ ﺍﻟﺒﺮﻭﺳﺘﺎﺗﺎ ﻋﺎﻟﻲ ﺍﻟﺠﻮﺩﺓ‪:‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫ﻣﺮﺍﺟﻌﺔﻣﺘﻌﺪﺩﺓ ﺍﻟﻤﺆﺳﺴﺎﺕ‪ .‬ﺇﻧﺖ (‪apy )3DCRT‬‬
‫‪10802357‬‬
‫]‪ [90‬ﺑﻮﺭﺗﻔﻴﻠﺪ ﺕ‪ .‬ﺇﻣﺮﺕ‪ :‬ﻣﺮﺍﺟﻌﺔ ﻭﻣﻌﺎﻳﻨﺔ‪ .‬ﻓﻴﺰ ﻣﻴﺪ ﺑﻴﻮﻝ ‪2006‬؛ ‪:(13)51‬‬
‫ﺹ‪.79-363‬‬
‫‪http://dx.doi.org/10.1088/0031-9155/51/13/R21 PMID: 16790913‬‬
‫]‪ [91‬ﺭﻭﻧﻎ ﻭﺍﻱ‪ ،‬ﻭﻳﻠﺶ ﺟﻲ ﺇﺱ‪ .‬ﻣﺮﺍﺟﻌﺔ ﻗﻴﺎﺱ ﺍﻟﺠﺮﻋﺎﺕ ﻭﺍﻟﺴﺮﻳﺮﻳﺔ ﻟﻠﻌﻼﺝ ﺍﻟﻤﻘﻄﻌﻲ‬
‫ﺍﻟﺤﻠﺰﻭﻧﻲ‪.‬ﺍﻟﺨﺒﻴﺮ ﺍﻟﻘﺲ ﺍﻟﻤﻀﺎﺩ ﻟﻠﺴﺮﻃﺎﻥ ﻫﻨﺎﻙ ‪2011‬؛ ‪.20-309 :(2)11‬‬
‫‪ http://dx.doi.org/10.1586/era.10.175‬ﺑﻤﻴﺪ‪21342048 :‬‬
‫]‪ [92‬ﺑﺎﻭﻧﻴﺴﻜﻮ ﺗﻲ‪ ،‬ﻭﻟﻮﺷﺎﻙ ﺟﻲ ﺇﻱ‪ .‬ﺍﻻﺗﺠﺎﻫﺎﺕ ﺍﻟﻤﺴﺘﻘﺒﻠﻴﺔ ﻟﻠﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺃﺛﻨﺎء‬
‫ﺍﻟﻌﻤﻠﻴﺔ‪:‬ﻣﺮﺍﺟﻌﺔ ﻣﻮﺟﺰﺓ‪ .‬ﺟﺒﻬﺔ ﺃﻭﻧﻜﻮﻝ ‪2017‬؛ ‪.300 :7‬‬
‫‪http://dx.doi.org/10.3389/fonc.2017.00300 PMID: 29312882‬‬
‫]‪ [93‬ﻣﻴﺮﺕ ﺇﻳﻪ ﺑﻲ‪ ،‬ﺑﻴﺴﻤﺎﻧﺰ ﺇﻡ‪ ،‬ﺑﻴﺮﺟﻤﺎﻧﺰ ﺗﻲ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﻟﺠﻤﺠﻤﺔ ﺍﻟﻮﻗﺎﺉﻴﺔ‬
‫ﺍﻟﺘﺸﻌﻴﻊﻓﻲ ﺳﺮﻃﺎﻥ ﺍﻟﺮﺉﺔ ﺫﻭ ﺍﻟﺨﻼﻳﺎ ﺍﻟﺼﻐﻴﺮﺓ‪ :‬ﻣﺮﺍﺟﻌﺔ ﻣﻨﻬﺠﻴﺔ ﻟﻸﺩﺑﻴﺎﺕ ﻣﻊ‬
‫ﺍﻟﺘﺤﻠﻴﻞﺍﻟﺘﻠﻮﻱ‪ .‬ﺑﻲ ﺇﻡ ﺳﻲ ﺍﻟﺴﺮﻃﺎﻥ ‪2001‬؛ ‪.15‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1186/1471-2407-1-5 11432756:‬‬
‫]‪ [94‬ﻭﺍﻧﻎ ﺩ‪ .‬ﺗﻘﻴﻴﻢ ﻧﻘﺪﻱ ﻟﻠﻔﺎﺉﺪﺓ ﺍﻟﺴﺮﻳﺮﻳﺔ ﻟﻠﻌﻼﺝ ﺑﺎﻟﺒﺮﻭﺗﻮﻥ ﻓﻲ ﻋﻼﺝ ﺍﻷﻭﺭﺍﻡ‪ .‬ﺍﻷﺟﻬﺰﺓ‬
‫ﺍﻟﻄﺒﻴﺔ)ﺃﻭﻛﻞ( ‪2015‬؛ ‪.46-439 :8‬‬
‫‪http://dx.doi.org/10.2147/MDER.S65594 PMID: 26604838‬‬
‫]‪ [95‬ﻓﻮﻧﺘﻴﻨﻮﺕ ﺟﻲ ﺩﻱ‪ ،‬ﻟﻲ ﺇﻳﻪ ﻛﻴﻪ‪ ،‬ﻧﻴﻮﻫﺎﻭﺯﺭ ﺩﺑﻠﻴﻮ ﺩﻱ‪ .‬ﺧﻄﺮ ﺍﻷﻭﺭﺍﻡ ﺍﻟﺨﺒﻴﺜﺔ ﺍﻟﺜﺎﻧﻮﻳﺔ‬
‫ﻣﻦﺍﻟﻌﻼﺝ ﺑﺎﻟﺒﺮﻭﺗﻮﻥ ﻭﺍﻟﻌﻼﺝ ﺑﺎﻷﺷﻌﺔ ﺍﻟﺴﻴﻨﻴﺔ ﺍﻟﻤﻌﺪﻟﺔ ﻟﺸﺪﺓ ﺳﺮﻃﺎﻥ‬
‫ﺍﻟﺒﺮﻭﺳﺘﺎﺗﺎﻓﻲ ﻣﺮﺣﻠﺔ ﻣﺒﻜﺮﺓ‪ .‬ﺇﻧﺖ ‪ J‬ﺭﺍﺩﻳﺎﺕ ﺃﻭﻧﻜﻮﻝ ﺑﻴﻮﻝ‬
‫ﻓﻴﺰ‪2009‬؛ ‪/j.ijrobp.2009.01.001 PMID: 19427561 .22-616 :(2)74‬‬
‫‪http://dx.doi.org/10.1016‬‬
‫]‪ [96‬ﻭﺍﻧﻎ ﺇﻛﺲ‪ ،‬ﺑﻮﻳﻨﻴﺶ ﺇﻑ‪ ،‬ﺳﺎﻫﻮ ﺇﻥ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﻳﻘﻠﻞ ﺍﻟﻌﻼﺝ ﺑﺎﻟﺒﺮﻭﺗﻮﻧﺎﺕ ﺑﻤﺴﺢ‬
‫ﺍﻟﺒﻘﻌﺔﻣﻦ ﺟﺮﻋﺔ ﺍﻟﻨﻴﻮﺗﺮﻭﻧﺎﺕ ﻓﻲ ﺇﻃﺎﺭ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﺬﻱ ﻳﺘﻢ ﺇﺟﺮﺍﺅﻩ ﺃﺛﻨﺎء‬ ‫ﻓﻲﺍﻟﻤﺮﺣﻠﺔ ‪ :G1‬ﻫﺪﻑ ﻭﺍﻋﺪ ﻟﺘﻄﻮﻳﺮ ﻋﻮﺍﻣﻞ ﺟﺪﻳﺪﺓ ﻣﻀﺎﺩﺓ ﻟﻠﺴﺮﻃﺎﻥ ﻟﻠﻌﻼﺝ‬
‫ﺍﻟﺤﻤﻞ‪J Appl Clin Med Phys 2016.‬؛ ‪.76-366 :(5)17‬‬
‫ﺑﺎﻟﺮﻧﻴﻦﺍﻟﻤﻐﻨﺎﻃﻴﺴﻲ ﺍﻟﻤﺘﻘﺪﻣﺔ ﻓﻲ ﺗﺸﺨﻴﺺ ﻭﺭﻡ ﺍﻟﺪﻣﺎﻍ ﺩﺍﺧﻞ ﺍﻟﻤﺤﻮﺭ‬
‫ﻓﻲﺍﻟﺒﺎﻟﻐﻴﻦ‪ .‬ﺍﻟﺘﺼﻮﻳﺮ ﺍﻟﺸﻌﺎﻋﻲ ‪2006‬؛ ‪) 26‬ﻣﻠﺤﻖ ‪rg.26si065513 :(1‬‬
‫‪ S173-89. http://dx.doi.org/10.1148/‬ﺑﻤﻴﺪ‪17050514 :‬‬
‫]‪ [66‬ﻣﺎﺭﺷﺎﻝ ﺇﻝ ﺇﻑ‪ ،‬ﻣﺎﺭﺷﺎﻝ ﺇﺱ ﺑﻲ‪ ،‬ﻛﻠﻮﺑﺮ ﺇﻡ ﺁﺭ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﻳﺘﻄﻠﺐ ﺗﺸﺨﻴﺺ ﺇﺻﺎﺑﺔ‬
‫ﺍﻟﺮﺃﺱﺗﺼﻨﻴﻔﺎً ﻳﻌﺘﻤﺪ ﻋﻠﻰ ﺍﻟﺘﺼﻮﻳﺮ ﺍﻟﻤﻘﻄﻌﻲ ﺍﻟﻤﺤﻮﺭﻱ‪ .‬ﺍﻟﺼﺪﻣﺎﺕ ﺍﻟﻌﺼﺒﻴﺔ‬
‫‪1992‬؛‪) 9‬ﻣﻠﺤﻖ ‪.S287-92 :(1‬‬
‫ﺑﻤﻴﺪ‪1588618:‬‬
‫]‪ [67‬ﻟﻴﻔﻴﻦ ﻓﻲ ﺇﻳﻪ‪ ،‬ﻛﺮﺍﻓﺘﺲ ﺩﻱ ﺳﻲ‪ ،‬ﻧﻮﺭﻣﺎﻥ ﺩﻱ ﺇﻡ‪ ،‬ﻫﻮﻓﺮ ﺑﻲ ﺑﻲ‪ ،‬ﺳﺒﺎﻳﺮ ﺟﻲ ﺑﻲ‪،‬‬
‫ﻟﻮﺭﻡﺍﻟﻤﺦ ﺍﻟﺨﺒﻴﺚ‪ .‬ﺟﻲ ﻧﻴﻮﺭﻭﺳﻮﺭﺝ ‪1977‬؛ ‪.35-329 :(3)47‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.3171/jns.1977.47.3.0329 894339:‬‬
‫‪]68[ Hammoud MA, Sawaya R, Shi W, Thall PF, Leeds NE. Prognos-‬‬
‫ﺃﻫﻤﻴﺔﺍﻟﺘﺸﻨﺞ ﺍﻟﻼﺇﺭﺍﺩﻱ ﻟﻔﺤﻮﺻﺎﺕ ﺍﻟﺘﺼﻮﻳﺮ ﺑﺎﻟﺮﻧﻴﻦ ﺍﻟﻤﻐﻨﺎﻃﻴﺴﻲ ﻗﺒﻞ ﺍﻟﺠﺮﺍﺣﺔ ﻓﻲ ﻭﺭﻡ ﺃﺭﻭﻣﻲ ﺩﺑﻘﻲ‬
‫ﻣﺘﻌﺪﺩﺍﻷﺷﻜﺎﻝ‪ .‬ﺟﻲ ﻧﻴﻮﺭﻭﻧﻜﻮﻝ ‪.73-65 :(1)27 ;1996‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1007/BF00146086 8699228:‬‬
‫]‪ [69‬ﺷﺎﺑﻴﺮﻭ ﺭ‪ .‬ﻋﻼﺝ ﻭﺭﻡ ﺍﻟﺪﻣﺎﻍ ﺍﻟﻌﺼﺒﻲ‪ .‬ﺁﻥ ﻧﻴﻮﺭﻭﻝ ‪1982‬؛ ‪.7-231 :(3)12‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1002/ana.410120302 6753729:‬‬
‫]‪ [70‬ﻣﺎﺟﻴﻠﻴﺠﺎﻥ ﺩﻱ ﺟﻲ ﺟﻮﻧﻴﻮﺭ‪ ،‬ﺩﻭﻓﻴﺮﻧﻮﻱ ﺳﻲ‪ ،‬ﻣﺎﻟﻚ ﺟﻲ‪ ،‬ﻟﻮﻳﺲ ﺟﻲ ﺩﺑﻠﻴﻮ ﺟﻮﻧﻴﻮﺭ‪ ،‬ﻧﺎﻳﺘﻮﻥ‬
‫ﺭ‪،‬ﻋﺜﻤﺎﻥ ﺟﻲ‪ .‬ﺍﻟﻨﻬﺞ ﺍﻟﺠﺮﺍﺣﻲ ﻟﺴﺮﻃﺎﻥ ﺍﻟﺮﺉﺔ ﻣﻊ ﻭﺭﻡ ﺧﺒﻴﺚ ﺩﻣﺎﻏﻲ ﺍﻧﻔﺮﺍﺩﻱ‪:‬‬
‫ﺧﺒﺮﺓﺧﻤﺴﺔ ﻭﻋﺸﺮﻳﻦ ﻋﺎﻣﺎً‪ .‬ﺁﻥ ﺛﻮﺭﺍﻙ ﺳﻮﺭﺝ ‪.4-360 :(4)42 ;1986‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1016/S0003-4975)10(60536-X3767508‬‬
‫‪http://dx.doi.org‬‬
‫]‪ [71‬ﻛﺎﺭﻭﺳﻮ ﺩﻱ ﺇﻳﻪ‪ ،‬ﺃﻭﺭﻣﻲ ﺇﻝ ﺇﻡ‪ ،‬ﻧﻴﻞ ﺇﻳﻪ ﺇﻡ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﻧﺘﺎﺉﺞ ﺩﺭﺍﺳﺔ ﺍﻟﻤﺮﺣﻠﺔ ﺍﻷﻭﻟﻰ‬
‫ﺑﺎﺳﺘﺨﺪﺍﻡﺍﻟﺨﻼﻳﺎ ﺍﻟﺠﺬﻋﻴﺔ ﺍﻟﻤﺸﺘﻘﺔ ﻣﻦ ﺍﻟﻮﺣﻴﺪﺍﺕ ﺍﻟﻨﺎﺑﻀﺔ ﺑﺎﻟﻮﺭﻡ‬
‫ﺍﻟﺤﻤﺾﺍﻟﻨﻮﻭﻱ ﺍﻟﺮﻳﺒﻲ ﻓﻲ ﺍﻷﻃﻔﺎﻝ ﻭﺍﻟﺸﺒﺎﺏ ﺍﻟﻤﺼﺎﺑﻴﻦ ﺑﺴﺮﻃﺎﻥ ﺍﻟﺪﻣﺎﻍ‪ .‬ﺍﻟﻌﺼﺒﻴﺔ ﺃﻭﻧﻜﻮﻝ‬
‫‪2004‬؛‪.46-236 :(3)6‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1215/S1152851703000668 15279716:‬‬
‫]‪ [72‬ﺟﺮﻳﻤﺴﻮﻥ ﻭﻱ‪ ،‬ﻛﻴﻜﻴﻨﻴﺲ ﺁﺭ‪ ،‬ﺟﻮﻟﻴﺰ ﺇﻑ ﺇﻳﻪ‪ ،‬ﺑﻼﻙ ﺑﻲ ﺇﻡ‪ .‬ﺍﻟﺠﺮﺍﺣﺔ ﺍﻟﻤﻮﺟﻬﺔ ﺑﺎﻟﺼﻮﺭ‪.‬‬
‫ﺍﻟﺨﻴﺎﻝﺍﻟﻌﻠﻤﻲ ﺁﻡ ‪1999‬؛ ‪.9-62 :(6)280‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1038/scientificamerican0699-6210349732‬‬
‫‪http://dx.doi.org‬‬
‫]‪ [73‬ﺑﺎﺭﻭﻥ ﺩﻱ ﺟﻲ‪ ،‬ﻟﻮﺭﻱ ﺗﻲ ﺇﻳﻪ‪ ،‬ﻫﺎﺭﺕ ﺇﻡ ﺟﻲ‪ .‬ﺻﻮﺭﺓ ﻟﻌﻤﻠﻴﺔ ﺟﺮﺍﺣﻴﺔ ﻣﻮﺟﻬﺔ ﻝ‬
‫ﺍﺳﺘﺉﺼﺎﻝﺃﻭﺭﺍﻡ ﺍﻟﻤﺦ‪ .‬ﻧﺴﺨﺔ ﻧﻈﺎﻡ ﻗﺎﻋﺪﺓ ﺑﻴﺎﻧﺎﺕ ﻛﻮﻛﺮﻳﻦ ‪2014‬؛ )‪:(1‬‬
‫‪.CD009685‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1002/14651858.CD009685.pub224474579‬‬
‫‪http://dx.doi.org‬‬
‫]‪ [74‬ﺷﻮﺍﺗﺶ ﺩﻱ ﺇﺱ‪ ،‬ﻃﺮﻳﻖ ﻛﻮﺗﺸﺘﺎ‪ .‬ﻣﻘﺪﻣﺔ ﻓﻲ ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﻟﻠﺴﺮﻃﺎﻥ‬
‫ﺍﻟﺘﺸﻨﺠﺎﺕﺍﻟﻼﺇﺭﺍﺩﻳﺔ‪ .‬ﺍﻟﻘﺲ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ‪2009‬؛ ‪/cr900208x .61-2859 :(7)109‬‬
‫‪ http://dx.doi.org/10.1021‬ﺑﻤﻴﺪ‪19583428 :‬‬
‫‪.‬ﻛﺄﻫﺪﺍﻑﻋﻼﺟﻴﺔ ﻟﻠﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ ﻟﻠﺴﺮﻃﺎﻥ‪ .‬ﺃﻭﻧﻜﻮﺟﻴﻦ ‪2006‬؛ ‪30-4812 :(34)25‬‬
‫‪L، Larochette N، Zamzami N، Kroemer G. Mitochondria‬‬
‫‪]75[ Galluzzi‬‬
‫‪http://dx.doi.org/10.1038/sj.onc.1209598 PMID: 16892093‬‬
‫]‪ [76‬ﻫﺎﺭﺗﻮﻳﻞ ﺇﻝ ﺇﺗﺶ‪ ،‬ﻛﺎﺳﺘﺎﻥ ﺇﻡ ﺑﻲ‪ .‬ﺍﻟﺴﻴﻄﺮﺓ ﻋﻠﻰ ﺩﻭﺭﺓ ﺍﻟﺨﻠﻴﺔ ﻭﺍﻟﺴﺮﻃﺎﻥ‪ .‬ﺍﻟﻌﻠﻮﻡ ‪1994‬؛‬
‫‪.8-1821:(5192)266‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1126/science.7997877 7997877:‬‬
‫]‪ [77‬ﺃﻭﺍ ﺗﻲ‪ ،‬ﻳﻮﺷﻴﻨﻮ ﺇﺗﺶ‪ ،‬ﻳﻮﺷﻴﻤﺎﺗﺴﻮ ﻛﻴﻪ‪ ،‬ﻧﺎﺟﺎﺳﻮ ﺗﻲ‪ .‬ﺗﻨﻈﻴﻢ ﺩﻭﺭﺓ ﺍﻟﺨﻠﻴﺔ‪-‬‬
‫ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‪.‬ﻛﻮﺭ ﻣﻴﺪ ﻛﻴﻢ ‪2001‬؛ ‪.503-1487:(12)8‬‬

‫‪http://dx.doi.org/10.1120/jacmp.v17i5.6327 PMID: 27685136‬‬ ‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.2174/0929867013371996 11562278:‬‬

‫]‪ [97‬ﺳﻤﻴﺚ ﺑﻲ ﺁﺭ‪ ،‬ﻫﺎﻳﺮ ﺩﻱ‪ ،‬ﻫﻴﻞ ﺑﻲ ﺇﻡ‪ ،‬ﻛﻮﻟﺒﻴﺮﺳﻮﻥ ﺩﺑﻠﻴﻮ ﺇﺱ‪ .‬ﺟﺮﻋﺔ ﻧﻴﻮﺗﺮﻭﻧﻴﺔ‬ ‫]‪ [78‬ﺑﻴﺘﺮﺯ ﺳﻲ‪ ،‬ﺑﺮﺍﻭﻥ ﺇﺱ‪ .‬ﻳﺘﺮﺍﻓﻖ ﻋﻘﺎﺭ ﺍﻷﺟﺴﺎﻡ ﺍﻟﻤﻀﺎﺩﺓ ﻛﻤﻀﺎﺩ ﺟﺪﻳﺪ ﻟﻠﺴﺮﻃﺎﻥ‬
‫ﺛﺎﻧﻮﻳﺔﻣﻦ ﻧﻈﺎﻡ ﺍﻟﻤﻮﺍﺯﺍﺓ ﺍﻟﺪﻳﻨﺎﻣﻴﻜﻲ ﺃﺛﻨﺎء ﺍﻟﻌﻼﺝ ﺑﺎﻟﺒﺮﻭﺗﻮﻥ ﻟﻤﺴﺢ ﺷﻌﺎﻉ ﺍﻟﻘﻠﻢ‬ ‫ﺍﻟﻌﻼﺝﺍﻟﻜﻴﻤﻴﺎﺉﻲ‪ .‬ﻣﻤﺜﻞ ‪Biosci 2015‬؛ ‪PMID: 26182432 :(4)35‬‬
‫ﺍﻟﺮﺻﺎﺹﺩﺍﺧﻞ ﺍﻟﺠﻤﺠﻤﺔ‪ :‬ﺗﺤﻘﻴﻖ ﻣﻮﻧﺘﻲ ﻛﺎﺭﻟﻮ‪ .‬ﺇﻧﺖ ﺝ‬ ‫‪e00225-5. http://dx.doi.org/10.1042/BSR20150089‬‬
‫ﺭﺍﺩﻳﺎﺕﺃﻭﻧﻜﻮﻝ ﺑﻴﻮﻝ ﻓﻴﺰ ‪2019‬؛ ‪PMID: 30114462 .50-241 :(1)103‬‬ ‫‪.‬ﻧﻬﺞﺟﺪﻳﺪ ﻟﻠﻌﻼﺝ ﺍﻟﻤﻨﺎﻋﻲ ﺑﺎﻟﺘﺒﻨﻲ ﻟﻠﺴﺮﻃﺎﻥ ﻣﻊ ﺍﻟﺨﻼﻳﺎ ﺍﻟﻠﻴﻤﻔﺎﻭﻳﺔ ﺍﻟﻤﺘﺴﻠﻠﺔ ﻟﻠﻮﺭﻡ‪.‬‬
‫‪http://dx.doi.org/10.1016/j.ijrobp.2018.08.012‬‬ ‫ﺍﻟﻌﻠﻮﻡ‪1986‬؛ ‪SA, Spiess P, Lafreniere R. 21-1318:(4770)233‬‬
‫‪http://dx.doi.org/10.1016/j.zemedi.2016.03.006 PMID: 27084590‬‬ ‫‪]79[ Rosenberg‬‬
‫‪.‬ﻣﻔﻬﻮﻡﺑﺼﺮﻳﺎﺕ ﺷﻌﺎﻋﻲ ﺟﺪﻳﺪ ﻓﻲ ﺟﺴﺮ ﺍﻟﻌﻼﺝ ﺑﺎﻟﺠﺴﻴﻤﺎﺕ ﺑﺎﺳﺘﺨﺪﺍﻡ ﻣﺰﺍﻳﺎ‬ ‫‪http://dx.doi.org/10.1126/science.3489291 PMID: 3489291‬‬
‫ﺍﻟﻤﻐﻨﺎﻃﻴﺲﻓﺎﺉﻖ ﺍﻟﺘﻮﺻﻴﻞ‪ .‬ﺯﺩ ﻣﻴﺪ ﻓﻴﺰ ‪2016‬؛ ‪Seidel M. 37-224 :(3)26‬‬ ‫]‪ [80‬ﺟﺮﻭﺩﺷﺘﺎﻳﻦ ﺇﻑ‪ ،‬ﻧﻴﻮﻛﻮﻣﺐ ﺑﻲ ﺇﻳﻪ‪ ،‬ﺳﺘﺎﻣﻔﺮ ﺇﻡ ﺟﻲ‪ .‬ﺍﻟﻌﻼﺝ ﺍﻟﻬﺮﻣﻮﻧﻲ ﺑﻌﺪ ﺍﻧﻘﻄﺎﻉ‬
‫‪]98[ Gerbershagen A، Meer D، Schippers JM،‬‬ ‫ﺍﻟﻄﻤﺚﻭﺧﻄﺮ ﺍﻹﺻﺎﺑﺔ ﺑﺴﺮﻃﺎﻥ ﺍﻟﻘﻮﻟﻮﻥ ﻭﺍﻟﻤﺴﺘﻘﻴﻢ‪ :‬ﻣﺮﺍﺟﻌﺔ ﻭﺗﺤﻠﻴﻞ ﺗﻠﻮﻱ‪.‬‬
‫‪.‬ﺭﺍﺩﻳﺎﺕﺑﻴﻮﻝ ‪2018‬؛ •••‪ J 8-1 :‬ﺍﻟﻤﺸﻌﻌﺔ ﺑﺎﻟﺒﺮﻭﺗﻮﻧﺎﺕ ﻋﻨﺪ ﺍﻟﺠﺮﻋﺎﺕ ﺍﻟﺴﺮﻳﺮﻳﺔ‪ .‬ﺇﻧﺖ‬ ‫ﺁﻡﺟﻲ ﻣﻴﺪ ‪1999‬؛ ‪.82-574 :(5)106‬‬
‫‪ MCF10A‬ﻣﺮﺍﻗﺒﺔ ﺍﻟﺘﺤﻠﻴﻞ ﺍﻟﻄﻴﻔﻲ ﻟﺮﺍﻣﺎﻥ ﻟﺨﻼﻳﺎ ‪S، Capozzi V.‬‬ ‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1016/S0002-9343)99(00063-710335731‬‬
‫‪]99[ Lasalvia M، Perna G، Manti L، Rasero J، Stramaglia‬‬ ‫‪http://dx.doi.org‬‬
‫ﺑﻤﻴﺪ‪30496011:‬‬ ‫]‪ [81‬ﺷﺮﻳﻒ ﻭﺍﻱ‪ ،‬ﺟﻤﻌﺔ ﺇﻑ‪ ،‬ﻛﻮﺑﻼﻥ ﺇﻝ‪ ،‬ﻛﺮﻭﺳﺮ ﺇﻳﻪ‪ ،‬ﺷﺮﻳﻒ ﻛﻴﻪ‪ ،‬ﺗﺎﺑﺲ ﺁﺭ ﺇﺱ‪ .‬ﺣﺎﺟﺰ‬
‫]‪ [100‬ﺭﻭﻳﺠﻴﻤﺎ ﺟﻲ ﺇﻡ‪ ،‬ﻻﻧﺠﻴﻨﺪﻳﻚ ﺟﻴﻪ ﺇﻳﻪ‪ ،‬ﺑﻮﻝ ﻓﺎﻥ ﺩﻳﺮ ﻻﻥ ﺇﺗﺶ‪ ،‬ﻟﻮﻛﻴﻨﺰ ﺟﻲ ﺇﻥ‪،‬‬ ‫ﺍﻟﺪﻡﻓﻲ ﺍﻟﺪﻣﺎﻍ‪ :‬ﻣﺮﺍﺟﻌﺔ ﻟﺘﺸﺮﻳﺤﻪ ﻭﻋﻠﻢ ﻭﻇﺎﺉﻒ ﺍﻷﻋﻀﺎء ﻓﻲ ﺍﻟﺼﺤﺔ‬
‫‪/10.1016/j.ijrobp.2018.12.055 PMID: 30625409‬‬ ‫ﻭﺍﻟﻤﺮﺽ‪.‬ﻛﻠﻴﻦ ﻋﻨﺎﺕ ‪.23-812 :(6)31 ;2018‬‬
‫‪. http://dx.doi.org‬ﺭﺍﺩﻳﺎﺕ ﺃﻭﻧﻜﻮﻝ ﺑﻴﻮﻝ ﻓﻴﺰ ‪2019‬؛ ‪J 62-553 :(3)104‬‬ ‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1002/ca.23083 29637627:‬‬
‫ﻧﻬﺞﻗﺎﺉﻢ ﻋﻠﻰ ﺍﻟﻨﻤﻮﺫﺝ ﻟﻠﺘﻨﺒﺆ ﺑﻔﻮﺍﺉﺪ ﺍﻟﺴﻤﻴﺔ ﻗﺼﻴﺮﺓ ﺍﻟﻤﺪﻯ ﻣﻊ ﺍﻟﻌﻼﺝ‬ ‫]‪ [82‬ﻛﻴﺴﺎﺭﻱ ﺇﺱ‪ ،‬ﺃﺩﻓﺎﻧﻲ ﺇﺱ ﺟﻴﻪ‪ ،‬ﻟﻮﺳﻮﻥ ﺟﻲ ﺩﻱ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﻻﺳﺘﺠﺎﺑﺔ ﻷﺿﺮﺍﺭ ﺍﻟﺤﻤﺾ‬
‫ﺑﺎﻟﺒﺮﻭﺗﻮﻥﻟﺴﺮﻃﺎﻥ ﺍﻟﻔﻢ ﻭﺍﻟﺒﻠﻌﻮﻡ‪ .‬ﺇﻧﺖ ‪Swisher-McClure SD، Lin A.‬‬ ‫ﺍﻟﻨﻮﻭﻱﻭﺇﺻﻼﺣﻬﺎ‪ :‬ﻧﻈﺮﺓ ﺛﺎﻗﺒﺔ ﻻﺳﺘﺮﺍﺗﻴﺠﻴﺎﺕ ﺍﻟﺘﻮﻋﻴﺔ ﺍﻹﺷﻌﺎﻋﻴﺔ ﻟﻸﻭﺭﺍﻡ ﺍﻟﺪﺑﻘﻴﺔ‪.‬‬
‫]‪ [101‬ﻳﻨﺞ ﺳﻲ‪ ،‬ﺑﻮﻟﺴﺖ ﺩ‪ ،‬ﺗﺮﺍﻥ ﺇﻝ‪ ،‬ﺟﻮﺍﺗﻴﻠﻲ ﺇﺱ‪ ،‬ﺭﻭﺯﻧﻔﻴﻠﺪ ﺃ‪ ،‬ﻛﺎﻣﻴﻞ ﺩﺑﻠﻴﻮ ﻛﻮﻥ‪-‬‬ ‫ﺍﻟﻤﺴﺘﻘﺒﻞﺃﻭﻧﻜﻮﻝ ‪2011‬؛ ‪.46-1335 :(11)7‬‬
 ‫ﺍﻟﺘﺼﻮﻳﺮﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ‪ ،2021،‬ﺭﺣﻠﺔ ﺟﻮﻳﺔ‪ ،17 .‬ﻻ‪1100 .‬‬
‫ﺍﻟﻤﺒﺎﺩﺉﺍﻟﺘﻮﺟﻴﻬﻴﺔ ﻟﻜﻠﻴﺔ ﺍﻷﻃﺒﺎء‪ J .‬ﻧﻴﻮﺭﻭﻝ ﻧﻴﻮﺭﻭﺳﻮﺭﺝ ﺍﻟﻄﺐ ﺍﻟﻨﻔﺴﻲ ‪2004‬؛‬
‫‪)75‬ﻣﻠﺤﻖ ‪.ii18-23 :(2‬‬
‫‪http://dx.doi.org/10.1136/jnnp.2004.040360 PMID: 15146035‬‬
‫]‪ [120‬ﻛﻮﻣﺎﺭ ﺇﻳﻪ ﺟﻴﻪ‪ ،‬ﻟﻴﺪﺯ ﺇﻥ ﺇﻱ‪ ،‬ﻓﻮﻟﺮ ﺟﻲ ﺇﻥ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﻷﻭﺭﺍﻡ ﺍﻟﺪﺑﻘﻴﺔ ﺍﻟﺨﺒﻴﺜﺔ‪MR :‬‬
‫ﻃﻴﻒﺍﻟﺘﺼﻮﻳﺮ ﻣﻦ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻭﺍﻟﻨﺨﺮ ﺍﻟﻨﺎﺟﻢ ﻋﻦ ﺍﻟﻌﻼﺝ ﺍﻟﻜﻴﻤﻴﺎﺉﻲ‬
‫ﻟﻠﺪﻣﺎﻍﺑﻌﺪ ﺍﻟﻌﻼﺝ‪ .‬ﺍﻷﺷﻌﺔ ‪.84-377 :(2)217 ;2000‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1148/radiology.217.2.r00nv3637711058631‬‬
‫‪http://dx.doi.org‬‬
‫]‪ [121‬ﺩﻳﺴﺎﻱ ﺃ‪ ،‬ﻳﺎﻥ ﻭﺍﻱ‪ ،‬ﺟﻴﺮﺳﻮﻥ ﺇﺱ ﺇﻝ‪ .‬ﻣﺮﺍﺟﻌﺎﺕ ﻣﻮﺟﺰﺓ‪ :‬ﻗﻄﺮﺍﻥ ﺍﻟﺨﻼﻳﺎ ﺍﻟﺠﺬﻋﻴﺔ ﺍﻟﺴﺮﻃﺎﻧﻴﺔ‬
‫ﺣﺼﻠﺖﻋﻠﻰ ﺍﻟﻌﻼﺟﺎﺕ‪ :‬ﻧﺤﻮ ﺍﻟﻨﺠﺎﺡ ﺍﻟﺴﺮﻳﺮﻱ‪ .‬ﺗﺮﺟﻤﺔ ﺍﻟﺨﻼﻳﺎ ﺍﻟﺠﺬﻋﻴﺔ ﻣﻴﺪ‬
‫‪2019‬؛‪.81-75 :(1)8‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1002/sctm.18-0123 30328686:‬‬
‫]‪ [122‬ﺗﻮﻟﻴﺴﻜﺎ ﺳﻲ‪ ،‬ﺟﻮﺭﺝ ﺇﻡ‪ ،‬ﺷﻴﺎﺑﺎﻛﺎﺱ ﺇﻝ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺳﻜﻴﻦ ﺟﺎﻣﺎ ﺭﺍ‪-‬‬
‫ﺍﻟﺠﺮﺍﺣﺔﺍﻟﺪﻳﻮﺍﻧﻴﺔ ﻟﻸﻭﺭﺍﻡ ﺍﻟﺸﻔﺎﻧﻴﺔ ﺩﺍﺧﻞ ﺍﻟﺪﻫﻠﻴﺰ ﻭﺩﺍﺧﻞ ﺍﻟﻘﻮﻗﻌﺔ‪ .‬ﺃﻛﺘﺎ‬
‫ﻧﻴﻮﺭﻭﺷﻴﺮ)ﻓﻴﻴﻨﺎ( ‪2019‬؛ ‪.7-63 :(1)161‬‬
‫‪http://dx.doi.org/10.1007/s00701-018-3762-y PMID: 30535852‬‬
‫‪ Ob-‬ﺍﻟﻌﻼﺝ ﻣﺘﻌﺪﺩ ﺍﻟﺨﻴﺎﺭﺍﺕ ﻣﻘﺎﺑﻞ ﺍﻟﻌﻼﺝ ‪]123[ Zanoletti E, Cazzador D, Faccioli C.‬‬
‫ﺧﺪﻣﺔﻟﻠﻮﺭﻡ ﺍﻟﻌﺼﺒﻲ ﺍﻟﺼﻮﺗﻲ ﺍﻟﺼﻐﻴﺮ‪ :‬ﺍﻹﺩﺍﺭﺓ ﺍﻟﺘﻲ ﺗﺮﻛﺰ ﻋﻠﻰ ﺍﻟﺴﻤﻊ‪Italica .‬‬
‫‪ :Acta otorhinolaryngologica‬ﺍﻟﻬﻴﺉﺔ ﺍﻟﺮﺳﻤﻴﺔ ﻟﻠﺠﻤﻌﻴﺔ ﺍﻹﻳﻄﺎﻟﻴﺔ‬
‫ﻟﻄﺐﺍﻷﻧﻒ ﻭﺍﻷﺫﻥ ﻭﺍﻟﺤﻨﺠﺮﺓ ﻭﺟﺮﺍﺣﺔ ﻋﻨﻖ ﺍﻟﺮﺣﻢ ﻭﺍﻟﻮﺟﻪ ‪2018‬؛ ‪:38‬‬
‫‪.92-384‬‬
‫]‪ [124‬ﻫﻴﺮﻱ ﺳﻲ ﺁﺭ‪ .‬ﺍﻟﻮﺭﻡ ﺍﻟﺤﺒﻠﻲ‪ :‬ﺍﻟﺒﺤﺚ ﻋﻦ ﺧﻴﺎﺭﺍﺕ ﻋﻼﺟﻴﺔ ﺃﻓﻀﻞ‪ .‬ﻋﻠﻰ‪-‬‬
‫ﺍﻟﻌﻘﻴﺪﻫﻨﺎﻙ ‪2016‬؛ ‪/10.1007/s40487-016-0016-0 .51-35 :(1)4‬‬
‫‪ http://dx.doi.org‬ﺑﻤﻴﺪ‪28261639 :‬‬
‫]‪ [125‬ﺧﺎﻥ ﺇﻡ ﺇﻳﻪ‪ ،‬ﻏﻮﺩﻳﻞ ﺇﺱ ﺇﺱ‪ ،‬ﺗﺎﺑﺎﻧﻲ ﺇﺗﺶ‪ ،‬ﺑﺎﻧﺠﻮ ﺇﺱ ﺇﻳﻪ‪ ،‬ﺇﻧﺎﻡ ﺇﺱ ﺇﻳﻪ‪ .‬ﺇﻋﺎﺩﺓ ﺍﻟﺴﺮﻳﺮﻳﺔ‬
‫ﻣﻨﻈﺮﻟﻸﻭﺭﺍﻡ ﺍﻟﻨﺠﻤﻴﺔ ﺍﻟﺸﻌﺮﻳﺔ ﻟﺪﻯ ﺍﻷﻃﻔﺎﻝ ﺍﻟﺘﻲ ﺗﻢ ﻋﻼﺟﻬﺎ ﻓﻲ ﻣﺴﺘﺸﻔﻰ ﺍﻟﺮﻋﺎﻳﺔ‬
‫ﺍﻟﺜﺎﻟﺜﻴﺔﻓﻲ ﺑﺎﻛﺴﺘﺎﻥ‪ .‬ﺳﻮﺭﺝ ﻧﻴﻮﺭﻭﻝ ﺇﻧﺖ ‪2012‬؛ ‪.90 :(1)3‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.4103/2152-7806.99936 23050204:‬‬
‫]‪ [126‬ﺑﻴﺪﺭﺳﻦ ﺳﻲ ﺇﻝ‪ ،‬ﺭﻭﻣﻨﺮ ﺏ‪ .‬ﺍﻟﻌﻼﺝ ﺍﻟﺤﺎﻟﻲ ﻟﻠﻮﺭﻡ ﺍﻟﻨﺠﻤﻲ ﻣﻨﺨﻔﺾ ﺍﻟﺪﺭﺟﺔ‪:‬‬
‫ﻣﺮﺍﺟﻌﺔ‪.‬ﻋﻴﺎﺩﺓ ﻧﻴﻮﺭﻭﻝ ﻧﻴﻮﺭﻭﺳﻮﺭﺝ ‪2013‬؛ ‪.8-1 :(1)115‬‬
‫‪http://dx.doi.org/10.1016/j.clineuro.2012.07.002 PMID: 22819718‬‬
‫]‪ [127‬ﺟﺮﻳﻢ ﺇﺱ ﺇﻳﻪ‪ ،‬ﺗﺸﺎﻣﺒﺮﻟﻴﻦ ﺇﻡ ﺳﻲ‪ .‬ﻭﺭﻡ ﻧﺠﻤﻲ ﻛﺸﻤﻲ‪ .‬ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺮﻛﺰﻱ ﻋﻠﻰ‪-‬‬
‫ﻛﻮﻝ‪2016‬؛ ‪/10.2217/cns-2016-0002 .57-145 :(3)5‬‬
‫‪ http://dx.doi.org‬ﺑﻤﻴﺪ‪27230974 :‬‬
‫]‪ [128‬ﺩﻳﻔﻴﺲ ﺇﻡ ﺇﻱ‪ .‬ﻭﺭﻡ ﺃﺭﻭﻣﻲ ﺩﺑﻘﻲ‪ :‬ﻧﻈﺮﺓ ﻋﺎﻣﺔ ﻋﻠﻰ ﺍﻟﻤﺮﺽ ﻭﺍﻟﻌﻼﺝ‪ .‬ﻛﻠﻴﻦ‬
‫ﺟﻲﺃﻭﻧﻜﻮﻝ ﻧﻮﺭﺱ ‪2016‬؛ ‪) (5)20‬ﻣﻠﺤﻖ(‪CJON.S1.2-8 PMID: 27668386 :‬‬
‫‪S2-8. http://dx.doi.org/10.1188/16.‬‬
‫ﺗﺸﺨﻴﺺﻭﻋﻼﺝ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺮﻛﺰﻱ ﺍﻷﻭﻟﻲ ‪]129[ Korfel A, Schlegel U.‬‬
‫ﺳﺮﻃﺎﻥﺍﻟﻐﺪﺩ ﺍﻟﻠﻴﻤﻔﺎﻭﻳﺔ‪ .‬ﻧﺎﺕ ﺭﻳﻒ ﻧﻴﻮﺭﻭﻝ ‪2013‬؛ ‪PMID: 23670107 .27-317 :(6)9‬‬
‫‪http://dx.doi.org/10.1038/nrneurol.2013.83‬‬
‫‪-‬ﺗﺤﻠﻴﻞﺗﻠﻮﻱ ﻟﻌﻼﺝ ﺍﻟﺪﻫﻠﻴﺰ ‪]130[ Rykaczewski B, Zabek M.‬‬
‫ﺍﻟﻮﺭﻡﺍﻟﺸﻔﺎﻧﻲ ﺑﺎﺳﺘﺨﺪﺍﻡ ﺍﻟﺠﺮﺍﺣﺔ ﺍﻹﺷﻌﺎﻋﻴﺔ ﺑﺎﺳﺘﺨﺪﺍﻡ ﺳﻜﻴﻦ ﺟﺎﻣﺎ‪ .‬ﻛﻮﻧﺘﻴﻤﺐ‬
‫ﺃﻭﻧﻜﻮﻝ)ﺑﻮﺯﻥ( ‪2014‬؛ ‪.6-60 :(1)18‬‬
‫‪http://dx.doi.org/10.5114/wo.2014.39840 PMID: 24876823‬‬
‫]‪ [131‬ﻣﺮﻭﺳﺰﻳﻨﺴﻜﻲ ﺃﻭ ﺩﻱ‪ ،‬ﻻﻧﺠﺎﻥ ﺇﺱ ﺗﻲ‪ ،‬ﺭﺯﻕ ﺇﻱ ﺑﻲ‪ .‬ﺍﻷﻭﺭﺍﻡ ﺍﻟﻘﺤﻔﻴﺔ ﺍﻟﺒﻠﻌﻮﻣﻴﺔ‪:‬‬
‫ﻣﺮﺍﺟﻌﺔﻣﻨﻬﺠﻴﺔ ﻭﺗﻘﻴﻴﻢ ﻟﻤﺸﻬﺪ ﺍﻟﻌﻼﺝ ﺩﺍﺧﻞ ﺍﻟﻔﻢ ﺍﻟﺤﺎﻟﻲ‪ .‬ﻋﻴﺎﺩﺓ ﻧﻴﻮﺭﻭﻝ‬
‫ﻧﻴﻮﺭﻭﺳﻮﺭﺝ‪2018‬؛ ‪.30-124 :166‬‬
‫‪http://dx.doi.org/10.1016/j.clineuro.2018.01.039 PMID: 29408768‬‬
‫]‪ [132‬ﺩﻱ ﺑﺮﺍﻏﺎﻧﻜﺎ ﻛﻴﻪ ﺳﻲ‪ ،‬ﺑﺎﻛﺮ ﺁﺭ ﺟﻴﻪ‪ .‬ﺧﻴﺎﺭﺍﺕ ﺍﻟﻌﻼﺝ ﻟﻠﻮﺭﻡ ﺍﻷﺭﻭﻣﻲ ﺍﻟﻨﺨﺎﻋﻲ ﻭﺭﻡ‬
‫ﺍﻟﺠﻠﺪﺍﻟﻌﺼﺒﻲ ﺍﻟﺒﺪﺍﺉﻲ ﻓﻲ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺮﻛﺰﻱ‪ .‬ﺧﻴﺎﺭﺍﺕ ﺍﻟﻌﻼﺝ ﺑﺎﻟﻌﻤﻠﺔ‬
‫‪Neurol2013‬؛ ‪.606-593 :(5)15‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1007/s11940-013-0255-4 23979905:‬‬
‫]‪ [133‬ﻟﻴﻔﻲ ﺃ‪ .‬ﻣﺮﺽ ﺍﻟﻐﺪﺓ ﺍﻟﻨﺨﺎﻣﻴﺔ‪ :‬ﺍﻟﻌﺮﺽ ﻭﺍﻟﺘﺸﺨﻴﺺ ﻭﺍﻹﺩﺍﺭﺓ‪ .‬ﻣﺠﻠﺔ ﻋﻠﻢ ﺍﻷﻋﺼﺎﺏ‬
‫ﻭﺟﺮﺍﺣﺔﺍﻷﻋﺼﺎﺏ ﻭﺍﻟﻄﺐ ﺍﻟﻨﻔﺴﻲ ‪2004‬؛ ‪.iii47-52 :(3)75‬‬
‫‪http://dx.doi.org/10.1136/jnnp.2004.045740‬‬
‫]‪ [134‬ﺗﻮﺭﻧﺴﻤﺎ ﺭ‪ .‬ﻣﻌﻀﻠﺔ ﺍﻟﻌﻼﺝ ﻭﺍﻟﻀﺮﺭ ﻓﻲ ﻭﺭﻡ ﺍﻟﺪﺑﻘﻴﺎﺕ ﻗﻠﻴﻠﺔ ﺍﻟﺘﻐﺼﻦ‪ :‬ﻃﺮﻕ‬
‫ﻟﺘﺮﺟﻴﺢﻛﻔﺔ ﺍﻟﻤﻴﺰﺍﻥ ﺑﻌﻴﺪﺍً ﻋﻦ ﺍﻟﻀﺮﺭ‪ .‬ﺍﻟﺴﺮﻃﺎﻥ )ﺑﺎﺯﻝ( ‪2018‬؛ ‪.431 :(11)10‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.3390/cancers10110431 30424475:‬‬
‫]‪ [135‬ﺟﺮﻳﻢ ﺇﺱ ﺇﻳﻪ‪ ،‬ﺗﺸﺎﻣﺒﺮﻟﻴﻦ ﺇﻡ ﺳﻲ‪ .‬ﻭﺭﻡ ﺟﺬﻉ ﺍﻟﺪﻣﺎﻍ ﺍﻟﺪﺑﻘﻲ‪ :‬ﻣﺮﺍﺟﻌﺔ‪ .‬ﻛﻴﺮ ﻧﻴﻮﺭﻭﻝ‬
‫ﻧﻴﻮﺭﻭﺳﺴﻲﺭﻳﺐ ‪2013‬؛ ‪.346 :(5)13‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1007/s11910-013-0346-3 23512689:‬‬
‫]‪ [136‬ﺑﺮﺍﻭﻥ ﺑﻲ ﺩﻱ‪ ،‬ﺑﺎﻟﻤﺎﻥ ﻛﻴﻪ ﻓﻲ‪ ،‬ﺳﻴﺮﻫﺎﻥ ﺟﻴﻪ ﺇﺗﺶ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﻟﺘﺼﻮﻳﺮ ﺍﻟﻤﺠﺴﻢ ﺑﻌﺪ ﺍﻟﻌﻤﻠﻴﺔ ﺍﻟﺠﺮﺍﺣﻴﺔ‪-‬‬
‫ﺍﻟﺠﺮﺍﺣﺔﺍﻹﺷﻌﺎﻋﻴﺔ ﺍﻟﺘﺸﻨﺠﻴﺔ ﻣﻘﺎﺭﻧﺔ ﺑﺎﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻜﺎﻣﻞ ﻟﻠﺪﻣﺎﻍ ﻟﻤﺮﺽ‬
‫ﺍﻟﺪﻣﺎﻍﺍﻟﻨﻘﻴﻠﻲ ﺍﻟﻤﺴﺘﺄﺻﻞ )‪ :(NCTG N107C/CEC·3‬ﺗﺠﺮﺑﺔ ﺍﻟﻤﺮﺣﻠﺔ ﺍﻟﺜﺎﻟﺜﺔ‬
‫ﻣﺘﻌﺪﺩﺓﺍﻟﻤﺮﺍﻛﺰ ﻭﺍﻟﻌﺸﻮﺍﺉﻴﺔ ﻭﺍﻟﻤﻀﺒﻮﻃﺔ‪ .‬ﻻﻧﺴﻴﺖ ﺃﻭﻧﻜﻮﻝ ‪2017‬؛ ‪:(8)18‬‬
‫‪.60-1049‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1016/S1470-2045)17(30441-228687377‬‬
‫‪http://dx.doi.org‬‬
‫]‪ [137‬ﺗﺸﺎﻧﻎ ﺇﻛﺲ ﺩﺑﻠﻴﻮ‪ ،‬ﻭﻭ ﺇﻛﺲ ﻭﺍﻱ‪ ،‬ﻭﺷﻴﻨﻎ ﺇﻛﺲ ﺇﻑ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺗﺸﺨﻴﺺ ﻭﺭﻡ ﺍﻟﺒﻄﺎﻧﺔ ﺍﻟﻌﺼﺒﻴﺔ‬
‫ﻭﺗﻘﺪﻡﺍﻟﻌﻼﺝ‪Int J Clin Exp Med 2016 .‬؛ ‪.7-15050 :(8)9‬‬
‫ﻭﺭﻡﺍﻟﺪﻣﺎﻍ ﺍﻷﺳﺒﺎﺏ ﻭﺍﻷﻋﺮﺍﺽ ﻭﺍﻟﺘﺸﺨﻴﺺ‬
‫ﺗﻮﺯﻳﻌﺎﺕﺍﻟﺘﺠﺰﺉﺔ ﺍﻟﺜﺎﻧﻮﻳﺔ ﺑﻮﺍﺳﻄﺔ ﺣﺰﻡ ﺃﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ ﻓﻲ ﺍﻟﻤﺎء ﺍﻟﻮﻫﻤﻲ‪:‬‬
‫ﻣﺤﺎﻛﺎﺓﻣﻮﻧﺖ ﻛﺎﺭﻟﻮ‪ .‬ﺟﻲ ﻓﻴﺰ ﻛﻮﻧﻒ ﺳﻴﺮ ‪2017‬؛ ‪.012033 : 851‬‬
‫‪http://dx.doi.org/10.1088/1742-6596/851/1/012033‬‬
‫‪.‬ﺍﻟﻌﻼﺝﺍﻟﺪﻳﻨﺎﻣﻴﻜﻲ ﺍﻟﻀﻮﺉﻲ ﻓﻲ ﻋﻼﺝ ﺍﻟﻮﺣﻤﺎﺕ ﺍﻟﻤﻠﻄﺨﺔ ﺑﻨﺒﻴﺬ ﺍﻟﻤﻴﻨﺎء ‪ -‬ﺍﻟﺘﻘﺪﻡ ﺍﻟﺤﺪﻳﺚ‪.‬‬
‫ﻓﻮﺗﻮﺩﻳﺎﺟﻦ ﻓﻮﺗﻮﺩﻳﻦ ﻫﻨﺎﻙ ‪2009‬؛ ‪Q، Yu WL، Huang Z. 94-189:(4-3)6‬‬
‫‪]102[ Yuan KH، Li‬‬
‫‪http://dx.doi.org/10.1016/j.pdpdt.2009.08.001 PMID: 19932450‬‬
‫]‪ [103‬ﺟﺮﻭﺷﺎﻧﺰ ﺩﻱ ﺁﺭ‪ ،‬ﺩﻭﻣﺎﻥ ﺟﻲ ﺟﻲ‪ ،‬ﺟﺎﺑﺮ ﺇﻡ ﺩﺑﻠﻴﻮ‪ ،‬ﺳﻮﺍﻛﻮﺷﻲ ﺟﻲ‪ .‬ﺑﺎﺭﺗﻴﻜﻞ ﺭﺍ‪-‬‬
‫ﻳﺴﺒﺐﺍﻟﺴﻤﻴﺔ ﺍﻟﻌﺼﺒﻴﺔ ﻓﻲ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ ﺍﻟﻤﺮﻛﺰﻱ‪ .‬ﺇﻧﺖ ‪ J‬ﺍﻟﺠﺰء ﻫﻨﺎﻙ‬
‫‪2018‬؛‪.83-74 :(1)5‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.14338/IJPT-18-00026.1 31773021:‬‬
‫]‪ [104‬ﺳﺘﻮﻥ ﺇﺗﺶ ﺑﻲ‪ ،‬ﻛﻮﻟﻤﺎﻥ ﺳﻲ ﺇﻥ‪ ،‬ﺃﻧﺸﺮ ﺇﻡ ﺇﺱ‪ ،‬ﻣﺎﻛﺒﺮﺍﻳﺪ ﺩﺑﻠﻴﻮ ﺇﺗﺶ‪ .‬ﺁﺛﺎﺭ ﺭﺍ‪-‬‬
‫ﺗﻤﺪﺩﻋﻠﻰ ﺍﻷﻧﺴﺠﺔ ﺍﻟﻄﺒﻴﻌﻴﺔ‪ :‬ﺍﻟﻌﻮﺍﻗﺐ ﻭﺍﻵﻟﻴﺎﺕ‪ .‬ﻻﻧﺴﻴﺖ ﺃﻭﻧﻜﻮﻝ ‪2003‬؛ ‪)4‬‬
‫‪.36-529 :(9‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1016/S1470-2045)03(01191-412965273‬‬
‫‪http://dx.doi.org‬‬
‫]‪ [105‬ﺟﻮﻧﺰ ﺃ‪ .‬ﺍﻋﺘﻼﻝ ﺍﻟﻨﺨﺎﻉ ﺍﻹﺷﻌﺎﻋﻲ ﺍﻟﻌﺎﺑﺮ‪ .‬ﺭ ﺝ ﺭﺍﺩﻳﻮﻝ ‪1964‬؛‬
‫‪.727-44 :(442)37‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1259/0007-1285-37-442-72714217730‬‬
‫‪http://dx.doi.org‬‬
‫]‪ [106‬ﺷﻴﻠﻴﻦ ﺟﻲ ﺇﻱ‪ ،‬ﻭﺍﺭﺍ ﺩﺑﻠﻴﻮ ﺇﻡ‪ ،‬ﺳﻤﻴﺚ ﻓﻲ‪ .‬ﺍﻟﺘﺸﻌﻴﻊ ﺍﻟﻌﻼﺟﻲ ﻭﺇﺻﺎﺑﺎﺕ ﺍﻟﺪﻣﺎﻍ‪.‬‬
‫ﺇﻧﺖ‪ J‬ﺭﺍﺩﻳﺎﺕ ﺃﻭﻧﻜﻮﻝ ﺑﻴﻮﻝ ﻓﻴﺰ ‪1980‬؛ ‪PMID: 7007303 .28-1215 :(9)6‬‬
‫‪http://dx.doi.org/10.1016/0360-3016)80(90175-3‬‬
‫]‪ [107‬ﺷﻨﻴﺞ ﺳﻲ ﺁﻱ‪ ،‬ﺭﻭﺑﻨﺰ ﺇﻡ ﺇﻱ‪ .‬ﺁﻟﻴﺎﺕ ﺍﻟﺤﻤﺎﻳﺔ ﺍﻟﻌﺼﺒﻴﺔ‬
‫‪.‬؛‪ PPAR 2011373560 :2011‬ﺗﻌﺪﻳﻞ ﺍﻹﺟﻬﺎﺩ ﺍﻟﺘﺄﻛﺴﺪﻱ ﻭﺍﻟﻌﻤﻠﻴﺎﺕ‬
‫ﺍﻻﻟﺘﻬﺎﺑﻴﺔ‪.‬ﻗﺮﺍﺭ ‪PPARδ:‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1155/2011/373560 22135673:‬‬
‫‪-‬ﺟﺮﻋﺔﻣﻨﺨﻔﻀﺔ ﺃﻭ ﻣﻌﺪﻝ ﺟﺮﻋﺔ ﻣﻨﺨﻔﻀﺔ ﻣﻦ ﺍﻹﺷﻌﺎﻉ ﺍﻟﻤﺆﻳﻦ ‪]108[ Tang FR, Loganovsky K.‬‬
‫ﺍﻵﺛﺎﺭﺍﻟﺼﺤﻴﺔ ﺍﻟﻨﺎﺟﻤﺔ ﻋﻦ ‪ ation‬ﻓﻲ ﺍﻹﻧﺴﺎﻥ‪J Environ Radioact 2018 .‬؛‬
‫‪.47-32:192‬‬
‫‪http://dx.doi.org/10.1016/j.jenvrad.2018.05.018 PMID: 29883875‬‬
‫]‪ [109‬ﻓﺎﺭﺍﻧﺪﺍ ﺇﻱ‪ ،‬ﺗﺎﻓﺎﺭﻳﺲ ﺩ‪ .‬ﺍﻟﺤﻤﺎﻳﺔ ﻣﻦ ﺍﻹﺷﻌﺎﻉ‪ :‬ﺍﻵﻟﻴﺎﺕ ﻭﺍﻟﺤﻤﺎﻳﺔ ﺍﻹﺷﻌﺎﻋﻴﺔ‬
‫ﺍﻟﻌﻮﺍﻣﻞﺍﻟﻮﻗﺎﺉﻴﺔ ﺑﻤﺎ ﻓﻲ ﺫﻟﻚ ﺳﻢ ﻧﺤﻞ ﺍﻟﻌﺴﻞ‪.‬‬
‫‪http://dx.doi.org/10.1590/S0104-79301998000100002‬‬
‫]‪ [110‬ﺃﺷﻮﻭﺩ ﺳﻤﻴﺚ ﻡ‪ .‬ﺧﺼﺎﺉﺺ ﺍﻟﺤﻤﺎﻳﺔ ﻣﻦ ﺍﻹﺷﻌﺎﻉ ﻭﺍﻟﺤﻤﺎﻳﺔ ﻣﻦ ﺍﻟﺒﺮﺩ‬
‫ﺛﻨﺎﺉﻲﻣﻴﺜﻴﻞ ﺳﻠﻔﻮﻛﺴﻴﺪ ﻓﻲ ﺍﻷﻧﻈﻤﺔ ﺍﻟﺨﻠﻮﻳﺔ‪ .‬ﺁﻥ ﻧﻴﻮﻳﻮﺭﻙ ﺃﻛﺎﺩ ﺍﻟﻌﻠﻮﻡ‬
‫‪1967‬؛‪.62-45 :(1)141‬‬
‫‪http://dx.doi.org/10.1111/j.1749-6632.1967.tb34865.x‬‬
‫]‪ [111‬ﺑﺎﺑﺎﻙ ﺁﺭ ﺟﻴﻪ‪ .‬ﺃﺻﻮﻝ ﻋﻼﺝ ﺍﻟﺴﺮﻃﺎﻥ‪ .‬ﻳﻴﻞ ﺟﻲ ﺑﻴﻮﻝ ﻣﻴﺪ ‪2001‬؛ ‪:(6)74‬‬
‫‪.391-8‬‬
‫ﺑﻤﻴﺪ‪11922186:‬‬
‫]‪ [112‬ﻧﻴﻜﻮﻏﻮﺳﻴﺎﻥ ﺇﻳﻪ ﻓﻲ‪ ،‬ﺭﺍﻭﺥ ﺟﻲ‪ ،‬ﻣﻮﻧﺘﺮ ﺇﻡ ﺩﺑﻠﻴﻮ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺗﺠﺮﺑﺔ ﻋﺸﻮﺍﺉﻴﺔ‬
‫ﺍﻟﻌﻼﺝﺍﻹﺷﻌﺎﻋﻲ ﺑﺎﻟﺒﺮﻭﺗﻮﻥ ﻣﻘﺎﺑﻞ ﺃﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ ﻓﻲ ﺍﻟﻤﺮﺿﻰ ﺍﻟﺬﻳﻦ ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺳﺎﺭﻛﻮﻣﺎ‬
‫ﻏﻀﺮﻭﻓﻴﺔﻣﻨﺨﻔﻀﺔ ﻭﻣﺘﻮﺳﻄﺔ ﺍﻟﺪﺭﺟﺔ ﻓﻲ ﻗﺎﻋﺪﺓ ﺍﻟﺠﻤﺠﻤﺔ‪ ،‬ﺩﺭﺍﺳﺔ ﺍﻟﻤﺮﺣﻠﺔ ﺍﻟﺴﺮﻳﺮﻳﺔ‬
‫ﺍﻟﺜﺎﻟﺜﺔ‪.‬ﺑﻲ ﺇﻡ ﺳﻲ ﺍﻟﺴﺮﻃﺎﻥ ‪2010‬؛ ‪.606 :10‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1186/1471-2407-10-606 21050498:‬‬
‫]‪ [113‬ﺃﻭﻳﻜﻲ ﺗﻲ‪ ،‬ﺳﺎﺗﻮ ﺇﺗﺶ‪ ،‬ﻧﻮﺩﺍ ﺇﺱ ﺇﻱ‪ ،‬ﻧﺎﻛﺎﻧﻮ ﺗﻲ‪ .‬ﺑﺤﺚ ﺗﺮﺟﻤﺔ ﺇﻟﻰ ‪-im‬‬
‫ﺇﺛﺒﺎﺕﻓﻌﺎﻟﻴﺔ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺑﺄﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ‪ :‬ﺗﺠﺮﺑﺔ ﺟﺎﻣﻌﺔ ﻏﻮﻧﻤﺎ‪ .‬ﺟﺒﻬﺔ‬
‫ﺃﻭﻧﻜﻮﻝ‪2016‬؛ ‪.139 :6‬‬
‫‪http://dx.doi.org/10.3389/fonc.2016.00139 PMID: 27376029‬‬
‫]‪ [114‬ﺷﺎﺭﻣﺎ ﺇﻥ ﻛﻴﻪ‪ ،‬ﺷﺎﺭﻣﺎ ﺁﺭ‪ ،‬ﻣﺎﺛﻮﺭ ﺩ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺩﻭﺭ ﺍﻹﺷﻌﺎﻋﺎﺕ ﺍﻟﻤﺆﻳﻨﺔ‬
‫ﻓﻲﺍﻷﻣﺮﺍﺽ ﺍﻟﻌﺼﺒﻴﺔ‪ .‬ﺍﻟﺸﻴﺨﻮﺧﺔ ﺍﻷﻣﺎﻣﻴﺔ ﺍﻟﻌﺼﺒﻴﺔ ‪2018‬؛ ‪.134 :10‬‬
‫‪http://dx.doi.org/10.3389/fnagi.2018.00134 PMID: 29867445‬‬
‫]‪ [115‬ﻣﻮﺭﻱ ﺇﺱ‪ ،‬ﺳﺎﻛﺎﺗﺎ ﻭﺍﻱ‪ ،‬ﻫﻴﺮﺍﻱ ﺁﺭ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺗﺸﻐﻴﻞ ﺟﻬﺎﺯ ﺍﻟﻔﻠﻮﺭﻭﺳﻜﻮﺏ‬
‫ﻧﻈﺎﻡﺗﺘﺒﻊ ﺍﻟﻮﺭﻡ ﺑﺪﻭﻥ ﻋﻼﻣﺎﺕ ﻓﻲ ﺍﻟﻮﻗﺖ ﺍﻟﺤﻘﻴﻘﻲ ﺍﻟﻘﺎﺉﻢ ﻋﻠﻰ ‪ IC‬ﻓﻲ‬
‫ﺟﺴﺮﻳﺔﺩﻭﺍﺭﺓ ﻓﺎﺉﻘﺔ ﺍﻟﺘﻮﺻﻴﻞ ﻟﻤﻌﺎﻟﺠﺔ ﻣﺴﺢ ﺷﻌﺎﻉ ﻗﻠﻢ ﺍﻟﺮﺻﺎﺹ ﺑﺄﻳﻮﻥ‬
‫ﺍﻟﻜﺮﺑﻮﻥ‪.‬ﻣﻴﺪ ﻓﻴﺰ ‪2019‬؛ ‪.74-1561 :(4)46‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.1002/mp.13403 30689205:‬‬
‫]‪ [116‬ﻧﺎﻛﺎﻧﻮ ﺗﻲ‪ ،‬ﺃﻭﻧﻮ ﺗﻲ‪ ،‬ﺇﻳﺸﻴﻜﺎﻭﺍ ﺇﺗﺶ‪ ،‬ﺳﻮﺯﻭﻛﻲ ﻭﺍﻱ‪ ،‬ﺗﺎﻛﺎﻫﺎﺷﻲ ﺗﻲ‪.‬‬
‫ﺍﻟﺘﻘﺪﻡﻓﻲ ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻟﺴﺮﻃﺎﻥ ﻋﻨﻖ ﺍﻟﺮﺣﻢ‪ .‬ﺟﻲ ﺭﺍﺩﻳﺎﺕ ﺭﻳﺲ )ﻃﻮﻛﻴﻮ(‬
‫‪2010‬؛‪.8-1 :(1)51‬‬
‫‪http://dx.doi.org/10.1269/jrr.09132 PMID: 20173313‬‬
‫]‪ [117‬ﻟﻲ ﻭﺍﻱ‪ ،‬ﻛﻮﺑﻮﺗﺎ ﻭﺍﻱ‪ ،‬ﺗﺎﺷﻴﺮﻭ ﺇﻡ‪ ،‬ﺃﻭﻧﻮ ﺗﻲ‪ .‬ﻗﻴﻤﺔ ﺛﻼﺛﻴﺔ ﺍﻷﺑﻌﺎﺩ‬
‫ﺃﻧﻈﻤﺔﺍﻟﺘﺼﻮﻳﺮ ﻟﻠﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﺑﺄﻳﻮﻥ ﺍﻟﻜﺮﺑﻮﻥ ﺍﻟﻤﻮﺟﻪ ﺑﺎﻟﺼﻮﺭ‪ .‬ﺍﻟﺴﺮﻃﺎﻥ )‬
‫ﺑﺎﺯﻝ( ‪2019‬؛ ‪.297 :(3)11‬‬
‫ﺑﻤﻴﺪ‪http://dx.doi.org/10.3390/cancers11030297 30832346:‬‬
‫]‪ [118‬ﺇﺑﻨﺮ ﺩﻱ ﻛﻴﻪ‪ ،‬ﺗﻴﻨﺠﺎﻧﻴﻠﻲ ﺩﺑﻠﻴﻮ‪ ،‬ﻫﻴﻠﻢ ﺃ‪،‬ﻭﺁﺧﺮﻭﻥ‪.‬ﺍﻹﻣﻜﺎﻧﺎﺕ ﺍﻟﺘﻨﻈﻴﻤﻴﺔ ﺍﻟﻤﻨﺎﻋﻴﺔ‬
‫ﻹﺷﻌﺎﻉﺍﻟﺠﺴﻴﻤﺎﺕ ﻓﻲ ﻋﻼﺝ ﺍﻟﺴﺮﻃﺎﻥ‪ .‬ﻓﺮﻭﻧﺖ ﺇﻳﻤﻮﻧﻮﻝ ‪2017‬؛ ‪.99 :8‬‬
‫‪http://dx.doi.org/10.3389/fimmu.2017.00099 PMID: 28220126‬‬
‫]‪ [119‬ﺟﺮﺍﻧﺖ ﺭ‪ .‬ﻧﻈﺮﺓ ﻋﺎﻣﺔ‪ :‬ﺗﺸﺨﻴﺺ ﺃﻭﺭﺍﻡ ﺍﻟﻤﺦ ﻭﺇﺩﺍﺭﺗﻬﺎ ‪ /‬ﺭﻭﻱ‪-‬‬
‫ﺭﺍﺟﺎﻓﺎﺑﻮﺩﻱﻭﺁﺧﺮﻭﻥ‪.‬‬ ‫‪12‬ﺍﻟﺘﺼﻮﻳﺮ ﺍﻟﻄﺒﻲ ﺍﻟﺤﺎﻟﻲ‪ ،2021،‬ﺭﺣﻠﺔ ﺟﻮﻳﺔ‪ ،17 .‬ﻻ‪00 .‬‬

‫ﺟﺰﻳﺉﻲ‪.‬ﺟﻲ ﻛﻠﻴﻦ ﺃﻭﻧﻜﻮﻝ ‪2017‬؛ ‪PMID: 28640708 .63-2355 :(21)35‬‬ ‫‪]138[ Jain A, Amin AG, Jain P,‬ﻭﺁﺧﺮﻭﻥ‪.‬ﻭﺭﻡ ﻋﺼﺒﻲ ﻓﺮﻋﻲ‪ :‬ﺍﻟﻤﻈﺎﻫﺮ ﺍﻟﺴﺮﻳﺮﻳﺔ‬
‫‪http://dx.doi.org/10.1200/JCO.2017.72.7842‬‬ ‫ﻭﺍﻟﻨﺘﺎﺉﺞﺍﻟﺠﺮﺍﺣﻴﺔ‪ .‬ﻧﻴﻮﺭﻭﻝ ﺍﻟﺪﻗﺔ ‪2012‬؛ ‪.84-677 :(7)34‬‬
‫]‪ [141‬ﺷﻴﺦ ﺇﻥ‪ ،‬ﺩﻳﻜﺴﻴﺖ ﻛﻴﻪ‪ ،‬ﺭﺍﻳﺰﺭ ﺟﻴﻪ‪ .‬ﺍﻟﺘﻄﻮﺭﺍﺕ ﺍﻷﺧﻴﺮﺓ ﻓﻲ ﺍﻹﺩﺍﺭﺓ‪/‬ﺍﻟﻤﺴﺎﻋﺪﻳﻦ‪-‬‬ ‫ﺑﻤﻴﺪ‪:‬‬ ‫‪/10.1179/1743132812Y.000000006422747714‬‬
‫ﻣﺮﺽﺍﻟﻮﺭﻡ ﺍﻟﺴﺤﺎﺉﻲ‪ F1000 .‬ﺍﻟﺪﻗﺔ ‪2018‬؛ ‪29770198 .7 :7‬‬ ‫‪http://dx.doi.org‬‬
‫ﺑﻤﻴﺪ‪:‬‬ ‫‪http://dx.doi.org/10.12688/f1000research.13674.1‬‬ ‫]‪ [139‬ﺑﺎﺭﺑﺮﺍ ﺗﻲ ﺇﻱ‪ .‬ﺍﻟﻌﻼﺝ ﺍﻹﺷﻌﺎﻋﻲ ﻟﻸﻭﺭﺍﻡ ﺍﻟﺪﺑﻘﻴﺔ ﺍﻟﺒﺼﺮﻳﺔ‪ :‬ﺗﻘﺮﻳﺮ ﺣﺎﻟﺔ ﻭ‬
‫ﻣﺮﺍﺟﻌﺔﻟﻸﺩﺏ‪J Nucl Med Radiat Ther 2012; 03)04( .‬‬
‫]‪ [140‬ﺭﺍﻣﺎﺳﻮﺍﻣﻲ ﻑ‪ ،‬ﺗﺎﻳﻠﻮﺭ ﺇﻡ ﺩﻱ‪ .‬ﻭﺭﻡ ﺃﺭﻭﻣﻲ ﻧﺨﺎﻋﻲ‪ :‬ﻣﻦ ﺍﻷﺳﻄﻮﺭﺓ ﺇﻟﻰ‬

‫ﺇﺧﻼءﺍﻟﻤﺴﺆﻭﻟﻴﺔ‪ :‬ﺗﻢ ﻧﺸﺮ ﺍﻟﻤﻘﺎﻝ ﺃﻋﻼﻩ ﻓﻲ ‪) Epub‬ﻗﺒﻞ ﺍﻟﻄﺒﺎﻋﺔ( ﻋﻠﻰ ﺃﺳﺎﺱ ﺍﻟﻤﻮﺍﺩ ﺍﻟﺘﻲ ﻗﺪﻣﻬﺎ ﺍﻟﻤﺆﻟﻒ‪ .‬ﺗﺤﺘﻔﻆ ﺇﺩﺍﺭﺓ ﺍﻟﺘﺤﺮﻳﺮ ﺑﺎﻟﺤﻖ ﻓﻲ ﺇﺟﺮﺍء ﺗﻌﺪﻳﻼﺕ ﻃﻔﻴﻔﺔ‬
‫ﻟﻤﺰﻳﺪﻣﻦ ﺍﻟﺘﺤﺴﻴﻦ ﻋﻠﻰ ﺍﻟﻤﺨﻄﻮﻃﺔ‪.‬‬

‫ﻋﺮﺽﺇﺣﺼﺎﺉﻴﺎﺕ ﺍﻟﻨﺸﺮ‬