Marti, 20 11 2018
Crimă din nepăsare: radioterapia la Iași se face „facultativ”

Crimă din nepăsare: radioterapia la Iași se face „facultativ”

Fără soluţii de rezervă la aparatura de radioterapie, bolnavii de cancer sunt condamnaţi pentru a doua oară. Ce-ar trebui să-l intereseze pe deputatul Ciuhodaru: să aducă mai multe acceleratoare la Iași. Din ianuarie până în martie, acceleratorul a stat mai mult pe avarie. Sunt pacienți care au făcut 21 de ședințe din schema obligatorie de 35. Restul zilelor, aparatul a fost defect. Anual, sunt peste 1.000 de bolnavi din toată Moldova amânați la tratament. Explicația medicilor: trebuie un număr dublu de aparate, pentru că se strică și e nevoie de „back-up”. În Ljubliana (Slovenia) sunt 8 acceleratoare tocmai din acest motiv. Deputații Ciuhodaru și Bănicioiu au alte preocupări, printre care bătălia pentru ciolan, în timp ce 3 milioane de euro investiți ar salva mii de vieți.

 

Institutul Regional de Oncologie (IRO) deţine acceleratoare de particule care acţionează interpretând datele şi lansează „razele” doar asupra tumorii localizate 3d. Aceste aparate sofisticate se defectează sau au nevoie de lucrări de întreţinere, iar în acele zile pacienţii pierd şedinţele de radioterapie. Faptul că nu există, în toată Moldova, o soluţie de a le înlocui face ca şedinţele să fie reprogramate. Ce spun medicii? „Pentru o zi, nu este nici o problemă. Există scheme de compensare. De la două-trei zile în plus pauză în tratament, compensarea nu mai este eficientă”.

 

Cancerul şi pauzele de tratament

Dacă medicii au decis o anumită schemă de tratament radiologic, aceasta trebuie respectată cu sfinţenie. La ora stabilită, pacientul trebuie întins pe masa de tratament a acceleratorului şi poziţionat perfect, pentru a se potrivi cu imaginea tridimensională a tumorii ce există deja în memoria aparatului. Apoi, dintr-o colaborare între fizicieni şi medici, rezultă o anumită intensitate a „razelor” cu care celulele canceroase şi doar ele vor fi bombardate. 15, 20, 35 de zile - în funcţie de deciziile luate -, pacientul urmează acceaşi rutină.

Problema este că în această rutină mai intervin, din când în când, revizii sau defecţiuni ale aparaturii. „Cu cât acceleratorul este mai performant, mai sofisticat, cu atât există şanse să se defecteze ceva la el. Are sisteme de protecţie şi atunci îşi comandă închiderea dispozitivelor, se blochează şi va reporni doar după intervenţii”, explică Mirela Grosu, managerul IRO. Chiar dacă aparatul este blocat efectiv doar o oră, timpul în care nu va funcţiona este, de fapt, mult mai îndelungat. Asta pentru că, după reparaţia sau revizia efectivă, intră pe mâna fizicienilor. Aceştia verifică, calibrează dacă este cazul şi totul mai durează încă două, trei sau patru ore. „Nu am realizat încă statistici pentru primele două luni din acest an, dar trăiesc cu senzaţia că anul acesta aparatele au fost blocate mai des”, spune Mirela Grosu. Problema la Iaşi este că nu există aparatură de rezervă care să preia pacienţii programaţi.

 

Acceleratorul de 10 milioane de electron-volţi (MeV), speranţa pentru mulţi pacienţi de la IRO

 

Efectele asupra pacienţilor

Medicii spun că o zi de pauză în radioterapie nu ar reprezenta un risc pentru pacienţi. Tot ei spun, însă, că pauzele de mai mult de două-trei zile sunt riscante şi evoluţia este imprevizibilă. „Există scheme de compensare a întreruperilor din tratament. Pauza mai mare de două-trei zile nu este de dorit. În statele civilizate, există contracte între spitalele care au astfel de aparate şi, în cazul unor defecţiuni, pacienţii sunt trimişi la alte clinici, dar nu se face pauză. În plus, în ţările dezvoltate nu există câte un singur aparat din fiecare model. Pentru fiecare accelerator există back-up. S-a defectat unul, automat treci la următorul până la finalizarea intervenţiei”, a declarat profesorul Gabriel Dimofte, directorul medical al IRO.

Medicul dă şi un exemplu: Ljubljana, capitala Sloveniei. Spitalele de aici deţin, în total, 8 acceleratoare. Cu toate acestea, sistemul a fost atât de prevăzător cu pacienţii de acolo încât nu s-a bazat doar pe existenţa acestor aparate. “Dacă, prin absurd, s-ar defecta toate în acelaşi timp, pacienţii din Slovenia sunt trimişi imediat în Germania, la clinici cu care există contracte în acest sens”, explică Dimofte. Ce se întâmplă la noi cu pacienţii dacă există o problemă a aparaturii? Şedinţa este pur şi simplu întârziată sau amânată.

 

20 de aparate la nivel naţional

În Iaşi există 3 aparate – unul mai vechi, amplasat la Spitalul Sfântul Spiridon, care funcţionează clasic, „bombardând” o zonă a corpului, dar afectează şi ţesut sănătos, şi două moderne, la IRO, care „bombardează” în spaţiu 3d doar zona bolnavă. În Moldova mai există un singur aparat, la Bacău, la noua secţie de radioterapie a Spitalului Judeţean. Celelalte aparate, până la 20, sunt ori în sudul ţării, ori în Ardeal. „Pacienţii din zona noastră depind doar de cele trei aparate pe care le avem şi, în special, de cele două de la IRO. Problema lipsei aparaturii de back-up pe domeniul radioterapie este cunoscută la nivel naţional, la Minister, peste tot. Nu este doar la Iaşi, celelalte centre de tratament au aceeaşi problemă”, mai spune Mirela Grosu.

 

„Dacă, prin absurd, s-ar defecta toate acceleratoarele în acelaşi timp, pacienţii din Slovenia sunt trimişi imediat în Germania”, Medic Gabriel Dimofte, director medical IRO

 

Câţi pacienţi sunt afectaţi

În 2016, IRO a tratat în ambulatoriu, timp de 220 de zile (în celelalte zile a fost week-end, sărbători sau aparatele au fost defecte sau în revizie) 1.378 de pacienţi care au beneficiat de 24.758 de şedinţe de radioterapie (medie de 20 de şedinţe la fiecare pacient). Încă 1.294 de pacienţi au fost trataţi fiind internaţi – 11.422 de zile (medie de 8 şedinţe de pacient). În total, au fost trataţi, în 2016, peste 2.600 de pacienţi, care au avut, la 220 de zile, 165 de şedinţe de radioterapie pe zi. O medie de peste 50 la fiecare aparat.

 

IRO are proiecte pentru achiziţia a două acceleratoare. Unul ar urma să fie montat la Hotelul IRO din Tătăraşi, într-un buncăr din subsol, iar cel de-al doilea la un viitor centru de diagnostic şi tratament de pe Sărărie. Aparatele costă, cu tot cu buncăre, 6 milioane de euro.

 

Defecţiuni şi revizii

Acceleratorul de 10 MeV al IRO a fost defect sau în revizie 15 zile în primele 6 luni de anul trecut. Acceleratorul de 15 MeV a fost defect, în aceeaşi perioadă, 8 zile. „Este un deficit de 70% la numărul de aparate. Service-ul îl face o firmă care asigură orice piesă defectă în maximum 24 de ore, în orice perioadă a anului”, declară Mirela Grosu. Spre exemplu, acum câteva zile, acceleratorul de 15MeV a fost blocat o zi din cauza unui rulment de uşă defect. Uşa are 5 tone greutate şi eventuala defectare ar bloca pacientul în interior. Tot aparatul a fost închis până la înlocuirea rulmentului.

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