Zometa kapena Bonefos zingathandize bwanji odwala matendawa?
Ngakhale kuti mankhwala odwala matenda a m'mimba akhala akugwiritsidwa ntchito kwa anthu omwe ali ndi kansa ya m'mawere ndi mafupa a metastases, malangizo atsopano a 2017 ochokera ku American Society of Clinical Oncology amalimbikitsa kugwiritsa ntchito mankhwala a bisphosphonate Zometa kwa amayi ena omwe ali ndi khansa ya m'mawere. Kodi kwenikweni bisphosphonates ndi momwe amagwirira ntchito? Kodi zingatheke bwanji kuti khansa yanu ya m'mawere ifalikire mafupa anu ndikupulumuka?
Kodi mungadziwe bwanji ngati mankhwalawa angakhale abwino kwa inu?
Khansa ya m'mawere ndi ngozi yowonongeka
Khansara ya m'mawere oyambirira imatha kuchiritsidwa kwambiri, ndipo miyoyo yowonjezera yakula bwino ndi kuwonjezereka kwa mankhwala a adjuvant ndi mahomoni kwa omwe akufunira mankhwalawa. Komabe ngakhale ndi khansa ya m'mawere oyambirira ( siteji I , siteji II , ndi siteji III ), kubwereza kumakhala kofala kwambiri.
Kuopsa kwa kubwereza kumasiyanasiyana ndi zinthu zingapo zomwe zimayambitsa kansa yanu, msinkhu wanu, mankhwala omwe mumalandira, ndi zina. Sitikudziwa chifukwa chake kansa imatuluka zaka zambiri kapena zaka zambiri, ngakhale ziganizo zokhudzana ndi chifukwa chake khansa ya m'mawere imaphatikizapo lingaliro lakuti pali otsogolera maselo a khansa, komanso kuti maselo a khansa (akuluakulu a khansa) akhoza kugona m'magazi mpaka chikhalidwe chiyenera kuyamba kukula kachiwiri.
Matenda a khansa ya m'mimba angakhale ya mitundu itatu:
- Kubwereza komweko , kumene chimatuluka m'mimba pafupi ndi malo a chotupa choyambirira.
- Kubwereza m'midzi, kumene khansara imayandikira pafupi ndi malo am'mimba kapena pafupi.
- Kubwereza kwambiri , kumene khansa imabwerera kumadera akutali a thupi monga mafupa, chiwindi, mapapo, kapena ubongo. Mwa awa, mafupa ndiwo malo ofala kwambiri a metastases.
Ndi khansara yam'mbuyo yambiri ya khansa (siteji ya khansa ya m'mawere 4) yomwe imayambitsa 90 peresenti ya imfa ya khansa ya m'mawere.
Ndani Angapezeke ndi Matenda a Matenda a Kachiwerewere?
Pafupi aliyense yemwe wakhala ndi khansa ya m'mawere akhoza kukhala pangozi yopanga mafupa a mitsempha, koma pali malo omwe angathe kukhala nawo.
Matenda a metastases amapezeka kwambiri kwa anthu omwe ali ndi khansa ya m'mawere yotchedwa estrogen . Matenda a Estrogen amatha kukhala okhudzidwa mobwerezabwereza, mwachitsanzo, zaka zambiri kapena makumi angapo kansalu yoyamba itapezeka ndikuperekedwa. Zina zomwe zimapangitsa kuti chiopsezo cha khansa ya m'mawere chibwererenso ndi matenda a mliri wam'thupi .
Pafupifupi 70 peresenti ya amayi omwe ali ndi khansa ya m'mawere (siteji ya khansa ya m'mawere 4) adzakhala ndi mafupa.
Udindo wa Bisphosphonates mu Khansara Yamatumbo
Bisphosphonates idagwiritsidwa ntchito koyamba m'ma 1990 pamene anavomerezedwa kuti athetse matenda odwala matenda a m'mimba . Kuyambira nthawi imeneyo amavomerezedwa kuti azitsatira mafupa a mitsempha kuchokera ku khansa ya m'mawere (ndi khansa zina) komanso hypercalcemia yokhudzana ndi khansa.
Njira zingapo zomwe bisphosphonates zingakhale zothandiza kwa anthu omwe ali ndi khansa ya m'mawere ndizo:
- Amayi omwe ali ndi khansara ya m'mawere yomwe yafalitsidwa ku mafupa ( kansa ya m'mawere ndi metastases ya fupa ), bisphosphonates monga Zometa amachepetsa chiopsezo cha mavuto monga mafupa osweka. Popeza kuti kupweteka kwa mafupa ndi chifukwa chachikulu cha ululu ndi kulemala, mankhwalawa angathe kusintha kwambiri moyo wa amayi omwe ali ndi matendawa.
- Aromatase inhibitors, mankhwala a mahomoni a kansa ya m'mawere omwe nthawi zambiri amagwiritsidwa ntchito m'mayi am'mbuyo, amachititsa kuti mafupa awonongeke. Kutaya kwa pfupa kumeneku kungachititse kuti mitsempha ikhale yokha, koma ikhoza kuonjezera mavuto pamene mafupa a metastases alipo.
- Muzofufuza, kugwiritsa ntchito Zometa mu khansa ya m'mawere yakusintha imapulumuka.
- Posachedwapa, kugwiritsidwa ntchito kwa bisphosphonates mu kansa ya m'mawere oyambirira ya atrogen yolandira chithandizo kunayambitsidwa ndi chiopsezo chochepa chokhazikitsa mitsempha ya mafupa pamalo oyambirira komanso kuchulukitsa kupitirira (onani m'munsimu).
Ubwino wa Bisphosphonates monga Chithandizo cha Adjuvant kwa Khansa ya M'mbuyo Yamatenda
Pofufuza kuyang'ana pamatenda a khansa ya m'mawere ku fupa, zinapezeka kuti bisphosphonates sikuti anangowonjezera chiwopsezo cha mitsempha chifukwa cha metastases koma adawonekeratu kuti athetse kufalikira kwa khansa ku mafupa.
Ngakhale kuti sitikudziŵa bwinobwino momwe amagwirira ntchito, mankhwalawa amawoneka kuti amachititsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda.
Popeza mafupa a metastases ndi omwe amachititsa kuti anthu azifa ndi khansa ya m'mawere, kuchepetsedwa kwa chiopsezo cha mitsempha yotereyi ikhoza kupulumuka kwa amayi omwe ali ndi matenda oyambirira.
Kafukufuku wotsatira adatsimikizira kuti mfundo izi zinali zolondola. Pambuyo poperekedwa opaleshoni komanso chemotherapy komanso mankhwala opatsirana pogwiritsa ntchito mankhwala a bisphosphonates kwa khansa ya m'mawere oyambirira kwa amayi omwe ali ndi postmenopausal amapezeka kuchepetsa chiopsezo chokhala ndi mafupa amtundu wa magawo atatu ndi kuchepetsa chiopsezo cha imfa imodzi -sixth. Ngakhale kuti chiwerengerochi chimawoneka chodabwitsa, kuchepetsa kwenikweni pa chiopsezo chachikulu ndi chochepa poyang'ana chithunzi chachikulu, ndi bisphosphonates kupereka pafupifupi 1 mpaka 2 peresenti kuchepa kwa chiopsezo cha imfa mwa amayi omwe akufunira mankhwala.
Kuwonjezera pa kuchepetsa chiopsezo cha metastases ndi kupititsa patsogolo kupulumuka, bisphosphonates ikhoza kugwira ntchito ina. Aromatase inhibitors, mtundu wa mankhwala omwe amachititsa kuti amayi omwe ali ndi menopausal (kapena amayi omwe ali ndi vuto loyambitsa matenda opatsirana pogonana) amatha kutaya mafupa ndi osteoporosis. Izi ndizofunika kwambiri tsopano kuti mankhwalawa akulimbikitsidwa kwa nthawi yayitali kapena atalandira chithandizo ndi tamoxifen. Zometa inapezeka kuti imachepetsa chiopsezo cha matenda a m'magazi omwe amapezeka ndi aromatase inhibitors. Mankhwala omwe amadziwika kuti aromatase inhibitors ndi Aromasin (exemestane), Arimidex (anastrozole), ndi Femara (letrozole).
Malangizo a Bisphosphonate Kumayambiriro Oyamba Khansara Yamatumbo
Zotsatira zamakono zimalimbikitsa kugwiritsa ntchito chimodzi mwa mankhwala awiri osiyana pa izi:
- Zometa (zoledronic acid): Zometa ndi mawonekedwe a bisphosphonate. Mlingo womwe ukuperekedwa ngati mankhwala a adjuvant pa khansa ya m'mawere oyambirira ndi 4 mg V IV miyezi isanu ndi umodzi kwa zaka zitatu kapena zisanu.
- Bonefos (clodronate): Bonefos ndi oral oral phophophonphonate yomwe ingagwiritsidwe ntchito ngati njira yowonjezera ku Zometa ngati pakufunika. Mlingo wa mankhwala a adjuvant ndi piritsi ya 1600 mg yomwe imatengedwa kamodzi pa tsiku kwa zaka ziwiri kapena zitatu. Bonefos si FDA yovomerezeka ku United States.
Chiwerengero cha Zometa chomwe chimagwiritsidwa ntchito pa khansa ya m'mawere oyambirira ndi yosiyana (kuposa kawirikawiri) kuposa yomwe imagwiritsidwa ntchito pa khansa ya m'mawere.
Ndani Angagwiritse ntchito Zometa kapena Bonefos kwa Chithandizo cha khansa ya m'mawere?
Zometa (kapena Bonefos) zikulimbikitsidwa kuti adjuvant adziwe khansa ya m'mawere yotchedwa estrogen receptor-positive intraductal. Izi ziyenera kugwiritsidwa ntchito kwa amayi omwe ali ndi postmenopausal panthawi yomwe akudziwidwa kapena omwe ali a premenopausal koma adalandira mankhwala ochotsera ovarian .
Azimayi ambiri omwe adatetezedwa ku khansa ya m'mawere oyambirira musanayambe izi, angadabwe ngati ayamba kuyamba mankhwalawa kapena ayi. Yankho ndilokuti zimadalira, ndipo pali zinthu zambiri zomwe muyenera kuziganizira. Maphunzirowa anachitidwa ndi amayi omwe adayambitsa bisphosphonates atatha opaleshoni ndi chemotherapy, ndipo tilibe deta yabwino yochepetsa kuchepa kwa mankhwala kapena kupindula kwa anthu amene ayambitsa mankhwalawa.
Tikudziwa kuti bisphosphonates ikhoza kuchepetsa kuperewera kwa mafupa kwa anthu omwe ali ndi matenda osteopenia komanso osteoporosis, ndipo aromatase inhibitors akuphatikizidwa ndi kutaya kwakukulu kwa mafupa kwa anthu ena. Madokotala ena amalimbikitsa bisphosphonates kwa osteopenia ngati palibenso kuperewera kwa mafupa (ngakhale mayeso osiyana angagwiritsidwe ntchito) kapena ngati munthu ali ndi zifukwa zazikulu zovulaza. Mutha kuyankhula ndi a oncologist anu pomuyesa musanayeso musanapange chisankho chanu. Ngati muli ndi kachilombo ka osteoporosis, pangakhale phindu logwiritsa ntchito mankhwalawa.
Mavuto ndi Zovuta za Bisphosphonates
Zotsatira zofala kwambiri za Zometa ndi matenda a chimfine omwe amakhalapo kwa masiku angapo mutatha kulowetsedwa.
Zotsatira za m'kamwa Bonefos zingaphatikizepo kutsekemera, kuthamanga, ndi kutupa kochepa. Mankhwala am'thupi ayenera kutengedwa ndi madzi ndipo anthu akuuzidwa kuti akhalebe owongoka kwa mphindi 30 mpaka 60 kuti athetse chiopsezo cha kukhumudwa.
Zovuta zochepa zomwe zimagwiritsidwa ntchito ndi bisphosphonates zimagwiritsidwa ntchito pamlomo kapena mwachisawawa, kuphatikizapo kuchepa kwa magazi (hypocalcemia), kupweteka kwa minofu, kuphatikizana, ndi / kapena kupweteka mafupa (izi zikhoza kuchitika nthawi iliyonse pogwiritsira ntchito mankhwala), ndi ntchito yovuta ya impso. Anthu omwe ali ndi vuto la impso asanayambe kugonana sangathe kugwiritsa ntchito mankhwalawa. Zowonjezereka zina zomwe zimakhala zovuta zimaphatikizapo ziphuphu zam'mimba zam'mimba ndi mafinya oopsa.
Chinthu chachilendo koma chovuta komanso chovuta cha zotsatira za bisphosphates ndi osteonecrosis wa nsagwada. Osteonecrosis imatanthawuza kuwonongedwa kwa fupa ndipo ikhoza kuchitika muyeso kapena maxilla. Zizindikiro zambiri zimayambira ndi ululu wa nsagwada kapena kutayidwa kwa dzino. Mu maphunziro akuyang'ana kugwiritsa ntchito Zometa monga mankhwala adjuvant pa khansa ya m'mawere, osteonecrosis ya nsagwada inapezeka pafupifupi 2 peresenti ya amayi omwe amatenga Zometa.
Zowopsa za osteonecrosis zimaphatikizapo matenda a gamu, ukhondo wabwino wa mano, kapena kugwiritsa ntchito zipangizo zamano. Kafukufuku akhala akuyang'ana njira zothetsera chiopsezo. Phunziro limodzi, kukhazikitsa mayeso a mano pakatha miyezi itatu ndikugwiritsira ntchito antibiotic prophylaxis musanayambe njira zamano kumagwirizanitsa ndi chiopsezo chochepa cha chikhalidwecho. Pamene osteonecrosis ya nsagwada imapezeka, zingakhale zovuta kuchiza. Kaŵirikaŵiri kuphatikiza mankhwala opha tizilombo, opaleshoni, zopometsera pakamwa, ndi mankhwala othandizira okosijeni otchedwa hyperbaric.
Pamene osteonecrosis ya nsagwada ikhoza kuchitika ndi bisphosphonate iliyonse, imakhala ikuwoneka bwino (94 peresenti ya nthawiyo) ndi ma bisphosphonates amkati.
Musanayambe Zometa kapena Bonefos
Musanayambe Zometa kapena Bonefos mukulimbikitsidwa kuti mukhale ndi kafukufuku wamkati mwachindunji mwakufunafuna umboni uliwonse wa matenda a chingamu. Ngati mukusowa ntchito iliyonse ya mano, monga kuchotsa dzino, zimalimbikitsanso kuti mutsirizitse njira zamanozi musanayambe ma bisphosphonates.
Bisphosphonates ndi Canast Metastatic Breast Breast
Bisphosphonates ndi mtundu wina wa mankhwala, denosumab (Xgeva kapena Prolia) amatchulidwa kuti mankhwala osokoneza mafupa. Mankhwalawa ndi othandiza kwambiri kuchepetsa chiopsezo cha zophulika zokhudzana ndi mafupa a mitsempha ya khansa ya m'mawere. Tsopano tikulimbikitsanso kuti bisphosphonates kapena denosumab ziyambe pamene mafupa a metastases amapezeka koyamba. Pogwiritsidwa ntchito pa mitsempha ya mafupa, mlingo wa Zometa uli wapamwamba ndipo umaperekedwa ngati 4 mg kulowetsedwa m'masabata khumi ndi awiri kapena masabata atatu kapena anayi.
Pamunsi pa Adjuvant Bisphosphonates kwa Gawo Loyambirira Khansara Yamatumbo
Bisphosphonates (Zometa) anawonjezeredwa ku chithandizo cha chithandizo cha 2017 cha mankhwala opatsirana pogwiritsa ntchito khansa ya m'mawere ya estrogen yomwe imapezeka m'mimba mwa amayi omwe amachititsa mimba. Mankhwalawa amachepetsa chiopsezo cha matenda opatsirana odwala matendawa, koma amawoneka kuti amachepetse chiopsezo chokhala ndi mitsempha ya mafupa ndipo akhoza kupulumuka.
Mankhwalawa amayamba atatha opaleshoni komanso mankhwala enaake komanso nthawi yomweyo mankhwalawa amayamba.
Matenda a metastases ndi khansara ya m'mawere sizitanthauza kuti khansayo sichichira koma imapweteka kwambiri. Zovuta za mafupa a metastases zimaphatikizapo fractures, kupanikizika kwa msana, ndi kuchuluka kwa magazi a calcium, zomwe zimachepetsera umoyo wa moyo ndi kuchepetsa kupulumuka.
Mabisphosphonates, monga mankhwala onse, akhoza kukhala ndi zotsatirapo. Zometa nthawi zambiri zimayambitsa matenda a chimfine kwa tsiku kapena awiri mutatha kulowetsedwa ndi Bonefos kungayambitse kupsa mtima. Anthu ena amakhalanso ndi vuto la impso losalimba kapena mlingo wochepa wa magazi. Zowopsa koma zoyipa kwambiri ndi osteonecrosis wa ntchito, chikhalidwe chomwe chiganiziridwa kuti chimakhudza mayi mmodzi mwa amayi 50 omwe amagwiritsa ntchito mankhwalawa motere. Ukhondo wabwino wa mano ndi kafukufuku wamazinyo asanayambe kulandira chithandizo kungachepetse ngozi.
Kwa amayi omwe adatetezedwa ku khansa ya m'mawere oyambirira, koma omwe akadakhala ovomerezeka pa mankhwala a adjuvant, pakalipano palibe ndondomeko m'malo mwake. Lankhulani ndi oncologist wanu za maganizo ake ndi zomwe akuwona kuti ndi ubwino ndi zovuta za mankhwala. Kudziwa kuchuluka kwa fupa lanu ndi kuyang'ana pa zoopsa, kaya kubwereza kapena zotsatira za mankhwala kungathandize kutsogolera chisankho chanu. Monga ndi chisamaliro chanu chonse, kukhala wothandizira anu pa chisamaliro chanu cha khansa kumapangitsa kusiyana.
> Zotsatira:
> Beth-Tasdogan, N., Mayer, B., Hussein, H., ndi O. Zolk. Zothandizira Kuthetsa Mankhwala Osteonecrosis Okhudzana ndi Mankhwala. Dongosolo la Cochrane la Zosintha Zogwirizana . 2017. 10: CD012432.
> Coleman, R. Impact ya Matenda-Matenda Otsatiridwa pa Matenda Otsalira ndi Kupulumuka mu Khansara Yamatumbo. Oncology (Williston Park) . 2016. 30 (8): 695-702.
> Dhesy-Pind, S., Fletcher, G., Blanchette, P. et al. Kugwiritsira Ntchito Adjuvant Bisphosphonates ndi Mafupa Ena-Othandiza Kusintha Khansa Yamatumbo: CancerCare Ontario ndi American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology . 2017. 35 (18): 2062-2081.
> Hadii, P., Coleman, R., Wilson, C. ndi al. Mankhwala a Adjuvant Bisphosphonates mu Khansara Yam'mbuyo Yam'mbuyo: Malangizo a Consensus for Clinical Practice Kuchokera ku European Panel. Annals of Oncology . 2016. 27 (3): 379-90.