Kuchiza kwa Matenda a Ubongo Kuchokera ku Khansa ya m'mawere
Kodi chimachitika n'chiyani ngati kansa ya m'mawere ikufalikira mu ubongo wanu? Nthawi zina, ubongo wa ubongo umapezeka pamene khansa ya m'mawere imapezeka koyamba, koma nthawi zambiri, ubongo wa ubongo umawoneka ngati kansalu kakang'ono ka khansa ya m'mawere yomwe yaperekedwa kale. Kodi ndi zizindikiro ziti zomwe zingachitike, ndipo ndi njira ziti zomwe mungapeze ngati kansa ya m'mawere ikufalikira mu ubongo wanu?
Kwachidziwikire, ubongo wa metastases umapezeka pakati pa 15 ndi 24 peresenti ya amayi omwe ali ndi kansa ya m'mawere. Pamene kupulumuka kumawongolera, chiwerengerochi chiyenera kuwonjezeka.
Tsatanetsatane ndi Zachidule
Ubongo ndi chimodzi mwa malo omwe anthu amatha kufalitsa khansa ya m'mawere , kuphatikizapo mafupa , mapapo, ndi chiwindi . Khansara ya m'mawere ikamapita ku ubongo imayesedwa gawo 4 kapena khansa ya m'mawere. Ngakhale kuti sichichiritsidwa panthawi imeneyi, imatha kuchiritsidwa, ndipo mankhwala amatha kusintha zizindikiro, kuthandiza ndi khalidwe labwino, ndipo nthawi zina amapitiriza kukhala ndi moyo.
Pamene khansa ya m'mawere imasokoneza ubongo, ikadali khansa ya m'mawere. Ngati mutatenga chitsanzo cha misa kapena masses mu ubongo, amakhala ndi maselo a khansa, osati ma maselo a ubongo. Matenda a ubongo samatchedwa "kansa ya ubongo" koma makamaka "khansa ya m'mawere ya m'mawere ku ubongo" kapena "khansa ya m'mawere ndi ubongo metastases." Choncho, mankhwala ndiwo omwe amagwiritsidwa ntchito pa khansa yapakati ya m'mawere, osati omwe amagwiritsidwa ntchito pa khansa ya ubongo.
M'mbuyomu, mitsempha ya ubongo nthawi zonse inkaonedwa kuti ndi yosavomerezeka komanso cholinga cha chithandizo chinali "kupweteka," kutanthauza kusamalira zizindikiro koma osati kuyesa chotupa. M'zaka zaposachedwapa, lingaliro la "oligometastase" latchulidwa. Izi zikutanthauza kuti, pamene munthu ali ndi metastases yokha kapena yochepa chabe, ndipo palibe metastases yodalirika ku zigawo zina za thupi, njira yothandizira kuthetsa metastases ikhoza kuyesedwa.
M'mawu ena, pamene mankhwala nthawi zambiri amakhala ochepa, makamaka kwa anthu ambiri omwe ali ndi masastases ambiri, kwa anthu ena, mankhwala omwe angakhale ochizira angakhale oyenera.
Zizindikiro
Pali zizindikiro zosiyanasiyana zosiyana siyana zomwe zingayambe kukhalapo kwa ubongo metastases. Nthawi zina palibe zizindikilo, ndipo izi zimapezeka pokhapokha ngati mayeso ojambula, monga PET osokoneza kapena ubongo wa MRI wapangidwa. Pamene zizindikiro zilipo zingakhale monga:
- Mutu: Mutu chifukwa cha metastases ubongo ukhoza kukhala wofanana ndi mutu wa mutu kapena mutu wa mutu wa migraine, koma ukhoza kutsatidwa ndi zizindikiro zina zamaganizo (onani m'munsimu). Mu phunziro limodzi, mutu unalipo mwa 35 peresenti ya anthu pamene metastases ya ubongo inapezeka. Mutu wokhudzana ndi ubongo wa mitsempha umakhala woipitsitsa ndi kugona, poyipa m'mawa kapena kupuma, komanso poyipiritsa ndi kukokera, kupopera, kapena kuponyera pang'onopang'ono. Izi zati, zingakhale zovuta kusiyanitsa mutu wa "mutu" ndi omwe chifukwa cha metastases popanda kujambula maphunziro.
- Kuwombera: Kuwombera (popanda kapena kunyoza) kunali chizindikiro chachiŵiri chodziwika bwino cha ubongo m'maganizo. Zitha kuchitika mosayembekezereka popanda chizoloŵezi chisanayambe ndipo nthawi zambiri chimakhala choipitsitsa pambuyo pogona ndi m'mawa. Kuthamanga chifukwa cha ubongo metastases kumafika poipa kwambiri komanso nthawi zambiri.
- Kufooka kwa mbali imodzi ya thupi, kufooka, kapena kupota kumapeto: Hemiparesis, kufooka kapena kuuma kwa mbali imodzi ya thupi, inali chizindikiro chachitatu kwambiri cha mitsempha ya ubongo metastases mu phunziro limodzi.
- Masomphenya akusintha : Mavuto monga masomphenya awiri, masomphenya ophwanyika, kuwona kuwala, kapena kutayika kwa masomphenya kungayambe.
- Zokhumudwitsa: Kugonjetsa kungakhale tonic-clonic (grand mal) imene thupi lonse limagwedezeka ndipo munthu amatha kuzindikira, kupweteka pang'ono, kumene kumagwira dzanja, ngati kugwedezeka kwa dzanja, kapena mitundu ina ya kugunda, mwachitsanzo, munthu akuwoneka akuyang'ana mu malo osadziwika.
- Kutaya malire: Kutayika kungayambe kuoneka ngati kosavuta, kumangoyenda kumalo owerengera kapena kubwezera ngati zizindikiro.
- Kusintha kwa maganizo: Kusintha kwa umunthu, kusintha kwa khalidwe, kusinthasintha kwa maganizo, kapena kukhumudwa kukhoza kuchitika.
Zinthu Zowopsa / Zomwe Zimayambitsa
Palibe amene akudziwa chifukwa chake anthu ena amapanga ubongo wa masewera ndi ena samatero. Tikudziŵa zina mwazidzidzidzi, komabe, zomwe zimalosera kuti ndi anthu ati ndi zotani zomwe zingathe kufalikira ku ubongo. Matenda a ubongo amapezeka kwambiri kwa atsikana omwe ali ndi khansara ya m'mawere , ndipo chiwerengerochi chimakhala chapamwamba kwambiri kwa iwo omwe ali ndi zaka 35 asanafike. Matenda omwe amatha kufalikira ku ubongo ndi awa omwe ali ndi matenda apamwamba , omwe ali HER2 positive ndi estrogen receptor zoipa, ndi zomwe ziri zitatu zosasangalatsa.
Matenda a ubongo amakhala ochuluka kwambiri kwa omwe ali ndi matumbo akuluakulu (oposa 2 cm mamita), komanso anthu omwe ali ndi ma lymph node pa nthawi yoyamba. Nthawi yochepa pakati pa kansa yapachiyambi ya khansa yapachiyambi ndi kubwerezanso kumayanjananso ndi chiopsezo chachikulu cha metastases ya ubongo.
Kudziwa
Kafukufuku woganizira omwe nthawi zambiri amazindikira ubongo wa ubongo ndi ubongo wa MRIs ndi PET. Mapepala a CT amatha kugwiritsidwa ntchito kwa omwe sangathe kukhala ndi MRI (mwachitsanzo, omwe ali ndi zipsyinjo zamoto), koma magetsi a CT sagwira ntchito pozindikira kukhalapo kwa ubongo. Kafukufukuyu amatengedwa kuchokera pa zojambula zojambulajambula ndi mbiri ya khansa ya m'mawere, koma chiwopsezo chingayesedwe. Popeza vuto la receptor lingasinthe (ngati chotupa ndi receptor estrogen, progesterone receptor, kapena HER2 positive) ndi metastases, chiwerengero chingakhale chofunikira kuti musankhe njira zoyenera kwambiri za chithandizo.
Malo ofala kwambiri a ubongo metastases ndi cerebellum (gawo la ubongo lomwe limayang'anira kayendedwe) ndi lobes kutsogolo . Osachepera theka la anthu omwe amapezeka ndi ubongo wa ubongo kuchokera ku khansa ya m'mawere adzakhala ndi mavitamini ambiri omwe alipo.
Chithandizo
Njira zochiritsira za ubongo metastases zikhoza kuthyoledwa mu mankhwala ochizira, omwe amachititsa khansayo kulikonse m'thupi, ndi mankhwala am'deralo, omwe amatsutsana makamaka ndi metastases ya ubongo. Kuwonjezera pa mankhwala omwe amagwiritsidwa ntchito kuthetsera khansa yokha, steroid imagwiritsidwa ntchito kuchepetsa ubongo wa ubongo, ndipo nthawi zina zimachepetsa kwambiri zotsatira.
Vuto lalikulu lochiza ubongo metastases ndilokuti mankhwala ambiri satha kulowa m'magazi a ubongo. Mitsempha ya ubongo ndi ubongo wa ma capillaries omwe amapangidwa kuti azitulutsa poizoni kuchokera mu ubongo. Mwamwayi, imathandizanso kusunga mankhwala osokoneza bongo, komanso mankhwala ena omwe amachokera mu ubongo. Zofukufuku panopa akuyang'ana njira zowonjezereka kuti chiwerengero cha magazi ndi ubongo chifike patsogolo.
Kuwonjezera pa mankhwala a steroid komanso mankhwala ochizira matenda a ubongo, ndizofunika kuthana ndi zizindikiro zina zokhudzana ndi khansa ya mthupi, kutopa, kusala kudya, kuvutika maganizo, ndi zina zambiri. Wachikulire wanu angakulimbikitseni kulumikizana mosamala , ndipo izi zingakhale zoopsa ngati simukudziwa bwino munda. Kusamalana sikunali kofanana ndi chipatala, koma njira yothetsera matenda yogwiritsidwa ntchito pochiza matenda, matenda, ndi zauzimu zomwe zikuchitika ndi matenda a khansa. Kusamalidwa kungakhale kothandiza ngakhale ndi zotupa zowonongeka kwambiri.
Zosankha Zosintha
Njira zothandizira ndizo zomwe zimagwiritsidwa ntchito pokonza khansara yanu ya m'mawere mosasamala kumene ili m'thupi lanu. Kaya muli ndi mankhwala am'deralo amtundu wa metastases, chithandizo chamankhwala nthawi zambiri chimakhala chithandizochi. Mankhwala othandizira khansa ya m'mawere imatha kukhala:
Chemotherapy
Chemotherapy nthawi zambiri imagwiritsidwa ntchito pa khansa ya m'mawere, makamaka kugwiritsa ntchito mankhwala osokoneza bongo kusiyana ndi momwe munaliri ndi mankhwala enaake. Pali njira zambiri zosiyana kapena "mizere" ya mankhwala omwe angagwiritsidwe ntchito. Monga taonera, mankhwala ambiri a chemotherapy sayenera kuloŵa m'magazi a ubongo, koma nthawi zambiri metastases kumadera ena alipo pamodzi ndi metastases ya ubongo. Zingathandizenso kuchepetsa chiopsezo cha mitsempha yambiri ku ubongo.
Thandizo la mahomoni
Mankhwala opatsirana pogonana a khansa ya m'mawere akhoza kukulimbikitsidwa ngati chotupa chanu chiri cholowa cha estrogen. Kugwiritsiridwa ntchito kwa mankhwalawa kumadalira ngati inu munali pa mankhwala a hormonal kale, ndipo ngati ziri choncho, ndi mankhwala ati omwe inu mumatenga. Pamene khansa ya m'mawere imatha kusokoneza, si zachilendo kuti malo obvomerezeka asinthe, mwachitsanzo, chilakolako choyambirira cha estrogen chokhala ndi chotupa chingakhale chosowa cha estrogen komanso mosiyana. Kawirikawiri amaganiza kuti ngati mutakhala ndi mankhwala enaake a khansa pamene khansara yanu imachepetsanso, kuti chotupacho chikutsutsana ndi mankhwalawo. Mosiyana ndi njira zambiri zothandizira mankhwala, tamoxifen ndi aromatase inhibitors zimawoneka kuti zikudutsa malire a ubongo
Zovuta zothandizira
Njira zochiza matenda a khansa yabwino ya khansa ya m'mawere ya HER2 imadalira pa mankhwala, ngati mulipo, omwe munalipo pamene chifuwa chanu chinachepetsedwa. Mofanana ndi malo otchedwa estrogen reception, HER2 chikhalidwe chingasinthe, kotero kuti chotupa chomwe chinali HER2 zabwino kale chikhoza kukhala HER2 cholakwika pamene chikufalikira ku ubongo ndi mofananamo. Kwa iwo omwe sanalandire HER2 kale chithandizo cha mankhwala, mankhwala ochiritsidwa ndi Herceptin (trastuzumab) kapena Perjecta (pertuzumab) angathe kupulumuka. Ngati ubongo wa metastases umachitika pamene wina akulandira Herceptin (kapena mkati mwa miyezi 12 yakuletsa mankhwala), mankhwala a T-DM1 (trastuzumab emtansine) amapezeka kuti akuwongolera kwambiri kupulumuka. Mwamwayi, HER2 yodalidwa ndi mankhwala nthawi zambiri sinawoloke malire a ubongo.
Kugwiritsidwa ntchito kwa Tykerb (lapatinib) ndi Xeloda (capecitabine) kungagwiritsidwe ntchito, koma kumawoneka kuti kumangowonjezera bwino kwambiri ndi poizoni wambiri (ngakhale mankhwalawa amawoneka kuti akuwoloka malire a ubongo). Zikuwoneka kuti Tykerb amatha kugwira bwino ntchito pamodzi ndi Xeloda kusiyana ndi momwe amagwiritsidwira ntchito yekha.
Zovuta zachipatala
Kuphatikizana kwa mankhwala operekedwa pamwambapa, komanso magulu atsopano a mankhwala monga mankhwala osokoneza bongo ndi PARP inhibitors, akuphunziridwa m'mayesero azachipatala pa khansa ya m'mawere ya 4
Zosankha Zam'dera
Mankhwala am'deralo ndiwo omwe amagwiritsidwa ntchito pochiza ubongo metastases makamaka ndipo nthawi zambiri amalimbikitsa ngati ubongo wa metastases ukuchititsa zizindikiro zazikulu, kapena ngati masastases angapo alipo ndi cholinga chochotsa metastases. Pamene metastases ambiri alipo, cholinga chake ndi kuchepetsa zizindikiro (palliative). Ndi zowonongeka pang'ono, kuthetseratu kwa metastases kungayesedwe ndi cholinga chokhalitsa kupulumuka (ndi cholinga chochizira). Kawirikawiri, zimamveka kuti mankhwala ochiritsira kwambiri (monga SBRT ndi metastasectomy) ayenera kuganiziridwa makamaka kwa anthu omwe akuyenera kukhala ndi moyo miyezi yoposa 6 mpaka 12.
Ubongo Wonse Radiotherapy (WBRT)
Ubongo wonse wa radiotherapy wasokonezeka m'zaka zaposachedwa chifukwa cha zotsatira zake. Nthawi zambiri amalimbikitsidwa kwa anthu omwe afalikira mitsempha ya ubongo yomwe imayambitsa zizindikiro zazikulu. Kusintha kwa chidziwitso, monga mavuto a kukumbukira, kukumbukira mwamsanga, ndi kufotokoza momveka bwino ndizofala, ndikukhumudwitsa anthu omwe akulimbana ndi zizindikirozi. Popeza kuti umoyo wabwino nthawi zambiri umakhala ndi cholinga chofunika kwambiri pa matenda a khansa ya m'mawere, kugwiritsa ntchito WBRT kumafunika kuyeza mozama phindu phindu ndi zoopsa. Posachedwapa, kugwiritsa ntchito Namenda (mementine) pamodzi ndi WBRT zapezeka kuti kuchepetsa kuchepa kwa chidziwitso kawirikawiri.
Opaleshoni (Metastasectomy)
Kuchita opaleshoni kuchotsa mitsempha imodzi kapena yochepa chabe (yomwe imatchedwa metastasectomy) yakhala ikugwiritsidwa ntchito m'zaka zaposachedwa ndipo ikhoza kupulumuka ngati ikugwiritsidwa ntchito kwa anthu omwe ali oyenerera kuchitapo kanthu (ali ndi miyeso yochepa chabe ndipo ali ndi thanzi labwino). Kuchita opaleshoni kungakhale njira yabwino (kuposa SBRT pansi) kwa metastases yaikulu (yaikulu kuposa masentimita atatu). Mosiyana ndi SBRT, opaleshoni imakhala ndi zotsatira zomwe zimatha kuchepetsa ubongo. Komabe, pali chiopsezo chachikulu cha kuwonongeka kwa mitsempha, komanso chiopsezo cha "zotupa zotupa" (kufalikira maselo a khansa kudzera mu ubongo) ndi opaleshoni.
Stereotactic Body Radiotherapy (SBRT)
Zomwe zimatchedwanso "Cyberknife" kapena "gamma knife," thupi la stereotactic radiotherapy kapena SBRT imagwiritsira ntchito mlingo waukulu wa miyeso m'malo ena aang'ono kuti ayese kuthetsa metastases. Kawirikawiri amagwiritsidwa ntchito pamene masitasi ochepa chabe alipo, koma malo ena amachititsa anthu ndi mavitamini 10 pa nthawi. Ndondomeko ikhozanso kubwerezedwa kuti muzitsatira zina zotchedwa metastases zomwe zilipo kapena zomwe zimachitika nthawi. SBRT ikhoza kukhala njira yabwino kuposa opaleshoni ya metastases yomwe ili mkatikati mwa ubongo, kapena m'madera ovuta kumene opaleshoni ingawononge kwambiri ku matenda a ubongo wathanzi. Imakhala yogwira mtima kwambiri ndi metastases yaing'ono, ndipo opaleshoni ikhoza kukhala yabwino kwa metastase yaikulu kuposa masentimita atatu. Pali kuchepa kwalingaliro kochepa komwe kumapezeka ndi SBRT kusiyana ndi ubongo wonse wa radiotherapy, ngakhale kuti zotsatira zina, monga radiation necrosis, zingachitike.
Zina Zotheka Posankha
Zina zothandizira zothandizira ubongo wa ubongo zomwe sizinakhazikitsidwe bwino monga kuphwanya kwafupipafupi (RFA) ndi hyperthermia.
Metastases M'madera Oposa Chigawo Chimodzi
Ngakhale m'mbuyomo, chithandizo cha m'deralo cha metastases cha ubongo kawirikawiri chinali kuganiziridwa ngati panalibe malo ena a masastasis, ena amakhulupirira kuti chithandizo cha oligometastases mu malo oposa limodzi chingathandizenso kupulumuka. Mankhwala oterewa, omwe amatchedwa "mazira kwambiri" a khansa ya oligometastatic khansa, tsopano akuyesedwa mu mayesero a zamankhwala. Pakalipano, akuganiza kuti, kwa anthu osankhidwa bwino, kupulumuka kwaukhondo kwa nthawi yayitali ndi poizoni pang'ono kungakhale kotheka kwa anthu ena omwe ali ndi masewera ochepa pa malo ena monga ubongo, mapapo, mafupa, ndi chiwindi.
Kuthamangitsani
Chizindikiro cha khansa ya khansa ya m'ma 4 yomwe yafalikira ku ubongo sichimene ife tikufuna, makamaka ngati pali masitima ambiri. Izi zinati, ubongo wa metastases chifukwa cha khansa ya m'mawere imakhala bwino kuposa ubongo wa metastases chifukwa cha khansa yambiri.
Zakale, kupulumuka ndi ubongo metastases kunali pafupi miyezi isanu ndi umodzi koma izi zikusintha. Kafukufuku wa 2017 anapeza kuti kupulumuka kwa khansa ya m'mawere ndi ubongo metastases (mitundu yonse kuphatikizidwa) kunali zaka zoposa 2, ndi chiyembekezo cha moyo kwa zaka zitatu kwa iwo omwe ali ndi ziphuphu zabwino za HER2. Kutha posachedwa kudziwa momwe izi zidzasinthire ndi mankhwala monga SBRT ndi metastasectomy, koma maphunziro oyambirira akulonjeza. Ndikofunika kudziwa kuti pali opulumuka nthawi yaitali, ndipo pafupifupi 15 peresenti ya anthu omwe ali ndi kansa ya m'mawere amakhala zaka 10.
Kulimbana
Kulimbana ndi ubongo wa metastases kungakhale kovuta pambali ya kukhala ndi kansa ya m'mawere, ndi zizindikiro zomwe zingayambitse. Oncology ikusintha mofulumira, ndipo ndi zothandiza kuphunzira zonse zomwe mungathe pa matenda anu kuti muthe kugwira nawo mbali mwachangu. Funsani mafunso ambiri. Tengani kamphindi kuti mudziwe momwe mungafufuzire khansa yanu . Funsani za mayesero alionse omwe angakhalepo. Palinso kuyesa kwachipatala kufanana ndi malo omwe athandizi amatha kukuthandizani kuti mukhale ndi ufulu ngati muli ndi mayesero aliwonse omwe angagwiritsidwe ntchito pa khansa yanu. Monga taonera kale, kafukufuku wina akupeza kuti kupulumuka kwa nthawi yaitali kungakhale kotheka ngakhale ndi metastases, koma njira zambiri zatsopano zimayesedwa ngati kuyesera. Ndikofunika kukhala wothandizira wanu pa chisamaliro chanu cha khansa.
Ndikofunika kuti muzisamaliranso nokha. Funsani thandizo, ndipo lolani anthu kuti akuthandizeni. Palibe amene angakumane ndi khansa yokhayokha. Ganizirani kutenga nawo mbali pagulu lothandizira kapena kulowetsa m'modzi mwa anthu omwe akudwala khansa ya m'mawere . Anthu ambiri omwe ali ndi kansa ya m'mawere amathandizira kupeza magulu omwe ali ndi kansa ya m'magazi, m'malo mwa anthu omwe ali ndi magawo onse a khansa ya m'mawere. Kwa omwe akukumana ndi khansa ya m'mawere ya m'mawere ndi ana aang'ono, kumbukirani kuti pali magulu othandizira (ndi misasa ndi kubwerera) kwa ana omwe ali ndi kholo lomwe ali ndi khansa.
Nthawi zina ubongo umakhala wochuluka kapena wophatikizidwa ndi metastases wambiri kumalo ena. Ngakhale kupweteka khansa ya m'mawere sikuli bwino, chisamaliro chapadera choletsa zizindikiro zanu ndikukupatsani moyo wabwino kwambiri nthawi yomwe mwatsala akadali yofunika kwambiri. Taphunzira kuti kukambirana kukathetsa mavuto a moyo ndi khansa ya m'mawere imachitika nthawi zambiri. Tsoka ilo, anthu omwe ali ndi khansa yambiri komanso achibale awo nthawi zambiri amayenera kuyambitsa zokambiranazi.
Kusankha kuleka chithandizo sikukutanthauza kuti mukusiya. M'malo mwake, zikutanthauza kuti mukusankha kukhala ndi moyo wabwino pamapeto pa ulendo wanu. Ngati ndi wokondedwa wanu amene ali ndi khansara ya m'mawere, kutenga mphindi kuti muwerenge poyang'anira wokondedwa ndi khansara ya m'mawere ingapangitse kuti masiku ochepa apite mosavuta kuyenda.
Mawu Ochokera
Ngati mwapezeka kuti muli ndi metastases ya ubongo, mwina mukuwopa ndi kusokonezeka. Matenda a mitsempha nthawi zambiri amapezeka ngati kutalika kwa khansa ya m'mawere oyambirira. Kumva kuti khansara yanu idabwerera ndipo sichichiritsidwa ndikumvetsa chisoni.
Njira zothandizira komanso zamakono zimapezeka kuti zithetse vuto la ubongo. Pamene masastases angapo alipo ndipo ngati thanzi lanu lonse liri bwino, kuchiza metastases ndi njira monga SBRT kapena opaleshoni ikhoza kupulumuka. Ngati metastases anu ali ambiri, pali zinthu zambiri zomwe zingatheke kuti mukhale ndi moyo wabwino nthawi iliyonse imene mwasiya.
Ulendo wa munthu aliyense ndi wosiyana, ndipo ndibwino kuti iwe usakhale wosankha wina woti apange. Onetsetsani kuti muzilemekeza zofuna zanu zomwe mumasankha. Landirani zopereka kuchokera kwa ena, koma kumbukirani kuti iyi ndi ulendo wanu .
> Zotsatira:
> Brown, P., Jaeckle, K., Ballman, K. et al. Zotsatira za mankhwala osokoneza bongo okhaokha ndi mankhwala opangira opaleshoni ndi mankhwala onse a ubongo okhudzana ndi chidziwitso kwa odwala ndi 1 - 3 ubongo Metastases. Zomwe Zili M'ndandanda Wazitsulo. JAMA . 2016. 316 (4): 401-409.
> Polivka, J., Kralickova, M., Polivka, J. et al. Maganizo a Matenda a Metastatic Ubongo M'thupi la Khansa Yamatenda: Kulimbitsa Maganizo Opatsirana, Kulimbana ndi Matenda ndi Kukonzekera Kwadongosolo Pazomwe Mukuyembekezera? . EPMA Journal . 2017. 8 (2): 119-127.
> Rostami, R., Mittal, S., Rostami, P., Tavassoli, F., ndi B. Jabbari. Matenda a ubongo mu kansa ya m'mimba: Ndemanga Yomvetsa Zambiri. Journal of Neurooncology . 2016. 127 (3): 407-14.
> Trovo, M., Furlan, C., Polesel, J. et al. Thandizo Labwino la Ma ARV kwa Oligometastatic Cancer ya M'bwere: Zotsatira za Zotsatira Zopambana Zachiwiri. Radiotherapy ndi Oncology . 2018. 126 (1): 177-180.
> National Library of Medicine. Medline Plus. Pamene Chithandizo cha Khansa Yanu Imasiya Ntchito. Kusinthidwa 08/15/16. https://medlineplus.gov/ency/patientinstructions/000851.htm