Mankhwala otchedwa chemthérapie (intraperitoneal chemotherapy) ndiwo njira yothandizira mankhwala a chemotherapy kwa khansara ya ovari m'mimba mwathu. Ngakhale mankhwala ambiri a chemotherapy ndi opatsirana, ndipo njira zambiri zatsopano zothandizira mankhwala kapena mankhwala ochiritsira ndizokamwa, njira yothandizira munthu kuti ayambe kulandira mankhwala a chemotherapy ndi imodzi mwa mankhwala ovomerezeka oyambirira kwa amayi omwe ali ndi khansa yowonongeka .
Phunziro Lofunika Kwambiri
Mu 2006, zotsatira za Gynecologic Oncology Group mayesero a GOG 172 anafalitsidwa ku New England Journal of Medicine. Phunziroli, amayi adayenera kulandira chithandizo ngati ali ndi kansa ya masewera atatu kapena khansara yoyamba ya piritoneal ndipo ngati ali ndi opaleshoni yabwino kwambiri yopanga mavitamini (kutanthauza kuti palibe chotupa choposa choposa 1 cm chimene chinasiyidwa pambuyo pa opaleshoni).
Chiyesocho chinali chokhazikika, chomwe chimatanthauza kuti odwala amapatsidwa gulu la mankhwala ndi flip ya ndalama. Mwa amayi 415 omwe amaphunzira, hafu analandira mankhwala amtundu wa mankhwala omwe amagwiritsa ntchito cisplatin ndi paclitaxel ( Taxol ). Theka lina analandira mankhwala omwewo, koma kuphatikizapo intravenous (paclitaxel) ndi intraperitoneal (cisplatin ndi paclitaxel) yobereka.
Izi sizowonjezera mankhwala ovuta, ndipo zotsatira za phunziro zimatsimikizira zimenezo. Azimayi 42% okha omwe ali m'magulu a intraperitoneal amatha kulandira mankhwala asanu ndi limodzi omwe amatha kupatsirana mankhwala.
Azimayi okwana 90% omwe ali m'magulu amkati adalandira maulendo asanu ndi limodzi. Azimayi omwe adalandira mankhwala opatsirana pogwiritsa ntchito mankhwala opatsirana pogwiritsa ntchito mankhwalawa anali ndi kutopa kwakukulu kapena kuopsa kwa moyo, kupweteka, kuchepa kwa magazi, ndi zotsatira za matenda a neurologic. Chofunikanso kudziwa ndikuti amayi asanu ndi anayi anamwalira pa mankhwala a chemotherapy - anayi m'magulu amkati mwa anthu omwe ali ndi intravenous ndipo asanu mwa gulu la intraperitoneal.
Imfayi inali chifukwa cha matenda.
Kupindula kwapulumuka
Kafukufuku uyu wa 2006 anapanga mitu, ngakhale poizoni wa mankhwala, chifukwa cha zotsatira za moyo. Ngakhale kuti amayi 42% okha omwe ali m'magulu a intraperitoneal adatha kulandira mankhwala onse asanu ndi limodzi, kupulumuka kwapanda pang'onopang'ono (nthawi yopitirira khansa isanakwane) inali yaitali kwa miyezi isanu ndi iwiri kwa gulu la mankhwala a chemthropiyoni. Chodabwitsa kwambiri chinali deta yonse ya moyo. Azimayi amene adalandira mankhwala opatsirana pogwiritsa ntchito mankhwala omwe ali ndi matendawa amakhala ndi moyo wautali kuposa miyezi 16 kuposa amayi omwe analandira mankhwala amtundu wa mankhwala okhaokha - miyezi 65.6 poyerekeza ndi miyezi 49.7.
Pogwiritsa ntchito kwambiri zotsatira za phunziro lino, komanso pa mayesero ena awiri, gawo la National Cancer Institute linapereka chidziwitso chachithandizo chodziwitsa anthu kuti chigwiritsire ntchito mankhwala a chemthrophyisoni ayenera kuganiziridwa mozama kwa oyenerera.
Mfundo Zothandiza
Kulandira mankhwala a chemthropiyamu am'thupi osati onse omwe ali ndi khansara ya ovari, komabe. Kumbukirani, pogwiritsa ntchito phunziro lofunika kwambiri, timadziwa kuti limapindulitsa amayi omwe ali ndi matenda a stage III amenenso ali ndi opaleshoni yabwino kwambiri yopanga opaleshoni (palibe chotsalira chamtundu woposa 1 masentimita otsalira pambuyo pa opaleshoni).
Kuti athandizidwe ndi intraperitoneal chemotherapy, catheter ya intraperitoneal (port) iyenera kuikidwa mu khoma la m'mimba ndi gynecologic oncologist. Ngati sichiyikidwa panthawi ya opaleshoni yoyamba, ikhoza kuikidwa pambuyo pake, mu njira yopangira opaleshoni yokhayokha ndi gynecologic oncologist kapena ndi radiologicalist interventional. A Nurses omwe amachititsa mankhwala a chemotherapy kudzera pa dokoli ayenera kukhala ndi luso komanso omasuka ndi njirayi. Catheter ikhoza kuyimitsa kapena kutsekedwa. Kuwongolera zotsatira zoyipa kumafuna katswiri wodziwa zachipatala wodziŵa zachipatala kapena ovomerezeka za amayi omwe ali ndi chithandizo cha mankhwalawa.
Kutsata
Kafukufuku waposachedwapa wa Dr. Wright ndi anzake, atulutsidwa mu Journal of Clinical Oncology, adawonetsa kuti si onse omwe ali oyenerera kulandira mankhwala ochepetsa intraperitoneal chemotherapy akuulandira. Gulu lake linaphunzira azimayi okwana 823 omwe anali ndi gawo lachitatu la ovary kapena la fallopian tube kapena primary peritoneal carcinoma. Akaziwa anachiritsidwa m'madera asanu ndi awiri akuluakulu a kansa omwe ali mbali ya National Comprehensive Cancer Network, kuphatikizapo City of Hope, Dana-Farber / Brigham ndi Akazi, Fox Chase, Ohio State University, University of Texas MD Anderson Khansa Center, ndi University of Michigan.
Gulu la Dr. Wright linapeza kuti amayi osachepera 50% omwe amayenerera kulandira mankhwala a intraperitoneal kwenikweni adalandira. Kuphunzira kwawo kunatsimikiziranso kuti amayi omwe analandira mankhwala opatsirana pogwiritsa ntchito mankhwala opatsirana amtundu amakhala moyo wautali kusiyana ndi omwe adalandira mankhwala okhaokha omwe amachititsa kuti thupi lawo lisamalowe.
Uthenga Wotengera Kwawo
Mankhwala opatsirana pogwiritsa ntchito khansa ya ovari kapena khansara yoyamba ya khansa ndizofunika kwambiri pochiza matendawa, ndi chiwerengero cha opulumuka omwe angalandire mankhwalawa. Komabe, zikhoza kukhala zovuta kwambiri ndi zotsatira zoyipa kwambiri kusiyana ndi mankhwala amtundu wa mankhwala ochizira. Ngati mwangoyamba kupeza kuti muli ndi kansa yapamwamba ya ovari kapena khansa yoyamba ya peritoneal, ndibwino kuti mukambirane ndi oncologist wanu ngati njirayi ndi yoyenera kwa inu.
> Zotsatira:
> Armstrong DK, Bundy B, Wenzel L, et al. Ine ntraperitoneal cisplatin ndi paclitaxel mu khansa ya ovarian. N Engl J Med . 2006; 354 (1): 34-43.
> NCI Clinical Advertise , 2006. https://ctep.cancer.gov/highlights/docs/clin_annc_010506.pdf.
> Wright AA, Cronin A, Milne DE, et al. Gwiritsani ntchito komanso kugwiritsira ntchito mankhwala opatsirana pogwiritsa ntchito mankhwala opatsirana pogwiritsa ntchito khansa ya ovari. J Clin Oncol . 2015 Aug 3. Epub patsogolo pa kusindikiza.