Matenda oyambirira a ubongo amayamba mwachindunji mu ubongo, m'malo mofalitsa kuchokera ku gwero lina monga khansa ya m'mapapo. Mitsempha ya ubongo yoyamba kwambiri imachokera ku maselo am'mlengalenga omwe nthawi zambiri amawathandiza mitsempha ya mitsempha. Pamene maselo a glial amakhala khansa, amatchedwa glioma .
Pali mitundu yambiri ya maselo amodzi, kuphatikizapo astrocytes, oligodendrocytes, microglia, ndi maselo ependymal.
Astrocytomas ndi mtundu wambiri wa glioma. Mabala a glium amagawidwa m'zigawo zinayi ndi zizindikiro za kugawidwa kwa selo pansi pa microscope. Maphunziro a III ndi IV ali apamwamba kwambiri, omwe ali ovuta kwambiri komanso osowa kwambiri ngati akutheka. Kalasi ya IV glioma, yomwe imatchedwanso glioblastoma multiforme kapena GBM, ili ndi vuto losauka kwambiri.
Njira yoyamba yopaleshoni yapamwamba kwambiri ya glioma ndi matenda a ubongo pofuna kuchotsa chotupa chachikulu ngati n'kotheka. Nthawi zina, izi sizingatheke-wodwalayo akhoza kudwala kwambiri kuti asapitirire kuchitidwa opaleshoni, mwachitsanzo, kapena chotupacho chikhoza kumakhala ngati malo omwe ubongo umakhala woopsa kwambiri. Ngakhale opaleshoni imachitidwa, zilonda zopweteka kwambiri zimakhala zoopsa kwambiri moti pafupifupi odwala onse azidzachitidwa opaleshoni pambuyo pake. Mwamwayi, njira zina zowonjezera zilipo kuti zitha kuwonjezera maopaleshoni ndi kuchitapo kanthu ngati opaleshoni sizingatheke.
Mafunde
Kupindula kwa radiation therapy (RT) kwa odwala omwe ali ndi vuto lalikulu la glioma poyamba kunawonetsedwa m'ma 1970. Pa nthawiyi, ubongo wonse unali wotsekedwa, njira yotchedwa whole-brain radiation therapy (WBRT). Kuchuluka kwake kwa ma radiation kumawonekera kuti ndi 50 mpaka 60 Grey (Gy), popanda kupindula kwina koma zotsatira zoonjezera pamwamba pa mlingowu.
Zotsatira zake zingaphatikizepo ndi radiation necrosis-imfa ya minofu yachibadwa ya ubongo chifukwa cha kutentha kwa dzuwa. Zovuta zina zimaphatikizapo chotengera cha magazi chocheperachepera, kupweteka tsitsi, kupweteka mutu ndi zina.
Kuchepetsa zotsatira zake, ma radiation tsopano akugwedezeka kwambiri pamtunda, wokhala ndi masentimita 1 mpaka 3, pogwiritsa ntchito njira yotchedwa - radiation treatment (IFRT). Mphepetewu imakhala pafupifupi 90 peresenti ya kubwereza komwe kumachitika pakati pa 2 cm pa malo oyambirira a zotupa pambuyo pa mazira.
Njira zina zimaphatikizapo 3D conformal radiotherapy (3D-CRT), yomwe imagwiritsa ntchito mapulogalamu apadera kuti apange njira zothandizira kuchepetsa kutentha kwa ubongo. RT (IMRT) yowonongeka kwambiri imasiyanasiyana ndi ma radiation m'madera opatsirana, omwe amathandiza pamene chotupacho sichimagwirizana ndi malo osokoneza ubongo. Ngakhale njira zam'mbuyomu zimagwiritsidwa ntchito popereka maulendo angapo ang'onoang'ono a ma radiation pakapita maulendo angapo, ma radio radiurgurgery (SRS) amapereka miyezi yeniyeni yeniyeni, yomwe imapangitsa kuti zikhale zochepa mu ubongo. Kupindula kwa SRS kumakhalabe kosagwiritsidwa ntchito mosagwiritsidwa ntchito pophatikizidwa ndi mankhwala a chemotherapy, ngakhale nthawi zina amagwiritsidwa ntchito pochizira matenda omwe sangafikire opaleshoni yowonongeka.
Mazira angathenso kuperekedwa mwa kuika mbewu za radioisotope mu resection cavity kapena chotupachokha, zomwe zimapangitsa kuti athandizidwe mwamsanga.
Mayesero ochiritsira matendawa asonyeza kuti phindu laling'ono limapindulitsa kwambiri pa njirayi. Mlingo wamakono wa chisamaliro ndi mankhwala omwe ali ndi mphamvu ya RT yomwe imakhala yoopsa kwambiri.
Chemotherapy
Temozolomide, wotchedwanso Temodar, ndi mankhwala ovomerezeka kwa odwala omwe ali ndi GBM. Poyerekeza ndi anthu amene adalandira kapena sanalandire mankhwalawa patatha chithandizo chamagazi, padalipo moyo wambiri (27 vs 11 peresenti pachaka). Methylation ya methyl guanine methyltransferase (MGMT) amalimbikitsa ndi chibadwa chomwe chimapindulitsa ndi chemotherapy, kuonjezera chiwerengero cha kupulumuka katatu pazaka ziwiri.
Chemotherapy ndi temozolomide kawirikawiri imaperekedwa tsiku ndi tsiku kwa masiku asanu masiku khumi ndi atatu (28), yomwe ili ndi masiku 23 otsalira pambuyo pa masiku asanu akuyang'anira. Izi zachitika kwa 6 mpaka khumi ndi ziwiri. Temozolomide imachulukitsa chiopsezo cha mavuto a hematologic monga thrombocytopenia, kotero kuti kuyesa magazi kumafunikira masiku 21 ndi 28 patsiku lililonse la mankhwala. Zotsatira zina zimaphatikizapo kunyowa, kutopa, ndi kuchepa kwa njala.
Kuphatikizana kwa chemotherapeutics yotchedwa procarbazine, lomustine, ndi vincristine (PCV) ndi njira inanso yothandizira pakhungu la ubongo. Chiwerengero cha maselo a m'magazi omwe amamenyana ndi matenda angathe kuchepetsedwa ndi mankhwalawa, monga momwe maselo amalepheretsa kuvulaza ndi kutuluka magazi. Kutopa, kunjenjemera, kupweteka, ndi kumenyedwa kungathenso kuchitika.
Nthawi zambiri opaleshoni ya carmustine (Gliadel) amaikidwa panthawi yopanga opaleshoni. Komabe, palibenso deta yokhudzana ndi mphamvu ndi chitetezo cha njirayi mu glioblastoma yatsopano yomwe ikupezeka pamodzi ndi mankhwala ena. Mankhwalawa ndi othandiza kwambiri m'kalasi ya III glioma, koma njirayi imayesedwa ngati kuyesera. Zoopsa zomwe zingakhalepo zimaphatikizapo matenda komanso kutentha kwa ubongo.
Bevacizumab (Avastin) ndi anti-antibody yomwe imapangitsa kuti matenda a VEGF apitirize kukula. Mankhwalawa amayesera kulepheretsa kupanga mitsempha yatsopano yomwe imapereka zakudya m'thupi. Komabe, palibe phindu lovomerezeka la bevacizumab kuphatikizapo temozolomide ndi RT. Mankhwalawa agwirizanitsidwa ndi neutropenia, kuthamanga kwa magazi, ndi thromboembolism. Maphunziro ena akufufuza momwe angapindulire m'magulu a odwala.
Okalamba Odwala
Mankhwalawa amasiyana kwambiri ndi okalamba omwe ali pachiopsezo chachikulu. Mankhwala ochepa omwe angapangidwe ndi othandizira odwala ndi ma radiation ndi chemotherapy. Kwa omwe ali ndi zotupa za MGMT-methylated, temozolomide yekha akhoza kukhala njira yowonjezera.
Kubwerera
Chithandizo cha mankhwala oopsa a glioma omwe adabwerera pambuyo poti mankhwalawa akutsutsana ndipo amadalira kwambiri odwala ndi madokotala. Kupititsa patsogolo mankhwalawa kumapangitsa kuti pakhale ngozi ya radiation necrosis, ngakhale kuti kafukufuku wina wanena kuti phindu lopulumuka pa amaplastic astrocytoma, koma osati pa GBM. Kuchiza ndi bevacizumab kungakhale koyenera kwambiri muzochiritsira zoterezi. Nthawi iliyonse, odwala ayenera kuganizira kulembetsa mayesero.
Zotsatira:
Buatti J, Ryken TC, Smith MC, ndi al. Mankhwala opatsirana pogwiritsira ntchito mankhwala a pathologically anatsimikizira kuti glioblastoma yatsopano yomwe idatulukira kumene kwa anthu akuluakulu. J Neurooncol 2008; 89: 313.
Greenberg HS, Chandler WF, Sandler HS. Matenda a ubongo (Zamakono a Series Neurology 54), Oxford University Press, New York 1999.
Paulino AC, Mai WY, Chintagumpala M, et al. Zomwe zimachititsa kuti anthu asamawonongeke. Kodi pali njira yothetsera vutoli? Int J Radiat Oncol Biol Phys 2008; 71: 1381.
Selker RG, Shapiro WR, Burger P, ndi al. Gulu la Ogwirizanitsa Ubongo la Chiberekero NIH Nkhanza 87-01: kuyerekezera mwadzidzidzi opaleshoni, kunja kwa radiotherapy, ndi carmustine ndi opaleshoni, mphamvu zamagetsi zowonjezereka, mankhwala opangidwa ndi ma radiation, ndi carmustine. Neurosurgery 2002; 51: 343.