Zanenedwa kuti nzeru ndi imodzi mwa nsembe zoyamba za nkhondo. Nsembe yomweyi ingakhalenso mbali ya nkhondo yonse ya wodwalayo yolimbana ndi khansara, monga mankhwala ambiri ophera khansara amachitanso mantha m'maganizo mwathu ndipo amachititsa kuti mitsempha imatumiza uthenga ku ubongo wathu.
Komanso monga nkhondo, sizingakhale zosavuta kunena kwa mnzako kuchokera kwa mdani. Kodi ndi chizindikiro chenicheni chochokera ku khansa, kapena mankhwala omwe amaperekedwa kuti amenyane ndi khansara?
Kapena kodi ndi chifukwa china chake?
Pali njira zosiyanasiyana zomwe mankhwala a chemotherapeutic amatha kuwononga dongosolo lamanjenje. Chotsatira chake sichitha zonse, koma chimapereka mwachidule njira zina za chemotherapy zingathe kuwononga dongosolo la manjenje.
Zovuta Zikhoza Kuchitika Posachedwa kapena Pambuyo pake
Ngakhale zotsatira za ubongo za chemotherapy zimachitika mwamsanga, zina zingatenge zaka kuti zikule. Mwachitsanzo, Busulfan nthawi zambiri amagwiritsidwa ntchito pokonzekera odwala chifukwa cha kusintha kwa maselo amtunduwu koma amakhalanso akugwirizanitsa ndi kupweteka panthawi yomwe akuyendetsa. Pachifukwachi, mankhwala ophera antiepileptic monga phenytoin angagwiritsidwe ntchito pokhapokha kuti apatsidwe pofuna kupeĊµa kugwidwa. Komabe, chiopsezo cha katemera chimakula pamene mankhwala sakuperekedwanso.
Nthawi zina Cytarabine imagwiritsidwa ntchito pochiza khansa ya m'magazi ndi maimymphomas , ndipo ikhoza kuchititsanso mavuto pakangopita nthawi yochepa. Mwachitsanzo, zingayambitse chisokonezo komanso kuvutika maganizo, komanso kupeza zotsatira zofanana ndi zomwe akupeza ( ataxia ).
Mankhwala ayenera kuimitsidwa mwamsanga ngati izi zikuchitika. Odwala ena amachira, koma odwala ena satero. Cytarabine ingathenso kuikidwa mkati mwa intrathecally , koma izi nthawi zina zingayambitse myelopathy yopitirira mimba ndi kupunduka kwa miyendo. Apanso, mankhwala ayenera kuthetsedwa mwamsanga ngati izi zikuchitika.
Kuwonongeka kwa msana kuchokera ku cytarabine nthawi zambiri kumakhala kosatha.
Methotrexate ingagwiritsidwe ntchito pochiza khansa zambiri, komanso zimayambitsa zotsatira zosiyanasiyana, zina zomwe zingayambike mofulumira ndi zina mochedwa. Mwachitsanzo, izi zimayambitsa aseptic meningitis yomwe imapezeka nthawi yomweyo pamene mankhwalawa amaperekedwa mwachangu. Mankhwala otchedwa aseptic meningitis nthawi zambiri amatsatira ubongo wodalirika ndipo amapezeka pafupifupi 10 mpaka 50 peresenti ya odwala omwe amalandira mankhwala motere. Zizindikiro zimaphatikizapo kupweteka mutu komanso kuuma khosi komanso kunyoza, kusanza, ndi malungo. Kuchiza sikukufunikira ngati zizindikiro zimadziyendera okha.
Mosiyana ndi mavuto ena ovuta kwambiri, methotrexate imayambitsa matenda a leukoencephalopathy, omwe amatanthauza matenda a ubongo chifukwa cha kusintha kwa zigawo zanga za ubongo, zomwe zingachitike ngakhale zaka zitatha mankhwalawa atatha. Izi zimakhudza makamaka pamene methotrexate imagwiritsidwa ntchito pochizira matenda a achinyamata, monga ubongo wa khansa. Zotsatira zake zimachokera ku zolemala zolepheretsa kuvutika maganizo. Pa MRI, zilonda zamtunduwu zimawoneka.
Kusintha kwachidziwitso
Kusintha kwakukulu kwa chidziwitso monga kulembetsa leukoencephalopathy sikuli kokha kwa mankhwala okhawo.
Kwenikweni, kusintha kwa chidziwitso kumakhala kofala kwambiri mu chemotherapy kuti mawu osavomerezeka, "chemofog," adapangidwa kuti afotokoze chodabwitsa. Chemofog imaphatikizapo zotsatira zosiyanasiyana zamaganizo zomwe nthawi zambiri zimagwiritsidwa ntchito ndi mankhwala a chemotherapeutic, ndi zizindikiro zochokera ku chisokonezo chochepa mpaka kuvutika maganizo kwakukulu. Kukhazikika kwa kusintha kumeneku kungakhalenso kosiyana.
Mwachitsanzo, ifosfamide ndi wothandizira kugwiritsa ntchito zilonda zolimba. Mankhwalawa nthawi zina amachititsa kuti munthu asakhumudwe, koma nthawi zambiri amatha msanga atangomaliza kugwira ntchitoyo. Encephalopathies enanso, monga leukoencephalopathy ya methotrexate, ingayambitse kupereĊµera kosatha.
Matenda oterewa omwe amatha kusintha kwambiri (PRES) ndi vuto lina la mankhwala ambiri a chemotherapeutic, makamaka cyclosporine ndi tacrolimus. Mankhwalawa nthawi zambiri amagwiritsidwa ntchito pokonzekera anthu opangira ziwalo. Zizindikiro zimaphatikizapo kupweteka mutu, kusokonezeka, kugunda , kapena kuwonongeka kwa maganizo. Pogwiritsa ntchito MRI, kuwonjezeka kwa mtambo kungaoneke kuti nthawi zambiri imakhala pafupi ndi kumbuyo kwa ubongo. Mankhwala ayenera kuyimitsidwa kapena kusintha ngati PRES ilipo.
Sitiroko
Kafukufuku amachititsa kuti madokotala azitchula kuti hypercoagulable state, kutanthauza kuti mazira a magazi amatha kupanga mawonekedwe komanso malo osayenera. Mwachitsanzo, chovalachi chingapangidwe mu ubongo, ndipo chimayambitsa matenda . Mwatsoka, mankhwala ena amathanso amachititsa zilonda, monga methotrexate, cisplatin, imatinib ndi zina.
Mankhwala ena, monga bevacizumab ndi sunitinib, amayambitsa mitsempha yamagazi mwachangu, chifukwa mitsempha nthawi zambiri imapanga zombo zatsopano zotumiza zakudya ku kukula kosazolowereka. Mwamwayi, zotsatira zake zingakhale monga kupweteka kwa magazi kapena zikwapu zamaschemic. Chitsanzo china, L-asparaginase nthawi zambiri imagwiritsidwa ntchito pochiza matenda a m'magazi aumphawi (ALL) ndipo nthawi zina imayambitsa matenda oopsa omwe amachititsa kuti anawo azikhala. Izi kawirikawiri zimatsimikiza ndi kupuma mu regimen ya mankhwala. Ngati magazi otetezedwa amaperekedwa nthawi zina, nthawi zina mankhwala akhoza kubwereranso.
Matenda a Mitsempha
Matenda a mphuno ndi omwe amachititsa kuti mankhwala a chemotherapy asagwiritsidwe ntchito makamaka makamaka kwa othandizira a platinum monga cisplatin ndi oxaliplatin. Nthenda ya ubongo yomwe imayambitsidwa ndi cisplatin imayambitsa kupweteka kwapadera ndi paresthesias zomwe zimayambira pamphepete mwa zala ndi zala ndikufalikira mkati. Ngakhale kuti thupi limataya mlengalenga, kuvutika ndi kutentha kumakhala kosatha nthawi zonse, zomwe zimasiyanitsa cisplatin neuropathy ku matenda ambiri omwe amayamba chifukwa cha khansa yokha. Zowopsa za kuchepa kwa mlingo kapena kusinthasintha kwa mankhwala osakanikirana ngati a carboplatin ayenera kuyeza phindu la kupitiriza cisplatin mankhwala. Nthepiratin imatha kuwonjezereka kapena kuyamba miyezi yambiri pambuyo pa cisplatin.
Oxaliplatin imagwirizanitsidwa ndi mitsempha yonse ya paresthesias yomwe ili m'manja, mapazi, ndi pakamwa, zomwe zonse zimaipitsidwa ndi kuzizira. Zingathe kuchititsanso matenda ofanana ndi ubongo chifukwa cha cisplatin, ngakhale kuti ubongo wa oxaliplatin umasintha mosavuta.
Ma chemotherapeutics ena okhudzana ndi matenda opatsirana m'mimba amachititsa docetaxel, vincristine, ndi paclitaxel, pakati pa ena ambiri.
Kuwonongeka kwa Neuromuscular
Kuwonongeka kwa nthendayi kumakhala kosazolowereka kuposa phokoso la m'mimba, koma kungakhalebe chifukwa cha chemotherapy. Doxorubicin, cisplatin, etoposide, ndi ena angayambitse chizindikiro chofanana ndi myasthenia gravis . Imatinib amagwiritsa ntchito mitundu ina ya khansa ya m'magazi, ingayambitse kupweteka kwa minofu ndi myalgia, koma kawirikawiri izi zimakhala zofatsa komanso zimamvera mankhwala monga calcium kapena magnesium.
Si chinsinsi chakuti chemotherapy ndi mankhwala amphamvu kwambiri omwe ali ndi mavuto akuluakulu. Chimene ndalemba pano ndi ndondomeko yaikulu kwambiri. Pali chifukwa chake mankhwalawa amawasungira matenda aakulu monga khansa, zomwe zimapindulitsa kutenga mankhwala osokoneza bongo ngakhale zoopsa zazikulu. Cholinga cha nkhaniyi sikuletsa anthu omwe akusowa mankhwalawa, koma kuonetsetsa kuti anthu akudziwa zovuta kuti athe kuyenda bwino ndi zovuta za khansa.
Zotsatira:
EQ Lee, IC Arrillaga-Romany, PY Wen. Matenda a Neurologic a Mankhwala Ochepetsa Mankhwala a Khansa. Kupitiriza Kuphunzira Kwambiri kwa Neurol 2012; 18 (2): 355-365.
EQ Lee, PY Wen. Zovuta za Neurologic za mankhwala otchedwa platinum based chemotherapy Mu: DMF Savarese, Ed
EQ Lee, PY Wen. Matenda a Neurologic a khansa yapamwamba yopanda platinamu. Mu: DMF Savarese, Ed UpToDate.