Pa zaka khumi ndi zisanu zapitazo, kuganizira zamakono za momwe tingachitire magawo oyambirira a prostate metastases wakhala akusintha. Kafukufuku wosiyanasiyana akusonyeza kuti odwala ochepa omwe ali ndi masewera oyambirira alibe mavitamini ambiri omwe amakhulupirira kale. Choncho, anthu ochepa omwe ali ndi mavitamini osachepera asanu angathe kuchiritsidwa ndi mankhwala achiwawa pogwiritsira ntchito ma radiation kapena opaleshoni kuthetsa metastases.
Oligometastases
N'zotheka kuti odwala ena omwe ali ndi matenda oyambirira a masastatic akadali ochiritsidwa amatchedwa oligometastases. Kulephera kwa oligometastases kwatsimikiziridwa ndi mitundu yosiyana ya khansa, kuphatikizapo khansa ya mapapo , colon, melanoma, ndi prostate. Anthu ena omwe mavitamini awo anachitidwa opaleshoni kapena ma radiation apita kumapeto kwa nthawi yaitali (Gawo II la mndandandawu).
Ndizosavuta kupereka chithandizo kwa nthendayi yaing'ono yamtundu kapena ya mafupa. Kawirikawiri imakhala yosavuta kuposa opaleshoni, koma khansa ya khansa imatha kuthetsedwa mwa kuchita opaleshoni. Chokhachokha ndicho chokhumudwitsa chenicheni chakuti chithandizocho chingawonongeke ngati ma micro-metastase osadziwika alipodi. Ngati chochitikachi chikuchitika khansara idzabwererenso pansi pamene mitsempha ya metastases ikukula mokwanira kuti ipezeke.
Chomwe chikudetsa nkhaŵa ndikuti pali chiopsezo cha zotsatira zoyambitsa mankhwala.
Komabe, pamene mankhwalawa akugwiritsidwa ntchito mwaluso ndipo mawanga ochepa okha amachiritsidwa, zotsatira zake zimakhala zochepa. Nthawi zambiri, mawanga 4 kapena 5 ayenera kuchiritsidwa. Ndi kuchuluka kwa metastases, mwayi wokhala ndi micro-metastases ndi wapamwamba. Chinthu chinanso chodetsa nkhaŵa ndichotseketsa mafupa a mitsempha akhoza kuwononga ntchito ya fupa la mafupa, kumene kumakhala ma chitetezo cha mthupi.
Kuwonjezera pa ma radiation mpaka mafupa, ndizolakwika kwambiri. Komabe, ngati malo a mafupa omwe amachiritsidwa ndi ochepa, zotsatira za nthawi yayitali pa chitetezo cha mthupi chiyenera kukhala chosasamala.
Oligometastases amatha kuchiritsa koma sitingathe kudziwiratu zomwe oligometastatic odwala adzachiritsidwa ndi mankhwala opweteka. Ngakhale kuti amuna ambiri omwe ali ndi matenda a oligometastatic amapita ku chikhululukiro chathunthu, ndi owerengeka okha omwe amakhalabe mukukhululukidwa kosatha. Choncho, ndi mchitidwe wamakono omwe alipo, njira yokhayo yothandizira anthu omwe amachiritsidwa oligometastases ndi kupereka chithandizo kwa aliyense amene angakhale woyenera.
Mapulogalamu ochizira oligometastas amadalira maizoni kapena opaleshoni kuti athetse malo onse owoneka a matenda. Matenda awiri omwe amatha kuika mazira ( IMRT ) ndi ma stereotactic radiation therapy (SBRT) angaganizidwe. IMRT yakhala ikugwiritsidwa ntchito pofuna kuchiza oligometastases omwe ali m'makina amaliseche, pamene SBRT ndi njira yothandiza kwambiri (ndipo mwina yothandiza kwambiri) yopaleshoni ya mitsempha ya mafupa. IMRT imapatsidwa mankhwala ochepa pa milungu 6 mpaka 8, pamene SBRT imagwiritsa ntchito mlingo wapamwamba womwe umayendetsedwa m'magawo ochepa ndipo nthawi zambiri umatha kumapeto kwa masabata awiri kapena kuposerapo.
Kuwonjezeka kwa mphamvu ya SBRT kungakhale chifukwa chakuti miyezo yapamwamba ya ma radiation yomwe imayendetsedwa kwa kanthaŵi kochepa imachititsa kuti kutupa kumatithandiza kukhala ndi chitetezo cha mthupi.
Mtheradi wa Abscopal
SBRT yasonyezedwa kuti iwonetsere mayankho omwe amachititsa kuti munthu asamayesedwe. Kafukufuku wasonyeza kuti ngakhale ndi mlingo umodzi wokha wa mazira ndi chifuwa, pali T-cell priming effect mu maselo ophera maselo. Yankho la T-selo limeneli lingapangitse kuti phindu la chitetezo cha mthupi likhoza kupewedwera ndi matenda a chitetezo m'magulu ena.
Kugwiritsira ntchito ma radiation pamalo amodzi omwe amachititsa kuti matenda a khansa kumadera ena m'thupi athe kuwonongeka amatchedwa "Abscopal Effect."
Mankhwala opanga mahomoni pogwiritsira ntchito Lupron nthawi zambiri amawonjezeredwa ndi ma radiation kuti apangitse zowonongeka. Lupron akhoza kukwaniritsa zinthu ziwiri: Choyamba, zimapangitsa kuti kuwonongeka kwa dzuwa kuwonjezeke. Chachiwiri, chimadutsa m'magazi momwe chingathetsere matenda a micro-metastatic (adjuvant chemotherapy ndi Taxotere, yomwe imayambanso kupyolera muzirombo kuti iwononge matenda a chiwerengero cha mthupi).
Zotsatira Zogwiritsa Ntchito SBRT
Ndapenda ndondomeko zina zam'mbuyo za momwe kuchiza matenda odwala ngati nthenda yochepa chabe ya malo, imakhala yopindulitsa, ndipo nthawi zina, ngakhale yothandizira. Pamsonkhano wa American Society of Clinical Oncology mu 2015, Dr. Daniel Henderson wochokera ku Royal Marsden Hospital ku London adanena za zomwe adachitapo akuchiza odwala magetsi a prostate 21 omwe ali ndi ma radiation.
Dr. Henderson anatchula khansa ya oligometastatic prostate monga malo a 1-3 a metastasis, omwe amatha zaka zingapo atatha kuchiza matenda oyamba ndi opaleshoni kapena ma radiation okhudza prostate gland. Iye adalongosola m'nkhani yake kuti mankhwala oyenera ndi a androgen deprivation therapy (ADT) omwe amawathandiza kuchepetsa khansa koma amachititsa kuti munthu asakhale ndi moyo wathanzi, chifukwa amachititsa kuti asatope, kulemera, kufooketsa thupi, kutaya thupi, kutentha kuwala ndi kutayika kwa libido.
Phunziroli, gulu la Dr. Henderson linayesa momwe iwo angachedwe kuyamba ADT pokhala ndi malo ochezera amtunduwu ndi mankhwala opatsirana pogwiritsa ntchito mpweya (SBRT), poganiza kuti SBRT idzachedwa kuchepetsa matenda ndikuthetsa kufunika kokhala ndi ADT.
Odwala omwe anali ndi mapulaneti a PSA atatha opaleshoni kapena ma radiation akale anayamba kufufuza ndi F-choline PET / CT. Palibe odwala omwe analandira mankhwala oyamba a mahomoni.
Pamene SBRT inkaperekedwa, chiwerengero cha 30 Gy mu magawo atatu chinaperekedwa ndi dongosolo la Cyberknife. Nthawi yocheperapo isanayambe kufunika koyambitsa ADT iwerengedweratu kuyambira nthawi ya SBRT. PSA inayang'aniridwa miyezi itatu iliyonse ndikuwonjezeranso zina ndi F-choline PET / CT ikuchitidwa ngati pakufunika.
Matenda a ADT a Matenda a Metastatic
Mwa odwala 21, 6 anapatsidwa miyezi 3 mpaka 6 ya ADT pamodzi ndi SBRT. Ambiri mwa amunawa anali ndi malo amodzi okhawo oligometastatic, ndipo malo ambiri amtunduwu anali m'magalasi m'malo mwa mafupa. Pang'ono ndi pang'ono, panali mafupa asanu ndi atatu ndi mafupa 20 omwe amachiza mafupa. Pakati pa miyezi 16.7, 81 peresenti (odwala 17) sanafunire mankhwala aliwonse ndi ADT. Kupulumuka kwapakati kwa ADT kwapakati pa miyezi 28 kwa gulu lonse. Odwala makumi awiri anali atatsikira PSA pambuyo pa chithandizo. Kuchepetsa kuchepetsa kuchepa kwa PSA kunali 84 peresenti. Palibe poizoni woopsa kwambiri wa poizoni pamwamba pa Gulu lachiwiri. Zotsatira za poizoni za grade 1 ndi 2 za CTCAE (onani m'munsimu) zinali 29 peresenti (odwala 6) ndi 5 peresenti (wodwala 1), motero. Palibe poizoni wa m'kalasi 3 kapena pamwamba. Kwachidule, Dr. Henderson ndi gulu lake adamva kuti SBRT idavomerezedwa bwino ndipo zimapindulitsa pochedwa kuchepetsa mankhwala opangira mahomoni.
Phunziroli likuwonetsa momwe mwayi watsopano wothandizira mankhwalawa umakhalira chifukwa cha kubwera kwa mitundu iwiri yatsopano ya matekinoloje apamwamba: Choyamba, teknoloji yabwino yowunikira yomwe ingathe kupeza mitsempha yaying'ono pasanapite nthawi kuti matendawa asafalikire kumadera ambiri m'thupi.
Ndipo kachiwiri, ndi mphamvu zotani zowonjezera zomwe zimatha "kufalitsa" khansara, komanso zimakhala zomveka bwino kuti zisawonongeke ziwalo zathanzi zowonongeka ndi mankhwala. Njira yowopsya yozindikira matenda odwala matenda oyambitsa matenda m'zaka zoyambirira zowonjezereka ndipo kenaka kuyambitsa njira yothandizira anthu odwala matendawa kumatchuka kwambiri pamene anthu akudziwa kuti mankhwalawa alipo.
> Chitsime:
> Chajon, E., Castelli, J., Marsiglia, H., & De Crevoisier, R. (2017). Chizindikiro cha Synergistic of Radiotherapy ndi Immunotherapy: Chigwirizano Chokha Chokha Chokha Chokha. Maphunziro Ovuta pa Oncology / Hematology , 111 , 124-132.