Ngaphezulu kweminyaka eyi-15 edlulileyo, ukucinga kwangoku malunga nendlela yokuphatha iindlela zokuqala zeprotate metastases kuye kwatshintsha. Izifundo ezahlukahlukeneyo zibonisa ukuba incinci yezigulane ezinokuqala kweemastastases zinezinto eziqhelekileyo ezinokuthintela imitha njengezikholelwa ngaphambili. Ngoko ke, iincinci zamadoda ezinamayeza angaphantsi kwamahlanu zisenokunyanga ngonyango olukhuseleyo usebenzisa i-radiation okanye utyando lokuphelisa i-metastases.
IOligometastases
Ubunokwenzeka ukuba ezinye izigulane ezinezifo zokuqala zesifo se-metastatic ziyaqhubeka zinyango zibizwa ngokuba yi- oligometastases. Ukunyanzeliswa kwe-oligometastase kuye kwabonakaliswa ngeentlobo ezahlukeneyo zomhlaza, kubandakanya i-cancer yepomphu , i-colon, i-melanoma kunye ne-prostate. Abanye abantu abaye baphathwa ngeendlela zokuhlinzwa okanye i-radiation baye kwiimpazamo zexesha elide (Ingxenye II yale chungechunge).
Ngokwenene kunokuba lula ukuphatha unyango kwinani elincinci le-oralases. Ngokuqhelekileyo kulula ukuba umlingo ulungele ukudlula, kodwa i-lymph nodes ezinomhlaza zingasuswa ngokusebenza. Inqobo yokukhupha yinto edidayo yokuba unyango lunokungabonakali xa i-micro-metastases engabonakaliyo ikhona. Ukuba imeko yokugqibela ifumaneka ngumhlaza uya kuphinda ahlawule umgca xa i-micro-metastases ikhula ngokwaneleyo ukuba ifumaneke.
Enye inkxalabo kukuba kukho umngcipheko weempembelelo ezibangelwa unyango.
Nangona kunjalo, xa i-radiation isetyenziswe ngobuchule kwaye iindawo ezimbalwa kuphela ziphathwa, imiphumo emibi isoloko encinci. Ngakumbi, amabala angama-4 okanye ama-5 kufuneka aphathwe. Ngamanani amaninzi e-metastases, amathuba okuba ne-micro-metastase ephakamileyo. Enye inkxalabo kukuba ukuphathwa kwethambo i-metastase ingaphazamisa umsebenzi we-bone lomnatha, apho i-immune system ihlala khona.
Umbane ogqithiseleyo kwithambo, ngoko ke, ingcamango engalunganga. Nangona kunjalo, ukuba indawo yomncuba uphathwa unyango, imiphumo emide kwixesha elide lomzimba kufuneka lithinteke.
I-Oligometastases iyakwazi ukuphilisa kodwa asikwazi ukucacisa kwangaphambili ukuba izigulane ze-oligometastatic ziza kuphiliswa ngonyango olubi. Nangona ininzi yamadoda aneesifo se-oligometastatic iya ekuxolelweni ngokupheleleyo, kuphela iincinci zazo zihlala zixolelwa ngokusisigxina. Ngoko ke, kunye nezobuchwephesha ezikhoyo, indlela kuphela yokuphilisa amadoda aphilileyo i-oligometastase kukuphatha unyango kuwo wonke umntu onokufumana umviwa.
Iiprotokto zokunyanga i-oligometastases zithembele kwi-radiation okanye ukuhlinzwa ukuze kupheliswe zonke iziza ezibonakalayo zesifo. Ulwaphulo lwe-radiation olusisigxina ( IMRT ) kunye ne-stereotactic body radiation therapy (SBRT) lunokuqwalaselwa. I-IMRT sele isetyenziselwe ukunyanga i-oligometastase ekhoyo kwii-lymph nodes, ngelixa i-SBRT iyona ndlela iyenzayo (kwaye mhlawumbi iphumelele) ukhetho lwezonyango zamathambo. I-IMRT inikezelwa ngamanani amancinci ngaphezu kweeveki ezingama-6-8, kanti i-SBRT isebenzisa i-dose ephezulu elawulwa kwiiseshoni ezimbalwa kwaye idla ngokugqitywa kwiiveki ezimbini okanye ngaphantsi.
Ukwenyuka kokusebenza kwe-SBRT kunokuba kungenxa yokuba iqondo eliphezulu leemitha ezilawulwe ngethuba elifutshane lidala ukuphendula okuvuthayo okukhuthaza umzimba wesigulane.
Absffal Effect
I-SBRT iboniswe ukuba isebenze zombini izimpendulo ze-immune ezingenangqondo. Ucwaningo luye lwabonisa ukuba nangona umthamo owodwa we-radiation kwi-tumor, kukho i-T-cell effect priming effect kwi-lymphatic draining. Le mpendulo yeT-cell ingenza inzuzo ye-antitumor ye-immitumor ekhuselweyo nomzimba apho isistim somzimba wesigulane singakwazi ukuhlasela umdlavuza kwezinye iindawo zomzimba.
Ukusebenzisa i-radiation kwisayithi enye ebangela ukutshatyalaliswa komhlaza kwenye indawo emzimbeni kuthiwa yi-"Abscopal Effect."
Ukwelapha iHormone esebenzisa iLupron kaninzi ifakwe kwi-radiation ukuze kuphuculwe umphumo we-antiticancer. I-Lupron inokufezekisa izinto ezimbini: Okokuqala, iphakamisa umonakalo wokubulala umbane. Okwesibini, ijikeleza ngegazi apho inokuphelisa isifo se-micro-metastatic (isifo se-acrovant chemotherapy ne-Taxotere), esasasaza ngegazi ukuhlasela isifo esincinci se-metastatic, inokuthi ingacingisisa ngokunjalo).
Iziphumo usebenzisa i-SBRT
Ndiye ndahlolisisa ezinye iingcamango zangemvelaphi malunga nendlela yokuphilisa izifo zesigxina xa kuphela inani elincinci leendawo zedolophu, zinokuba luncedo, kwaye kwezinye iimeko, zonyango. Kwintlanganiso ye-American Society of Clinical Oncology ngo-2015, uDkt. Daniel Henderson waseRoyal Marsden Hospital eLondon wabika ngamava akhe aphatha izigulane zomhlaza ze-prostate ezingama-21 ze-prostate.
UDkt. Henderson uchaza umdlavuza we-oligometastatic prostate njengama-1-3 e-sites of metastasis, ngokuqhelekileyo eyenzeka kwiminyaka emininzi emva kokunyanga okukhulu kwizifo eziphambili kunye nokuhlinzwa okanye i-radiation ejoliswe kwi-prostate gland. Wachaza kwingxelo yakhe ukuba unyango oluqhelekileyo luyinkqubo yokunyanga i-androgen yonyango (ADT), elisebenzayo ekulawuleni umdlavuza kodwa unempembelelo embi kwimigangatho yobomi, njengoko kubangela ukukhathala, ukufumana ubunzima, i-osteoporosis, ukulahleka kwemisipha, ukushisa ukukhanya kunye nokulahleka kwe-libido.
Esi sifundo, iqela likaDkt. Henderson lihlolisise ixesha elide lokulibaziseka ukuqala i-ADT ngokuphatha isitifiketi se-metastatic nge-stereotactic ye-radiation therapy (SBRT), ngethemba lokuba i-SBRT izakulibazisa ukuqhubela phambili kwezifo kwaye ibeke isidingo sokusebenzisa i-ADT.
Izigulane ezinezinga eliphezulu lePSA emva kokuhlinzwa okanye i-radiation yangaphambili yatshintshela nge-F-choline PET / CT. Akukho nanye kwezigulane ezithe zafumana unyango lwe-hormone yangaphambilini.
Xa i-SBRT ilawulwa, i-dose ye-30 Gy kumaqhezu amathathu yanikwa nge-Cyberknife system. Ixesha lokulibaziseka ngaphambi kokuba kubekho isidingo sokuqala i-ADT ibalwa ukusuka ekuqaleni kwe-SBRT. I-PSA ihlolwe rhoqo emva kweenyanga ezintathu kunye nokuhlaziywa okongezelelweyo nge-F-choline PET / CT eyenziwe njengoko kuyimfuneko.
I-ADL ye-Palliative yezifo zeMetastatic
Kwizigulane ezingama-21, 6 zanikwa iinyanga ezi-3 ukuya kwezi-6 ze-ADT kunye ne-SBRT. Ininzi yamadoda yayineziko elilodwa kuphela le-oligometastatic, kwaye uninzi lweziza ze-metastatic zasezikhungweni zeelym ngaphezu kwamathambo. Ngokubanzi, kwakukho izilonda zesithambo ezingama-8 kunye namaziko angama-20 e-lymph node. Kwimizuzu eyi-167 yokulandelelanisa i-median, iipesenti ezingama-81 (izigulane ezingama-17) azifunanga nayiphi na unyango nge-ADT. Ukusinda kwama-ADT-mahhala kwinyanga ezingama-28 kwiqela lonke. Iingamashumi amabini ezigulane zaye zancipha kwi-PSA emva kwonyango. Ukunciphisa ipesenti ye-median kwi-PSA yayingama-84 ekhulwini. Akukho netyhefu ebangelwa yimitha ephezulu ngaphezu kwebanga lesi-2 laphawulwa. Isiganeko se-grade 1 kunye ne-2 CTCAE inetyity (jonga ngezantsi *) yayingu-29 ekhulwini (izigulane ezingama-6) kunye neepesenti ezingama-5 (1 isigulane), ngokulandelanayo. Akukho netyhefu ebangeni lesi-3 okanye ngasentla ibonwa. Ngokubanzi, uDkt. Henderson kunye neqela lakhe banomuvo wokuthi i-SBRT yayinyamezelekile kwaye inenzuzo ekulibalekeni ukuqaliswa kweyeza le-hormone.
Olu pho nonongo lubonisa indlela amathuba amatsha olutsha olwenziwe ngayo unyango olusukela ekufikeni kweentlobo ezimbini ezintsha zeteknoloji ephuculweyo: Okokuqala, iteknoloji engcono yokutyikitya engakwazi ukubona amancinci amancinci ekuqaleni kweso sifo sisasazeka kwiindawo ezininzi emzimbeni.
Okwesibini, yintoni imitha enamandla enamandla ekwazi ukwenza "umdlavuza", nangona ichanekile ngokwaneleyo ukukhusela izitho ezinobungozi ezisemgangathweni kunoma yimuphi umonakalo owenziwe ngonyango. Indlela enobudlova yokufumana izifo zesifo se-metastatic kwisigaba sokuqala esingangoko kwaye emva kokuqalisa inkqubo yokunyanga ngokunyanzeliswa ngokulawulwa kwamanqanaba okukhusela omninzi kuya kuba yintando xa abantu beqonda ukuba olu khetho lukhona.
> Umthombo:
> Chajon, E., Castelli, J., Marsiglia, H., & De Crevoisier, R. (2017). I-Synergistic Impact ye-Radiotherapy kunye ne-Immunotherapy: Ukusebenzisana okuthembisayo kodwa okulula. Iingxelo eziPhambili kwi-Oncology / Hematology , 111 , 124-132.