Izibilini zengqondo eziphambili zikhula ngqo kwingqondo, kunokuba zisasaze kwenye imvelaphi enjengomdlavuza wamaphaphu. Uhlobo oluqhelekileyo lwezondo eziphambili zeengqondo zivela kwiiseli ze-glial eziqhelekileyo zixhasa isebenzi yeseli yesisebenzi. Xa iillial cell ziba nomhlaza, zibizwa ngokuba yi- glioma .
Zininzi iintlobo zeeseli ze-glial, eziquka i-astrocytes, i-oligodendrocyte, i-microglia kunye neeseli ependymal.
I-astrocytomas yinto eqhelekileyo ye-glioma. I-Gliomas ikwahlulwa ngokubanzi kwiibakala ezine ngempawu yesahlulo seseli phantsi kwe-microscope. AmaBakala III kunye ne-IV awona mabakala aphezulu, kunye nesifo esibi kunazo zonke kunye neyona mfuneko enkulu yonyango xa kunokwenzeka. IBakala IV glioma, ebizwa ngokuba yi- glioblastoma multiforme okanye i-GBM, inokholo olubi kakhulu.
Isinyathelo sokuqala kunyango lwe-glioma ephezulu i-neurosurgery ukususa ubuninzi be-tumor ngangokunokwenzeka. Ngamanye amaxesha, oku kungenakwenzeka-isigulane sinokugula kakhulu ukunyamezela ukuhlinzwa, umzekelo, okanye i-tumor ingaba kwindawo efana ne-brainstem apho ukuhlinzwa kwakuyingozi. Nangona utyando luyenziwa, ama-gliomas ahlaseleyo anesibindi kangangokuthi phantse zonke izigulane ziza kubuya emva kokuhlinzwa. Ngethamsanqa, ezinye iindlela ezikhoyo zifumanekayo ukuze zenzele i-neurosurgery kwaye zitshintshe kwakhona ukuba ukuhlinzwa kungenakwenzeka.
I midiyo
Inzuzo yonyango lwe-radiation (RT) kwizigulane ezine-glioma ezibi zaqala ukubonakaliswa ngawo-1970. Ngelo xesha, ingqondo yonke yayilungelelaniswa, inqubo ebizwa ngokuba yi-whole brain-braination therapy (WBRT). Ubuninzi bomthamo wemisebe bubonakala bubungama-50 ukuya ku-60 Grey (Gy), kungekho nzuzo eyongezelelweyo kodwa ukongeza iziphumo ezingaphezulu kweli dose.
Lezo ziphumo zingabandakanywa i-necrosis ye-radiation-ukufa kweethambo eziqhelekileyo zengqondo ngenxa yemitha. Ezinye iingxaki ziquka umlotha wegazi, ukulahleka kweenwele, intloko kunye nokunye.
Ukunciphisa imiphumo yecala, i-radiation ngoku igxininise ngakumbi kwi-tumor, ene-1 ukuya kwi-3-centimeter margin, usebenzisa ubuchule obubizwa ngokuba bubandakanya-unyango lwe-radiation field (IFRT). Umda usekelwe malunga neepesenti ezingama-90 zokuphindaphinda eziphakathi kwe-2 cm yesayithi ye-tumor yokuqala emva kwemitha.
Ezinye iindlela ziquka i-3D ehambisana ne-radiotherapy (i-3D-CRT), esebenzisa isofthiwe ekhethekileyo ukwenza izicwangciso zonyango ukunciphisa irradiation yengqondo eqhelekileyo. I-RT-IM e-intanethi (IMRT) ifana ne-radiation kwiindawo zonyango, eziyiluncedo xa i-tumor ingqubuzana neengqondo zengqondo. Njengoko iindlela ezidlulileyo zisetyenziselwa ukuhambisa amanani amancinci amancinci ngexesha lokutyelela, i-radiosurgery ye-stereotactic (SRS) inika imitha echanekileyo, ephezulu yokujolisa kwiinjongo ezincinci kwingqondo. Inzuzo ye-SRS ihlala ingacacisiwe xa isetyenziselwa ukudibanisa ne-chemotherapy, nangona ngamanye amaxesha kusetyenziswa ukuphatha izicubu ezingenakufikeleleka kutyando oluqhelekileyo.
Izaphulo zinokuhanjiswa ngokubeka imbewu ye-radiosotope kwindawo yokuthengisa okanye i-tumor ngokwayo, ekhokelela ekuhambisweni kwezonyango eziqhubekayo.
Izilingo zamakliniki ezingaqhelekanga zibonise inzuzo engaphantsi kweyona ndlela. Umgangatho ofanelekileyo wokunyamekela unyango ngama-RT-modulated-intoliti kwiimeko ezininzi ze-glioma ezibi.
Chemotherapy
I-Temozolomide, ebizwa nangokuthi iTemarar, isilwanyana esicetywayo kwizigulane ezine-GBM. Xa kuthelekiswa nabantu ababenayo okanye abangazange bamkele i-temozolomide emva kokunyanga kwamayeza, kwakukho ubomi obuninzi (27 vs 11 ekhulwini ngonyaka). I-methylation ye-methyl guanine methyltransferase (MGMT) umgqugquzeli yinto efuzekileyo yokufumana inzuzo kunye ne-chemotherapy, ukwandisa izinga lokusinda ngaphezu kweminyaka emithathu kwiminyaka emibili.
I-Chemotherapy ne-temozolomide idla ngokuqhutywa imihla ngemihla iintsuku ezingama-28 nganye iintsuku ezingama-28, ezinokudlulelwa kweentsuku ezingama-23 emva kweentsuku ezi-5 zolawulo. Oku kwenziwa kwimizuzu engama-6 ukuya kweyeshumi elinesibini. I-Temozolomide yandisa umngcipheko weengxaki ze-hematologic ezifana ne-thrombocytopenia, kwaye ke iimvavanyo zegazi zifunekayo iintsuku ezingama-21 kunye ne-28 kumjikelezo ngamnye wonyango. Ezinye iziphumo ezichaphazelekayo zibandakanya isisongulu, ukukhathala kunye nokunciphisa ukutya.
Inhlanganisela ye-chemotherapeutics ebizwa ngokuthi i-procarbazine, i-lomustine, kunye ne-vincristine (i-PCV) enye indlela ekunyangwa ngayo i-tumor yengqondo. Inani lamaseli egazi alwa nosulelo lunokuncitshiswa yile nyango, njengokuba iiseli ezithintela ukulimaza nokukhupha. Ukukhathala, isisongela, ukugada, kunye nokubetha kungenzeka.
Iifama ze-carmustine (i-Gliadel) ngamanye amaxesha zifakela ngexesha lokuthengiswa komsebenzi. Nangona kunjalo, idatha ayinakho malunga nokusebenza nokukhuseleko kule ndlela kwi-glioblastoma esanda kufumanisa idibeneyo kunye nezinye iindlela zokwelapha. Isilwanyana sinokusebenza ngokugqithiseleyo kwiBakala lesi-3 glioma, kodwa isicatshulwa sisabonwa njengoluvavanyo. Imiphumo emibi yentsholongwane ibandakanya ukusuleleka kunye nokukhuba kwengqondo ebulalayo.
I-Bevacizumab (i-Avastin) yintsholongwane ebophezela kwi-vascular endothelial growth factor (VEGF). Izabisi zizama ukuphazamisa ukuveliswa kwemithambo yegazi entsha ezinika izondlo kwi-tumor ekhulayo. Nangona kunjalo, akukho nzuzo eqinisekisiweyo ye-bevacizumab ngokudibanisa ne-temozolomide ne-RT. Isiza lidibene ne-neutropenia, ingozi yexinzelelo, kunye ne-thromboembolism. Uphando olongezelelweyo luhlola iingenelo ezinokuthi zibe ngamacandelwana ezigulane.
Abagulayo abadala
Iingcebiso zonyango zihlala zihluke kwiigulane ezithe zadlulileyo. I-dose ephantsi ye-radiation inokucetyiswa kwabo bafunyanwa bengafanelekanga unyango kunye nombane kunye ne-chemotherapy. Kwalabo abaneemathumba eziMGMT-methylated, i-temozolomide yodwa ingenokuba yinto efanelekileyo.
Ukubuyela kwakhona
Unyango lwe-glioma ebulalayo ebuye yabuya emva kokuba unyango luphikisana kwaye luxhomekeka kakhulu kwizigulane ngabanye kunye noogqirha. Ukuphinda kwakhona unyango lwe-radiation kwandisa umngcipheko we-radiation necrosis, nangona uphando lucebise inzuzo yokuphila kwi-plastiki astrocytoma, kodwa ngokungekho ngokucacileyo kwi-GBM. Utyando nge-bevacizumab lungafaneleka ngakumbi kwezo zonyango. Xa kunokwenzeka, izigulana kufuneka zibhekiselele ekubhaleni kwilingo leklinikhi.
Imithombo:
Buatti J, Ryken TC, Smith MC, et al. Uphulo lwe-radiation lwe-pathologically olusandul J Neurooncol 2008; 89: 313.
IGreenberg HS, uCandler WF, uSandler HS. Ubunzima be-Brain (i-Contemporary Neurology Series 54), i-Oxford University Press, eNew York 1999.
UPaulino AC, uMay WY, uCchintagumpala M, et al. Ama-gliomas awonakalisa ama-radiation: ngaba kukho indima yokuvuselelwa kwakhona? Int J Radiat Oncol Biol Phys 2008; 71: 1381.
Selker RG, Shapiro WR, Burger P, et al. I-Brain Tumor Cooperative Group I-Trial NIH 87-01: ukuthelekiswa okungahleliwe kokuhlinzwa, i-radiotherapy yangaphandle, kunye ne-carmustine kunye nokuhlinzwa, ukuxhaswa kwe-radiotherapy kwangaphakathi, i-radiation yangaphandle kunye ne-carmustine. Neurosurgery 2002; 51: 343.