Intraperitoneal chemotherapy ndiyo nzira yekugadzirisa chemotherapy yekenza yemavhiiyo zvakananga mudumbu remuviri. Kunyange zvazvo chikafu chemotherapi yakawanda, uye zvizhinji zvebiologic kana kuti zvirongwa zvinorapwa ndezvomuromo, nzira yekurapa chemotherapy ndiyo inotaridzika yeimwe nzira yakarongedzerwa yekutanga kune vakadzi vane kenza yepakati yechitatu yevhidhiyo .
Chidzidzo Chinokosha
Muna 2006, migumisiro yeGynecologic Oncology Group yekuongororwa kwechipatara GOG 172 yakabudiswa muNew England Journal of Medicine. Muchidzidzo ichi, vakadzi vaikodzera kurapwa kana vaine kamuti yechitatu yekenza yevana kana kanhi yepisitoneal yepamusoro uye kana vane chirongwa chepamusoro chekuvhiya (kureva kuti hapana chigarire chemaitiro mashoma kupfuura 1 cm yakasara shure mushure mekuvhiyiwa).
Mhosva yacho yakarongeka, izvo zvinoreva kuti varwere vakagoverwa kuboka rekurapa ne flip yekombiyuta yemari. Pakati pevakadzi ava 415 vari muchidzidzo, hafu yakagamuchira tsika dzechipatro inonzi intravenous chemotherapy ne cisplatin uye paclitaxel ( Taxol ). Iyo imwe hafu yakagamuchira mishonga imwe chete, asi inobatanidza intravenous (paclitaxel) uye intraperitoneal (cisplatin uye paclitaxel) kutumirwa.
Izvi hazvirevi kurapa kwakanyanya kutora, uye zviitiko zvidzidzo zvakatsigira izvozvo. 42% chete yevakadzi muboka reva intraperitoneal vakakwanisa kuwana maitiro matanhatu emakiratikiti emishonga epraperitoneal.
Vakadzi makumi mapfumbamwe kubva muzana muboka rakagamuchirwa vakagamuchira zvese zvitanhatu. Vakadzi avo vakagamuchira intraperitoneal chemotherapy vaiva neutano hwakanyanya kana kuti hunotyisa hupenyu, marwadzo, kushaya ropa kwepamusoro, uye neurologic side effects. Uyezve kukosha kuziva ndeyekuti vakadzi vapfumbamwe vakafa mukati memakemikrasi - vana muboka revanopinza uye mashanu muboka remukati.
Rufu rwakanga rwakakonzerwa nehutachiona.
Kuponeswa Kunobatsira
Ichi chakaitwa muna 2006 chakaita nhepfenyuro, pasinei nekutyisa kwehutano, nekuda kwehupenyu huripo. Pasinei nekuti 42% chete yevakadzi muboka remitraperitoneal vakakwanisa kugamuchira mishonga mitanhatu yekurapa, kupona-kusununguka-kusununguka (nguva yekurarama isati yasati yasvika) yaive yemwedzi 5 1/2 yakareba yeboka remitrapeitoneal chemotherapy. Kunyanya kunakidza kwaiva kudarika kwese data. Vakadzi vakagamuchira intraperitoneal chemotherapy vane hupenyu hwemakore gumi nemakore kupfuura vakadzi vakagamuchira intravenous chemotherapy chete - mwedzi 65.6 yakaenzana nemwedzi 49.7.
Kubva zvakanyanya pamigumisiro yechirongwa ichi, pamwe chete nedzimwe nhanho mbiri dzechikamu chechitatu, National Cancer Institute yakabudisa chisingaiti Clinical Announcement ichiratidza kuti kushandiswa kwemishonga inokonzera maitiro ekurapa kunofanira kunyatsoongororwa kune vakakodzera.
Kufunga Kubatsira
Kugamuchira intraperitoneal chemotherapy haisi yemunhu wese ane kenza yemuvha, asi zvakadaro. Yeuka, zvichibva pachidzidzo chinokosha, isu chete tinoziva kuti inobatsira vakadzi vane danho rechitatu rezvirwere avo vanewo chirongwa chakakura chekurotoreductive (hakuna residual tumor mass kupfuura 1 cm yakasara shure mushure mekuvhiyiwa).
Kuti ave ne-intraperitoneal chemotherapy, catheter inonzi intraperitoneal (ganda) inofanira kuiswa mudumbu remuviri nejena gynecologic oncologist. Kana isina kuiswa panguva yekuvhiyiwa kwokutanga, inogona kuiswa gare gare, mune imwe nzira yekuvhiya yakasiyana neye gynecologic oncologist kana neine interventional radiologist. Vanachiremba vanotungamirira chemotherapy kuburikidza nechigungwa ichi vanofanira kuva vane unyanzvi uye vakagadzikana nekutaura. Iyo catheter inogona kuchema kana kudziviswa. Kutungamirirwa kwemigumisiro inoda kuti munhu ane unyanzvi wezvehutano wezvokurapa kana gynecologic oncologist uyo ane ruzivo rwemhando iyi yekurapa.
The Follow Up
Kuongorora kwechangobva kuitwa naDkt. Wright nevamwe vaishanda navo, yakabudiswa mu Journal of Clinical Oncology, yakaratidza kuti havasi vakadzi vose vanofanirwa nekurapwa kwemakirinikiti ekugamuchira iyo. Tende rake rakadzidza vakadzi vanomwe 823 avo vaiva nechitatu III ovarian kana fallopian tube kana primary peritoneal carcinoma. Vakadzi ava vakabatwa pamatunhu matanhatu akasiyana nekenza iyo inhengo ye National Comprehensive Cancer Network, kusanganisira City of Hope, Dana-Farber / Brigham nevakadzi, Fox Chase, Ohio State University, University of Texas MD Anderson Cancer Center, uye University of Michigan.
Boka raDkt. Wright rakawana kuti vakadzi vanopfuura 50% avo vakakodzera kugamuchira intraperitoneal chemotherapy zvirokwazvo vakaigamuchira. Kudzidza kwavo kwakaratidza zvakare kuti vakadzi vakagamuchira intraperitoneal chemotherapy vairarama kwenguva yakareba kupfuura avo vakagamuchira chirwere chemhemotherapy chete.
Mharidzo Yotora-Musha
Intraperitoneal chemotherapi yekenza yevarivha kana kanhi yepisitoni inonyanya kukosha inoshandiswa mukurapwa kwezvirwere izvi, nehuwandu hwekuchengetedzwa kwevarwere vanogona kugamuchira kurapwa. Zvisinei, inogona kuva yakaoma kurapwa nehuwandu hwemigumisiro yakaipa kupfuura tsika dzekodha dzakagadzirirwa chemotherapy. Kana iwe uchangobva kuongororwa nekenza yepamusoro ye ovarian kana kuti primary peritoneal kansa, zvakakosha kuti tive nekukurukurirana newe oncologist pamusoro pekuti nzira iyi yakarurama kwauri.
> Sources:
> Armstrong DK, Bundy B, Wenzel L, et al. Ini ntraperitoneal cisplatin uye paclitaxel mukenza yevana. N Engl J Med . 2006; 354 (1): 34-43.
> NCI Clinical Announcement , 2006. https://ctep.cancer.gov/highlights/docs/clin_annc_010506.pdf.
> Wright AA, Cronin A, Milne DE, et al. Kushandisa uye kubudirira kwepraperitoneal chemotherapi yekurapwa kwekenza yevana. J Clin Oncol . 2015 Aug 3. Epub mberi kwekunyora.