Pamakore gumi apfuura kana zvakadaro, mazuva ano kufunga nezvekurapa maitiro epakutanga eprostate metastases zvave zvichichinja. Zvidzidzo zvakasiyana-siyana zviri kuratidza kuti vashomanana vevarwere vane danho rekutanga metastases havakwanisi kupararira microscopic metastases sezvakaitika kare. Nokudaro, vashomanana vevarume vane metastases vasingapfuuri mashanu vanogona kurapwa nekurapa kwechisimba vachishandisa mazairo kana kuti chirwere kupedza masitasti.
Oligometastases
Izvo zvingaitika kuti vamwe varwere vane zvirwere zvekutanga zvekare zvinoramba zvichirapwa zvinonzi oligometastases. Kuregererwa kweiligometastases kwakaratidza kuti yakasiyana nemhando dzekenza, kusanganisira kanzira yemapapu , colon, melanoma, uye prostate. Vamwe vanhu vane maitiro avo akabatwa nekuvhiyiwa kana kupiswa kwezuva zvakapinda mumazuva akawanda (Chikamu II chezvikamu izvi).
Izvo chaizvoizvo zviri nyore nyore kupa utachiona kune nhamba shomanana yeinodal or bone metastases. Mishonga inowanzova nyore kupfuura kuvhiyiwa, asi kenza yemaronda inokonzerwa nekenza inogona kubviswa kuburikidza nokuita chirwere. Izvo zvinokonzera chinhu chinoodza mwoyo kuti kurapwa kungaratidza kusina basa kana zvisingaonekwi micro-metastases zviripo zvechokwadi. Kana chiitiko chekupedzisira chikaitika kenza ichadzoka zvakare pasi pemutsara apo micro-metastases inokura yakakura zvakakwana kuti ionekwe.
Chimwe chinetso ndechokuti kune ngozi yekurapa-induced side effects.
Zvisinei, kana mashizha ari kushandiswa nounyanzvi uye mashoma mavara ari kutapurirwa, migumisiro inowanzo kazhinji. Pakawanda, 4 kana 5 mavara anofanira kubatwa. Nehuwandu hwemagetsi, mikana yekuve ne-micro-metastase yakakwirira. Chimwe chinetseka ndechokuti kurapa mabhesi emasasa kunogona kukanganisa basa remapfupa emapfupa, uko ndiko kunogara maitiro ezvirwere zvezvirwere.
Kuwedzera kwemazuva ano kusvika pfupa, naizvozvo, chinhu chakaipa kwazvo. Zvisinei, kana nzvimbo yemafupa ari kubatwa ishoma, kwenguva yakareba zvinogadziriswa pamuviri wekudzivirira muviri zvinofanira kunge zvisingakoshi.
Oligometastase inogona kurapwa asi isu hatigoni kutarisa mberi kuti mailigometastatic varwere vacharapwa nehutano hwehasha. Kunyange zvazvo vazhinji vevarume vane chirwere che oligometastatic vachienda mukuregererwa kwakakwana, vashomanana chete ndivo vanoramba vari mukuregererwa zvachose. Saka, nehupo huripo hwekombiyuta iripo, nzira chete yekurapa varume vane chirwere chinoporesa oligometastase ndechokupa kurapa kune wese anenge ari mubvunzo.
Mitemo yekurapa oligometastases inotsigira kupiswa kwemazuva kana kuti kuvhiyiwa kupedza nzvimbo dzose dzinooneka dzezvirwere. Izvo zvose zvakasimba-modulated radiation therapy ( IMRT ) uye stereotactic ray radiation therapy (SBRT) inogona kuongororwa. IMRT yakawanzoshandiswa kurapa oligometastase inowanikwa mumakirini, apo SBRT inonyanya kukosha (uye zvichida yakanyanya kubudirira) sarudzo yekurapa masasita emapfupa. IMRT inopiwa mune zviduku zvishoma pamasvondo matanhatu, asi SBRT inoshandisa chikwata chapamusoro chinoshandiswa muzvikamu zvishomanana uye inowanzopedzwa mumavhiki maviri kana pasi.
Kuwedzera kwehuwandu hweSBRT kunogona kunge kuripo nokuda kwekuti kunyanya kukwirira kwemaawa anowanikwa kwenguva shomanana kunobatsira kugadzirisa zvinogadzirisa izvo zvinokurudzira zvirwere zvemuviri wezvirwere.
Abscopal Effect
SBRT yakave yakaratidzwa kuti iite zvose zvinyorwa zvisinganzwisisiki uye zvigadziriswa. Zvidzidzo zvakaratidza kuti kunyange nehana imwe chete yakasviba yemirairo kusvika kumarara, kune T-cell priming effect muine lymphatics inodhaka. Iyi mhinduro ye -T-cell inogona kuumba maitiro ekudzivirira zvirwere zvekudzivirira zvirwere mumuviri umo murwere wezvirwere zvehurwere anogona kukwanisa kurwisa kenza mune dzimwe nhengo dzomuviri.
Kushandisa mashizha pane imwe nzvimbo inoita kuti shrinkage yemukenza kune imwe nzvimbo mumuviri inonzi "Abscopal Effect."
Utachiona hweHormone uchishandisa Lupron inowanzowedzerwa kune maratidzo kuti uvandudze anticancer effect. Lupron inogona kuita zvinhu zviviri: Kutanga, inowedzera kuurayiwa kwemirairo. Chechipiri, inopararira kuburikidza neropa iro rinogona kupedza matanho epachikoro chekutanga-stast metastatic (adjuvant chemotherapy ne Taxotere, iyo inopararira kuburikidza neropa kurwisa chirwere chema micro-metastatic, inogona kuonekwawo saizvozvo).
Migumisiro Kushandisa SBRT
Ndakaongorora mamwe maonero ezvokurapa zvirwere zvinokonzerwa nehutachiona kana huwandu huwandu hwenzvimbo dzakasiyana-siyana huripo, hunogona kuva hunobatsira, uye mune zvimwe zviitiko, kunyange kunyora. Pamusangano weAmerican Society of Clinical Oncology muna 2015, Dr. Daniel Henderson kubva kuRoyal Marsden Hospital muLondon akarondedzera pamusoro pezvakaitika kwaari kubata chirwere chemagiramu eligometastatic prostate 21 ane mazaisai.
Dr. Henderson akatsanangura kenza yerogometastatic prostate se 1-3 nzvimbo dzemasastasis, zvinowanzoitika makore apfuura mushure mekunyanyisa kwechirwere chechirwere nekuvhiyiwa kana kupiswa kwemhepo kunotungamirirwa ne prostate gland. Akataura muhurukuro yake kuti chirwere chinogara kwenguva refu uye androgen inoshaiwa chirwere (ADT), iyo inoshanda pakurapa kenza asi ine simba rakaipa pamararamiro ehupenyu, sezvo inokonzera kuneta, kuwedzera kuwanda, osteoporosis, kurasikirwa kwematumbo, kupisa kupenya uye kurasika kwe libido.
Muchidzidzo, boka raDkt. Henderson rakatarisa kuti vangatadza kusvika sei kutanga ADT kuburikidza nekurapa nzvimbo inoshandiswa nemasiteti ane stereotactic ray radiation therapy (SBRT), mune tarisiro yokuti SBRT inogona kunonoka kufambira mberi kwechirwere uye kusimbisa kudiwa kwekushandisa ADT.
Varwere vaiva nehupamhi hwechikwata chePSA mushure mekuvhiyiwa kwekare kana kuti kupisa kwemazuva kwakatanga kuongorora naF-choline PET / CT. Hapana mumwe wevarwere wakagamuchira kare hormone therapy.
Apo SBRT yaigadziriswa, chirwere che 30 Gy muzvikamu zvitatu zvakapiwa neCyberknife system. Nguva yakanonoka kusati kwave nekudikanwa kwekutanga ADT yakaverengwa kubva panguva yeSBRT. PSA yakarongedzwa mwedzi mitatu yoga uye kuwedzera kuenzanisa neF-choline PET / CT yakaitwa sezvinodiwa.
Kurongeka kweAdT yeMatastatic Disease
Kunze kwevatano 21, 6 vakapiwa mwedzi 3 kusvika ku6 ye ADT pamwe neSBRT. Vakawanda vevarume vaiva nenzvimbo imwe chete yeigeriystatic site, uye ruzhinji rwemasimiti e-metastatic dzaive mumakirini emagetsi panzvimbo pemapfupa. Pasi pose, paive neine hutachiona hwemapfupa makumi mapfumbamwe uye masero makumi maviri emakirini anoremekedzwa. Pavanotevera mamiririyoni gumi nemaviri (16,7), 81 muzana (17 varwere) havana kutora chero kurapwa ne ADT. Kupona kwemaMedhia kweAIDS-kune mwedzi 28 yeboka rese. Makumi makumi maviri evarwere aive nekuderera muPSA mushure mekurapa. Mazana emadhora ekuderedzwa kwePSA aiva 84 muzana. Hapana chakanyanya kukanganiswa kwemirasi yepamusoro pegorosi 2 yakaonekwa. Chiitiko chegadziriro 1 ne2 CTCAE chekutyisa (ona pasi apa *) raiva 29 muzana (6 varwere) uye 5 muzana (1 murwere), maererano. Hapana chepfu yegorosi 3 kana pamusoro yakaratidzwa. Pasi pose, Dr. Henderson neboka rake vakafunga kuti SBRT yakanyatsotaridzirwa uye inobatsira pakurambidza kutanga kwemaawa ekurapa.
Ichi chidzidzo chinoratidzira kuti maitiro matsva emishonga ekurapa anokonzerwa nekuuya kwemhando mbiri mitsva yekuvandudza teknolojia: Kutanga, zviri nani kutsvaga teknolojia iyo inogona kuona zviduku zvishoma pakutanga kwechirwere chisati chapararira munzvimbo dzakawanda mumuviri.
Uye chechipiri, majekesa akawanda ane simba sei e "kufema" kenza, asiwo kuva yakarurama zvakakwana kusachengetedza nhengo dzakapoteredza nhengo dzakanaka kubva chero kupi kwekukuvadza kubva muhutano hwehutachiona. Iyi nzira inoshungurudza yekuona zvirwere zvinokonzerwa nehutachiona pamatambo ekutanga uye zvichizotanga kurwisa chirwere chinotyisa kuburikidza nekugadzirisa maitiro ekurapa kwemazuva ano inogona kuve yakakurumbira sezvo vanhu vanoziva kuti kurapwa uku kunovapo.
> Kwakabva:
> Chajon, E., Castelli, J., Marsiglia, H., & De Crevoisier, R. (2017). Shanduro yeSynergistic yaRadiotherapy uye Immunotherapy: Chipikirwa asi Chisina Kubatana. Mazano Anotsoropodza muOncology / Hematology , 111 , 124-132.