Zvirwere zvepfungwa dzepfungwa dzinokura zvakananga muuropi, pane kupararira kubva kune imwe mhuka yakadai somukenza wemapapu. Nzira yakakurumbira yemakumbo emakumbo ekutanga anobva kumagetsi emasero anowanzobetsera nerve cell function. Apo maziso mashoma anova kenza, anonzi glioma .
Kune marudzi mazhinji emasero emagetsi, kusanganisira astrocytes, oligodendrocytes, microglia, uye ependymal masero.
Astrocytomas ndiyo inonyanyozivikanwa yeglioma. Gliomas inowanikwazve muzvikamu zvina nezviratidzo zvechipinda chechikamu pasi pe microscope. Mavambo III uye IV ndiwo mazera makuru, ane chirevo chakaipisisa uye chinonyanya kukosha chokurapa kana zvichibvira. Chikoro IV glioma, iyo inonziwo glioblastoma multiforme kana GBM, inonyanya kufara.
Nhanho yekutanga mukurapa kwepamusoro-grade glioma inonzi neurosurgery kubvisa zvakanyanya zvechiremera sezvinobvira. Dzimwe nguva, kunyange zvakadaro, izvi hazvibviri-murwere angave akarwara zvikuru kuti arege kubvumira kuvhiyiwa, somuenzaniso, kana chironda chinogona kunge chiri mune imwe nzvimbo yakafanana neuropiystem uko kuvhiyiwa kwaizova kwakaipisisa. Kunyange kana kuvhiyiwa kuchiitwa, zvirwere zvinouraya zvinotyisa zvikuru zvokuti vanenge vanenge varwere vose vachadzokazve shure kwekuvhiyiwa. Nenzira yakanaka, mamwe maitiro anowanikwa kuti awedze neurosurgery uye kunyange akatsiva iyo kana chirwere chisingaiti.
Radiation
Kubatsirwa kweropa reradio (RT) kune varwere vane glioma yakaipa kwakatanga kuratidzwa muma1970. Panguva iyoyo, uropi hwose hwakanga huri irradied, chirongwa chinonzi whole-brain radiation therapy (WBRT). Iyo yakawanda inonzi mazhizha inoratidzika kuva 50 kusvika ku 60 Grey (Gy), isina ruzivo rwakawedzerwa asi yakawedzerwa migumisiro yakaipa pamusoro peji iyi.
Iyo migumisiro yemigumisiro inogona kusanganisira radiation necrosis-kufa kwechimiro chetachiona chepfungwa nekuda kwehutachiona. Zvimwe zvinetso zvinosanganisira ropa yemidziyo inoputika, kusuruvara kwevhudzi, musoro wepamusoro nezvimwe.
Kuti kuderedza migumisiro yemigumisiro, kupisa kwemazuva iko zvino kwakanyatsonyanya kuomarara pamarara, ine 1 kusvika 3-centimeter margin, uchishandisa nzira inonzi inobatanidza-munda rayation therapy (IFRT). Nharaunda yacho inobva kune 90 kubva muzana yekudzoka kunoitika pakati pe 2 cm yepakutanga chivara chemasimba pashure pemirairo.
Mimwe nzira inosanganisira 3D inoenderana neyodotherapy (3D-CRT), iyo inoshandisa purogiramu yakakosha kuita zvirongwa zvekurapa kuderedza irradiation yehutano hwehutano. Nhamba-modulated RT (IMRT) inokonzera mashizha mukati mehutano hwemishonga, iyo inobatsira kana bundu racho risingapikisi nzvimbo dzehuropi dzisina kunaka. Nepo nzira dzakapfuura dzinowanzoshandiswa kuunza maitiro mashomanana emagetsi panguva yekushanyirwa, sarotactic radiosurgery (SRS) inopa miviri yakanyatsojeka, yakakwirira yepamusoro kune zviduku zvishoma muuropi. Kubatsirwa kweRSS kunoramba kusinganzwisisiki kana yakashandiswa pamwe chete nemakemikrasi, kunyange dzimwe nguva inoshandiswa kurapa zviremara zvisingakwanisi kuvhiyiwa.
Mishonga inogonawo kuendeswa nekuisa radiyoisotope mbeu mumagetsi ekugadzirisa kana chiremera chacho pachavo, zvichiita kuti kuendeswa kwechirwere kuchienderera mberi.
Randomized kliniki miedzo yakaratidza marginal profitable zvakanakisisa pane iyi nzira. Ikozvino maitiro ekuchengetedza inorapwa nehuwandu-modulated RT mune dzakawanda zviitiko zvinouraya glioma.
Chemotherapy
Temozolomide, inonziwo Temodar, ndiyo inorambidzwa mishonga kune varwere vane GBM. Pakuenzanisa vanhu vakaita kana vasina kugamuchira temozolomide mushure mekurapwa kwemaawa, pane hupenyu hwehupenyu hwehuwandu (27 vs 11 muzana pagore). Methylation ye methyl guanine methyltransferase (MGMT) inokurudzira inonzi genetic iyo inofanirwa kubatsirwa nechemotherapy, zvichiwedzera kuwedzera kwehupfumi kupfuura katatu pamakore maviri.
Chemotherapy neTemozolomide inowanzopiwa zuva rega rega kwemazuva mashanu mazuva makumi mana nerimwe, iyo iri nemazuva makumi maviri nemaviri apera mushure memazuva mashanu ekutungamira. Izvi zvinoitwa 6 kusvika kune gumi nemaviri. Temozolomide inowedzera mukana wehematologic zvinetso zvakadai se-thrombocytopenia, uye saka kuongororwa kweropa kunodiwa 21 nemazuva makumi maviri muhutano hwega hwega. Dzimwe mimwe migumisiro inosanganisira kuora mwoyo, kuneta, uye kuderera kwechido.
Kusanganiswa kwemakemikarirapeutics inonzi procarbazine, lomustine, uye vincristine (PCV) ndeimwe nzira inoshandiswa pakurapa kwepfungwa. Nhamba yemasero eropa anorwisana nehutachiona anogona kuderedzwa nekurapa uku, sezvingaita masero anodzivisa kupwanya uye kubuda ropa. Kuneta, kushungurudzika, kupera, uye kurira kunogonawo kuitika.
Wafers of the drug carmustine (Gliadel) dzimwe nguva inowanikwa munguva yekuvhiya kushandiswa. Zvisinei, deta iri kushayikwa maererano nekubudirira uye kuchengeteka kweiyi nzira mune glioblastoma ichangobva kuongororwa pamwe chete nezvimwe zvirwere. Mushonga uyu unonyatsogutsikana muchechi III glioma, asi nzira yacho ichiri kuongororwa kuongororwa. Zvimwe zvinokonzerwa nemigumisiro zvinosanganisira utachiona uye zvinogona kuuraya uropi huputi.
Bevacizumab (Avastin) is antibody inosungira vascular endothelial growth factor (VEGF). Chirwere ichi chinoedza kupindira nekugadzirwa kwemishonga yeropa idzva inopa mishonga kumarara ekukura. Zvisinei, hapana chibvumirano chinopupurirwa kuti bevacizumab pamwe chete ne temozolomide ne RT. Mushonga uyu wakabatanidzwa neutroenia, hypertension, uye thromboembolism. Zvimwe zvidzidzo zviri kutsvaga zvingawanikidzwa mune zvikamu zvevarwere.
Vakwegura Vakwegura
Mishonga inorayira inowanzosiyana nevarwere vakwegura vari pane ngozi yakawanda yemigumisiro. Nhamba yakaderera yemirasiyo inogona kukurudzirwa kune avo vanoonekwa vasina kukodzera kurapwa nemarayiti uye chemotherapy. Kune avo vane mimba yeMGMT-methylated, temozolomide chete inogona kuva imwe nzira inonzwisisika.
Kudzokorora
Kurapa kwechirwere chinonzi glioma chakadzoka zvakare mushure mekurapa kunokakavara uye kunowirirana zvikuru nevarwere mumwe nomumwe uye vanachiremba. Kudzokorora rushonga rwemaawa kunowedzera dambudziko reyeroation necrosis, kunyange zvazvo kumwe kutsvakurudza kwakaratidza kubatsirwa kwekuchengetedzwa muaplastic astrocytoma, asi kwete zvakajeka kuGGM. Kurapa newavacizumab kunogona kuva yakakodzera zvakadai mukurapa kwakadaro. Pose pazvinenge zvichibvira, varwere vanofanira kufungidzira muchiremba chekuongorora.
Sources:
Buatti J, Ryken TC, Smith MC, et al. Radiation therapy ye pathologically yakatsigira glioblastoma yakanga ichangobva kuwanikwa muvanhu vakuru. J Neurooncol 2008; 89: 313.
Greenberg HS, Chandler WF, Sandler HS. Utano hweBongo (Contemporary Neurology Series 54), Oxford University Press, New York 1999.
Paulino AC, Mai WY, Chintagumpala M, uye al. Mishonga inokonzerwa nehupenzi yakaipa: pane chimwe chinhu chinonzi reirradiation? Int J Radiat Oncol Biol Phys 2008; 71: 1381.
Selker RG, Shapiro WR, Burger P, et al. Bhuku reBongo Tumor Cooperative Group NIH Kurongwa 87-01: kuenzaniswa kwemaitiro ekuvhiya, kunze kwema radiotherapy, uye carmustine nekuvhiya, kupindirana kwema radiotherapy, kukura kwemaawa, kunze kwechirwere uye carmustine. Neurosurgery 2002; 51: 343.