I-lymphoma ingavela ezindaweni eziningi ezihlukahlukene emzimbeni, futhi ezinye izingosi ziqhamuka kunezinye. Ngezidakamizwa ezingavamile, ngezinye izikhathi azikho into efana nokwelapha okuvamile. Kulezi zimo, odokotela benza konke okusemandleni ukuze bathole ukwelashwa okuyoba nokuphumelela okukhulu kunobuthi obuncane. Iminyaka yakho kanye nesimo somphakathi jikelele kungaba yizici ezinkulu ekunqumeni ukuthi yiziphi izindlela zokwelapha okufanele zilungele wena.
I-Primary Central Nervous System Lymphoma
Uhlelo oluyisisekelo lwe-nervous system lymphoma (i-PCNSL) luhlobo olungavamile nolubundlululo lwe-non-Hodgkin lymphoma . I-prognosis ivame ukuba mpofu kakhulu kulabo abaneminyaka engama-60 nangaphezulu ubudala.
Ingxenye yazo zonke izimo ze-PCNSL zenzeka kule nkathi yobudala.
Yize kungavamile, i-PCNSL ikhuphuke eminyakeni engu-30 edlule. Ucwaningo lweziguli ezingama-579 ezikhulile ezitholwe nge- PCNSL ema-1990s e-US zabonisa ukuthi ukusinda okuphakathi kwaba izinyanga ezingu-7 kuphela. Ngaleso sikhathi, i-radiotherapy eyedwa kuphela ingokwelashwa okuvame kakhulu kule nkathi yobudala, ngamaphesenti angu-46.
Nakuba abantu asebekhulile bangase babekezelele i-PCNSL enobudlova be-systemic chemic, bavame ukuhlaselwa kabi kakhulu uma kuqhathaniswa neziguli ezincane. Abantu asebekhulile banethinteka kakhulu yi-toxicity, ikakhulukazi imiphumela emibi ye-neurological elandelayo i-radiotherapy yonke yobuchopho.
Iziguli ezine-CNS lymphoma eyinhloko ngokuvamile ziphathwe ngezigaba ezimbili: isigaba sokungeniswa, okuhloswe ukudala ukukhululwa, nesigaba sokuhlanganiswa, esinikezwe uma ukuxolelwa kufezwa.
Ukwelashwa okuvame ukwedlula yonke i-Trexall (methotrexate) -based chemotherapy elandelwe ukulandela i-radiotherapy ephelele, kodwa iziguli eziningi zibuyela emuva futhi zifa nge-lymphoma noma zibe nenengozi eyingozi yokweshukela kwisimiso sezinzwa.
Amaphethini Wokunakekela
Njengoba kunikezwe le nselelo, uDkt. Benjamin Kasenda kanye nozakwethu bahamba bebheke ngokuhlelekile ngezifundo zokwelapha ezisetshenziswa kule sifo kubantu abangaphezu kuka-60.
Ngokuqondile, babefuna ukwazi ukuthi yiziphi izindlela zokwelashwa kwe- oncologists ezisebenzisayo njengendlela yokwelashwa kokuqala emdlalweni kaningi ezigulini ezine-PCNSL esanda kutholakala.
Bathole izifundo ezingu-20 ezishicilelwe, kuhlanganise nolwazi oluvela ezigulini ezingu-783 ezihlangabezana nezindlela zabo zokutadisha okungukuthi, esanda kutholakala nge-PCNSL, eminyakeni engaphezu kwengu-60 kanye nesistimu yomzimba omzimba ephelele / enempilo. Ngokubanzi, bathole ukwelashwa kokuqala komuntu ngabanye kuleli qembu kuhluke, nokuthi kwakungekho ukwelashwa okujwayelekile kweziguli ezindala nge-PCNSL.
Izinkomba ezibalulekile
- Abacwaningi bathola nokuthi, ngaphezu kweminyaka eyishumi edlule, ukubikezela kule nkathi yobudala kuye kwathuthuka.
- Imithi eyayihilela i-methotrexate ye-high-dose yayihambisana nemiphumela engcono kakhulu.
- I-high-dose methotrexate kanye okungenani imithi emibili ye-IV - ukwelashwa okunamandla - uma kuqhathaniswa ne-methotrexate ye-high-dose kanye ne-chemotherapy yomlomo ayengahlanganiswa nokuphendula okungcono noma ukusinda
- Kubantu abathola i-chemotherapy ephezulu-dose-methotrexate esekelwe, i-radiotherapy yonke yobuchopho yayihlotshaniswa nokusinda okuthuthukisiwe, kodwa futhi neyingozi eyengeziwe yemiphumela emibi yegazi.
- I-Methotrexate manje isiyidakamizwa efundwa kakhulu kunazo zonke ekwelapheni i-PCNSL. Iziguli ezimbalwa manje zelashwa ngelashwa lonke lezokwelapha zomsakazo, kuphela.
Ngaphansi
Lolu cwaningo lubuke emuva emuva kokwenzekile esikhathini esidlule. Kwakuyinkimbinkimbi yokuhlola futhi yokuhlola, ngakho-ke inomkhawulo obalulekile. Noma kunjalo, idatha ecacile kakhulu esuka ku-PCNSL ukuhlolwa okuzayo kubantu asebekhulile ayitholakali. Nakhu okwenziwa leli qembu:
- Ukwelashwa okusekelwe phezulu-dose-methotrexate kufanele kuhlinzekwe ngisho neziguli ezinobuthakathaka, uma kunokwenzeka.
- Ukwelashwa kokuqala kwe-line ngehlanganisela ye-high-dose methotrexate kanye nama-oral agents, procarbazine noma i-temozolomide, isibonelo-futhi kubonakala sengathi uthembise futhi kufanelekile ukuphenywa.
- Ukuphefumula okuphelele kobuchopho kungase kuthuthukise umphumela, kodwa kuhlobene nengozi eyengeziwe yemiphumela emibi ye-neurological.
Okokugcina, uKasenda nabalingani bakhe baqokomisa isidingo sezilingo ezizobhekana neziguli ezigugile ze-PCNSL.
> Imithombo:
UFerreri AJM, uCwynarski K, uPulczynski E, et al. I-Chemoimmunotherapy Ne-Methotrexate, i-Cytarabine, i-Thiotepa, ne-Rituximab (I-MATRix Regimen) kwiziguli ezine-Primary CNS i-Lymphoma: Imiphumela ye-First Randomisation ye-International Extranodal Lymphoma Study Group-32 (IELSG32) yesigaba sesivivinyo sesi-2. I-Lancet Hematology. 2016; 5; e217-e227.
Kasenda B, Ferreri AJM, Marturano E, et al. Ukwelashwa kokuqala kanye nomphumela wabagulayo asebekhulile abaneSystem Central Nerveous System Lymphoma (PCNSL) - Ukubuyekezwa Okuhlelekile kanye Nokwaziswa Kwamalungu Eziguli Meta-Analysis. Ann Oncol . 2015. [Epub ngaphambi kokuphrinta].
I-Roth P, i-Hoang-Xuan K. Izinselelo ekuPhilweni kwabagulayo asebekhulile abane-Primary Central Nervous System Lymphoma. I-Curr Opin Neurol. 2014; 27: 697-701.
I-Panageas KS, i-Elkin EB, uBen-Porat L, et al. Amaphethini Wokulashwa Kubantu Abadala Abaphethe I-Primary Central Nerveous System Lymphoma. I-Cancer 2007; 110: 1338-1344.