Eminyakeni engu-15 edlule noma ngaphezulu, ukucabanga kwanamuhla mayelana nendlela yokuphatha izigaba zakuqala ze-prostate metastases kuye kwashintsha. Ucwaningo oluhlukahlukene lubonisa ukuthi abambalwa beziguli ezinesisindo sokuqala samathambo asinayo imithi elula kakhulu efana nokukholelwa ngaphambili. Ngakho-ke, ambalwa abantu abano-metastases abangaphansi kwezingu-5 basengakwelashwa nge-aggressive therapy esebenzisa imisebe noma ukuhlinzwa ukuze kuqedwe imishanguzo.
Ama-oligometastases
Kungenzeka ukuthi ezinye iziguli ezinezifo zokuqala zesasasa zisaphila kuthiwa yi- oligometastases. Ukuguqulwa kwama-oligometastase kuye kwafakazelwa ngezinhlobo ezahlukene zomdlavuza, kuhlanganise namagciwane wephaphu , i-colon, i-melanoma ne-prostate. Abanye abantu abanezifo zabo ezithinteka ngokuhlinzwa noma ukushiswa kwemisebe baye bangena ezinkampanini zesikhathi eside (Ingxenye II yalolu chungechunge).
Empeleni kunalokho kunzima ukuphatha ukwelashwa kwinani elincane le-metastases ye-nodal noma ye-bone. Ngokuvamile imisebe ilula ukwedlula ukuhlinzeka, kodwa ama-lymph node cancery angasuswa ngokusebenza. Isici esinqunyelwe yiqiniso elidabukisayo lokuthi ukwelashwa kungase kungabi nalutho uma ama-micro-metastases engabonakali ekhona ngempela. Uma isimo esilandelayo senzeke umdlavuza uzobuyela phansi uma umzila lapho i-micro-metastase ikhula ngokwanele ukuze ibonakale.
Okunye okukhathazayo ukuthi kukhona ingozi yokwelashwa okubangelwa ukwelashwa.
Kodwa-ke, uma imisebe isetshenziswe ngobuchule futhi amabala ambalwa kuphela aphathwa, imiphumela emibi ivame ukuncane. Ngokuvamile, ama-4 noma ama-5 amabala kufanele aphathwe. Ngezinombolo eziningi ze-metastases, amathuba okuba nama-micro-metastases aphezulu. Okunye ukukhathazeka ukuthi ukuphathwa kwamathambo ayisifo kungaphazamisa ukusebenza komnkantsha wamathambo, lapho lapho isimiso somzimba samasosha omzimba sihlala khona.
Ngakho-ke imisebe eyengeziwe emathanjeni ingumqondo omubi kakhulu. Kodwa-ke, uma indawo yomnyofu uphathwa uphansi, imiphumela yesikhathi eside esimisweni somzimba sokuzivikela kufanele singabi nakancane.
Ama-oligometastases angaphilika kodwa asikwazi ukucacisa kusengaphambili ukuthi iziphi iziguli ze-oligometastatic zizokwelashwa ngokuthethelela. Ngisho noma iningi labesilisa abanesifo se-oligometastatic singena ekuxoxweni okuphelele, kuphela abambalwa babo abahlala bekholelwa ekugcineni. Ngakho-ke, ngesimo samanje sobuchwepheshe obukhona, indlela kuphela yokuphulukisa amadoda ane-oligometastases ephilile ukuphatha ukwelashwa kuwo wonke umuntu ongabhekwa.
Izivumelwano zokuphatha i-oligometastases zithembele emisebeni noma ekuhlinzekeni ukuqeda zonke izingosi ezibonakalayo zesifo. Kokubili ukwelashwa kwama-radiation-modulated therapy ( IMRT ) kanye ne-stereotactic radiation body radiation (SBRT) ingacatshangwa. I-IMRT isetshenziswe ngokujwayelekile ukuphatha ama-oligometastases asezindaweni zamakhansela, kanti i-SBRT iyindlela ewusizo kakhulu (futhi mhlawumbe ephumelelayo) yokwelashwa kwamathambo ayisithupha. I-IMRT inikezwa ngama-dose amancane ngaphezu kwamasonto ayisithupha kuya kwangu-8, kuyilapho i-SBRT isebenzisa umthamo ophezulu olawulwa ngezikhathi ezimbalwa futhi uvame ukuqedwa emavikini amabili noma ngaphansi.
Ukwenza ngcono kwe-SBRT kungase kubangelwe ukuthi ukuphakama okukhulu kwemisebe elawulwa isikhathi esifushane kubangela ukusabela okuvuthayo okuvuselela isimiso somzimba sokuzivikela somzimba.
I-Abscopal Effect
I-SBRT iye yaboniswa ukuze isebenze kokubili izimpendulo zomzimba zangasese nezingaguquguquki. Ucwaningo luye lwabonisa ukuthi ngisho nangomthamo owodwa we-radiation of the radiation kuya kwe-tumor, kukhona umphumela wokubamba i-T-cell ku-lymphatics yokudonsa. Le mpendulo ye -T-cell ingase idale inzuzo yokuzivikela emzimbeni omzimba lapho isisombululo somzimba wesiguli singakwazi khona ukuhlasela umdlavuza kwezinye izingxenye zomzimba.
Ukusebenzisa imisebe kwenye indawo okuholela ekuqotheni komdlavuza kwenye indawo emzimbeni kuthiwa "I-Abscopal Effect."
Ukwelapha ama-hormone usebenzisa i-Lupron kuvame ukungezwa emisebeni ukuze kuthuthukiswe umphumela we-anticancer. I-Lupron iyakwazi ukufeza izinto ezimbili: Okokuqala, ithuthukisa umonakalo wokubulala kwemisebe. Okwesibili, ijikeleza ngegazi lapho ingaqeda khona isifo se-micro-metastatic zakudala esesisencane (i-adjuvant chemotherapy ne-Taxotere, ephinde ijikeleze ngegazi ukuze ihlasele isifo se-micro-metastatic).
Imiphumela usebenzisa i-SBRT
Ngiphakamisile ezinye izinkolelo zasemuva ngokuthi ukwelashwa kanjani izifo zesimiso lapho kuphela inani elinqunyelwe lezingosi zemethamusi ezikhona, kungase kube nenzuzo, futhi kwezinye izimo, ngisho nokuphefumula. Emhlanganweni we-American Society of Clinical Oncology ngo-2015, uDkt. Daniel Henderson waseRoyal Marsden Hospital eLondon wabika ngokuhlangenwe nakho kwakhe okwelapha iziguli ezingama-21 ze-oligometastatic prostate ze-radiate.
UDkt. Henderson wachaza umdlavuza we-oligometastatic prostate njengezindawo ezingu-1-3 ze-metastasis, okwenzeka eminyakeni ethile ngemva kokuphathwa okunamandla kwezifo eziyinhloko nokuhlinza noma ukushiswa komlilo okuqondiswe ku-prostate gland. Ukhulume enkulumweni yakhe ukuthi ukwelashwa okuvamile kuyi-androgen empravation therapy (ADT) ehlala isikhathi eside, okusebenza kahle ekulawuleni umdlavuza kodwa kunomthelela omubi emgangathweni wokuphila, njengoba kubangele ukukhathala, ukutholakala kwesisindo, ukuguqulwa kwamathambo, ukulahleka kwemisipha, ukushisa ukukhanya nokulahlekelwa kwe-libido.
Esicwaningweni, iqembu likaDkt. Henderson lihlolisise ukuthi bangakabambezeleka isikhathi esingakanani ukuqala i-ADT ngokuphatha isitifiketi se-metastatic nge-stereotactic radiation therapy (SBRT), ngamathemba wokuthi i-SBRT ingalimaza ukukhula kwesifo futhi ibeke isidingo sokusebenzisa i-ADT.
Iziguli ezazingamazinga e-PSA ngemuva kokuhlinzwa kwangaphambilini noma imisebe yanyuka iskena nge-F-choline PET / CT. Akukho namunye weziguli ezitholwa ukwelashwa kwe-hormone yangaphambilini.
Lapho i-SBRT ihlinzekwa, inani elingu-30 Gy emaqenjini amathathu lanikezwa uhlelo lwe-Cyberknife. Ukubambezeleka kwesikhathi ngaphambi kokuba kube nesidingo sokuqala i-ADT kubalwa kusukela ngesikhathi se-SBRT. I-PSA ihlolwe njalo ezinyangeni ezintathu nokukhishwa okungeziwe nge-F-choline PET / CT eyenziwe njengoba kudingeka.
I-ADT ye-Palliative yeMetastatic Illness
Kulezi ziguli ezingu-21, abangu-6 banikezwa izinyanga ezingu-3 kuya kwezi-6 ze-ADT kanye ne-SBRT. Iningi lala madoda lalinesayithi elilodwa kuphela le-oligometastatic, futhi iningi lezingosi ze-metastatic lalingama-lymph nodes kunamathambo. Ngokuvamile, kwakukhona izilonda ezingu-8 zethambo namasayithi angu-20 aphathwa ngamathambo e-lymph node. Ekulandeleni okuphakathi kwamaphesenti angu-16,7, amaphesenti angu-81 (iziguli ezingu-17) azange afune noma yiluphi ukwelashwa nge-ADT. Ukusinda kwama-Median ADT-mahhala izinyanga ezingu-28 zeqembu lonke. Iziguli ezingamashumi amabili zahlaselwa ePSA ngemuva kokwelashwa. Ukunciphisa amaphesenti amaphakathi ePSA kwakungamaphesenti angu-84. Ayikho isifo esibi kakhulu se-radiation ngaphezu kwebanga lesi-2. Isimo se-grade 1 no-2 se-CTCAE (bheka ngezansi *) sasingamaphesenti angu-29 (iziguli ezingu-6) namaphesenti angu-5 (isiguli esisodwa), ngokulandelana. Akukho ubuthi bebanga lesi-3 noma ngaphezulu okwakubhekwa. Ngokuvamile, uDkt. Henderson kanye neqembu lakhe babe nomuzwa wokuthi i-SBRT yayinakekelwa kahle futhi inenzuzo ekubambezelekeni kokuqala kwe-hormone therapy.
Lolu cwaningo luchaza ukuthi amathuba amasha okwelashwa omusha abangelwa kanjani ukufika kwezinhlobo ezimbili ezintsha zobuchwepheshe obuthuthukisiwe: Okokuqala, ubuchwepheshe bokuskena okungcono kakhulu obungathola imithi encane ngaphambi kwesikhathi ngaphambi kokuba lesi sifo sisakaze ezindaweni eziningi emzimbeni.
Futhi okwesibili, ukuthi imishanguzo enamandla kangakanani engakwazi ukuyenza "umdlavuza," kuyilapho futhi inembile ngokwanele ukuvikela izitho ezinempilo eziseduze kunoma yimuphi umonakalo wezokwelapha. Le ndlela yokuhlukumezeka yokuthola isifo se-metastatic ekuqaleni kwesigaba esithile esingaba khona bese uqala ukwelashwa okunamandla ukwelashwa ngokuhlinzeka ngezilinganiso zokuvimbela imisebe cishe kuyodumeka njengoba abantu beqaphela ukuthi le ndlela yokwelapha ikhona.
> Umthombo:
> Chajon, E., Castelli, J., Marsiglia, H., & De Crevoisier, R. (2017). I-Synergistic Effect ye-Radiotherapy ne-Immunotherapy: Ukusebenzisana Okuthembisayo Kodwa Okungavamile. Ukubuyekeza Okubalulekile ku-Oncology / Hematology , 111 , 124-132.