Izicubu zomqondo eziyinhloko zikhula ngokuqondile ebuchosheni, kunokuba zisakaze kwenye imithombo efana nomdlavuza wamaphaphu. Uhlobo oluvame kakhulu lwezicubu eziyinhloko zobuchopho livela kuma-glial cell ngokuvamile asekela umsebenzi we-nerve cell. Lapho amangqamuzana e-glial eba umdlavuza, abizwa ngokuthi i- glioma .
Kunezinhlobo eziningi zamaseli we-glial, kufaka phakathi ama-astrocytes, ama-oligodendrocytes, ama-microglia, nama-ependymal amaseli.
I-Astrocytomas yihlobo olujwayelekile kakhulu lwe-glioma. I-Gliomas ihlukaniswa ngezigaba ezine ngezibonakaliso zokuhlukaniswa kweseli ngaphansi kwe-microscope. Amabanga III no-IV angamamaki aphezulu kakhulu, anesifo esibi kunazo zonke nesidingo esikhulu sokwelashwa okunonya uma kunokwenzeka. I-Grade IV glioma, ebizwa nangokuthi i- glioblastoma multiforme noma i-GBM, inokuhlushwa okubi kakhulu.
Isinyathelo sokuqala ekwelapheni i-glioma ephakeme kakhulu yi-neurosurgery ukususa isifo sofuba ngangokunokwenzeka. Nokho, ngezinye izikhathi, lokhu akunakwenzeka-isiguli singase sigule kakhulu ukubekezelela ukuhlinzwa, isibonelo, noma isisu singase sibe endaweni efana ne-brainstem lapho ukuhlinzwa kuyoba yingozi kakhulu. Ngisho noma kwenziwa ukuhlinzeka, ama-glioma amabi kabi kakhulu kangangokuthi cishe zonke iziguli zizohlinzwa ngemva kokuhlinzwa. Ngenhlanhla, ezinye izinketho zitholakalayo ukuze zenzeke nge-neurosurgery futhi zithathele indawo uma ukuhlinzwa kungenakwenzeka.
Umswakama
Inzuzo ye-radiation therapy (RT) ezigulini ezine-glioma ezimbi zaboniswa okokuqala ngawo-1970. Ngaleso sikhathi, lonke ubuchopho babuye baxiliswa, inqubo ebizwa ngokuthi i-whole-brain radiation therapy (WBRT). Isilinganiso esiphezulu semisebe sibonakala singama-50 kuya ku-60 Grey (Gy), singenayo inzuzo eyengeziwe kodwa sanda imiphumela emibi ngaphezu kwalesi sifo.
Lemiphumela emibi ingabandakanya i-necrosis ye-radiation-ukufa kwezicubu ezivamile zobuchopho ngenxa yemisebe. Ezinye izinkinga zibandakanya isitsha segazi esincane, ukulahlekelwa izinwele, ukuphathwa ikhanda nokuningi.
Ukuze unciphise imiphumela emibi, imishanguzo manje igxile kakhulu emzimbeni, ene-margin 1 kuya ku-3 cm, besebenzisa inqubo ebizwa ngokuthi ihilelekile-i-radiation therapy (IFRT). I-margin isekelwe ngamaphesenti angama-90 okuphindaphindiwe okwenzeka phakathi kuka-2 cm we-site yangempela ye-tumor ngemva kwemisebe.
Amanye amasu ahlanganisa i-radiotherapy ehambisana ne-3D (3D-CRT), esebenzisa isofthiwe ekhethekile yokwenza izinhlelo zokwelapha ukunciphisa irradiation yobuchopho obuvamile. I-RT-Intelligent-modulated RT (IMRT) ihlukahluka emisebeni emikhawulweni yezokwelapha, ewusizo lapho i-tumor iphikisana nezindawo ezibucayi zobuchopho. Nakuba izindlela zangaphambilini ezivame ukusetshenziselwa ukuletha amanani ambalwa amancane emisebeni yokuvakashelwa, i-radiosurgery (stereotactic radiosurgery) (SRS) inikeza imisebe eqondile, ephakeme kakhulu emigomeni encane ebuchosheni. Inzuzo ye-SRS ihlala ingacacisiwe uma isetshenziselwa ukuhlanganiswa ne-chemotherapy, nakuba ngezinye izikhathi isetshenziselwa ukuphatha izicubu ezingafinyeleleki ekuhlinzekeni okujwayelekile.
I-radiation ingabuye ihanjiswe ngokufaka imbewu ye-radioisotope emgodleni wokuthengisa noma isisu ngokwayo, okuholele ekuhambisweni kwezinga lokuqhubeka.
Izivivinyo zemitholampilo engahleliwe zibonise inzuzo engafanele kulolu hlelo. Isimo samanje sokunakekelwa ukwelashwa nge-RT-ene-modulated kakhulu ezimweni eziningi ze-glioma ezimbi.
I-Chemotherapy
I-Temozolomide, ebizwa ngokuthi i-Temodar, yisidakamizwa esikhutsisiwe kwiziguli ezine-GBM. Uma kuqhathaniswa nabantu abenza noma abangazange bathole i-temozolomide ngemuva kokuthola imishanguzo ye-radiation, kwakukhona ukusinda okubaluleke kakhulu (ama-27 no-11 amaphesenti ngonyaka owodwa). I-methylation yomgqugquzeli we-methyl guanine methyltransferase (MGMT) iyisici sezakhi zofuzo ezibikezela ukuzuza nge-chemotherapy, okwandisa izinga lokuphila ngokuphindwe kathathu eminyakeni emibili.
I-Chemotherapy ne-temozolomide ivame ukunikezwa nsuku zonke izinsuku ezinhlanu njalo ezinsukwini ezingu-28, okungukuthi ngemva kwezinsuku ezingu-23 ukuphumula ngemuva kwezinsuku ezingu-5 zokuphatha. Lokhu kwenziwa imijikelezo engu-6 kuya kweziyishumi nambili. I-Temozolomide yandisa ingozi yezinkinga ze-hematologic ezifana ne-thrombocytopenia, ngakho-ke ukuhlolwa kwegazi kuyadingeka izinsuku ezingu-21 no-28 kumjikelezo ngamunye wezokwelapha. Ezinye imiphumela emibi zibandakanya ukunxanxathela, ukukhathala nokunciphisa ukudla.
Inhlanganisela ye-chemotherapeutics ebizwa ngokuthi i-procarbazine, i-lomustine, ne-vincristine (i-PCV) yinye indlela yokwelapha ubuhlungu bobuchopho. Inani lamangqamuzana egazi alwa nokutheleleka lingancishiswa yilolukwelapha, njengoba kungenzeka namaseli avimbela ukulimaza nokuphuma. Kungakhathaliseki ukuthi ukukhathala, ukucabangela, ukungafihli, nokuxubha kungenzeka.
Amafutha omuthi we-carmustine (i-Gliadel) ngezinye izikhathi atshalwa ngesikhathi sokuvuselelwa kokuhlinzwa. Kodwa-ke, idatha ayitholakali ngokuphathelene nokusebenza nokuphepha kwalolu daba ku-glioblastoma esanda kutholakala ngokuhambisana nezinye izindlela zokwelapha. Isidakamizwa sisebenza ngokuphumelelayo ebangeni lesi-III glioma, kodwa le nqubo isacatshangelwa ukuhlolwa. Imiphumela emibi engaba khona ihlanganisa ukutheleleka kanye nokuvuvukala kobuchopho obubulalayo.
I-Bevacizumab (i-Avastin) i-antibody ehlangene nesici sokukhula se-vascular endothelial factor (VEGF). Ngakho-ke lesi sidakamizwa sizama ukuphazamisa ukukhiqizwa kwemithambo yegazi entsha enikeza izakhi ezithombeni ezikhulayo. Kodwa-ke, ayikho inzuzo eqinisekisiwe ye-bevacizumab ngokuhambisana ne-temozolomide ne-RT. Isidakamizwa siye sahlotshaniswa ne-neutropenia, umfutho wegazi ophakeme, kanye ne-thromboembolism. Ucwaningo oluqhubekayo luhlola izinzuzo ezingase zibe ngaphansi kwamagundane weziguli.
Iziguli ezindala
Izincomo zokwelapha zivame ukuhlukana neziguli ezindala ezisengozini enkulu yemiphumela emibi. Umthamo ongaphansi we-radiation unganconywa kulabo abathintekayo abangafaneleki ukwelashwa kokubili ama-radiation nama-chemotherapy. Kulabo abanezicubu ze-MGMT-methylated, i-temozolomide yedwa ingase ibe yinto ehlukile.
Ukubuyela emuva
Ukwelashwa kwe-glioma ebulalayo okubuyiselwe ngemuva kokwelashwa kuxabana futhi kuxhomeke kakhulu kwiziguli ngabanye kanye nodokotela. Ukuphinda ukwelashwa kwama-radiation kwandisa ingozi ye-necrosis emisebeni, nakuba ucwaningo oluthile luphakamisa inzuzo yokuphila e-astrocytoma ye-amaplastic, kodwa hhayi ngokucacile ku-GBM. Ukwelashwa nge-bevacizumab kungase kudingeke kakhulu kulezo zonyango. Noma nini lapho kungenzeka, iziguli kufanele zicabangele ukubhalisa esilingo somtholampilo.
Imithombo:
Buatti J, Ryken TC, Smith MC, et al. Ukwelashwa kwezidakamizwa ze-pathologically kwaqinisekisa ukuthi i-glioblastoma esanda kutholakala kubantu abadala. J Neurooncol 2008; 89: 313.
I-Greenberg HS, i-Chandler WF, i-Sandler HS. I-Brain Tumors (I-Contemporary Neurology Series 54), i-Oxford University Press, eNew York 1999.
Paulino AC, Mai WY, Chintagumpala M, et al. Ama-gliomas ahlambalaza ama-radiation: ingabe kunendima yokuvuselelwa kabusha? I-Int J Radiat Oncol Biol Phys 2008; 71: 1381.
Selker RG, Shapiro WR, Burger P, et al. I-Brain Tumor Cooperative Group NIH Trial 87-01: Ukuqhathaniswa okungahleliwe kokuhlinzwa, radiotherapy yangaphandle, nokuhlinzekwa kwe-carmustine, ukuxhaswa kwe-radiotherapy kwangaphakathi, ukukhipha imishanguzo yangaphandle kanye ne-carmustine. I-Neurosurgery 2002; 51: 343.