I-intraperitoneal chemotherapy iyindlela yokuphatha i- chemotherapy yomdlavuza we-ovariya ngqo emgodini wesisu. Ngenkathi iningi le-chemotherapy liyinkimbinkimbi, futhi izindlela eziningi zokwelapha eziphilayo noma ezithintekayo zikhuluma ngomlomo, indlela yokwelapha i-chemotherapy ingenye yezindlela zokunconywa zokuqala ezenzelwe abesifazane abanomdlavuza wesigaba se-ovarian .
Isifundo Esibalulekile
Ngonyaka ka-2006, imiphumela ye-Gynecologic Oncology Group yokuhlolwa kwamagciwane eGOG 172 yanyatheliswa eNew England Journal of Medicine. Kulolu cwaningo, abesifazane babefanelekele ukwelashwa uma benesifo somdlavuza wesifo se-ovarian esiteji noma umdlavuza oyinhloko ye-peritoneal futhi uma benesisindo esihle sokuhlinzeka nge-cytoreductive (okusho ukuthi akekho isisindo esilalayo esingaphezu kuka-1 cm esashiywa ngemva kokuhlinzwa).
Icala lalingakahleleki, okusho ukuthi iziguli zanikezwa eqenjini lokulashwa nge-flip yekhompyutha. Kulaba besifazane abangu-415 ocwaningweni, isigamu sathola imithi yamakhemikhali ejwayelekile yesikhumba nge cisplatin ne paclitaxel ( Taxol ). Lesinye isigamu sathola izidakamizwa ezifanayo, kodwa ngokuhlanganiswa kokulethwa kwe-intravenous (paclitaxel) kanye ne-intraperitoneal (cisplatin ne-paclitaxel).
Lokhu akulona ukwelashwa okulula ukuthatha, futhi imiphumela yokutadisha iqinisekisile lokho. Amaphesenti angu-42 kuphela kulaba besifazane eqenjini le-intraperitoneal bakwazi ukuthola yonke imijikelezo eyisithupha ye-intraperitoneal chemotherapy.
Abesifazane abangamaphesenti angama-90 kulelo qembu elibambe iqhaza bathola yonke imijikelezo eyisithupha. Abesifazane abathola i-intraperitoneal chemotherapy babe nokukhathala okunzima kakhulu noma okusongela ukuphila, ubuhlungu, inani eliphansi legazi, nemiphumela emibi ye-neurologic. Okunye okubalulekile ukuphawula ukuthi abesifazane abayisishiyagalolunye bafa ngesikhathi samakhemikhali - abane eqenjini eliqhamukayo nalabo abayisihlanu eqenjini le-intraperitoneal.
Ukufa kwakungenxa yokutheleleka.
Inzuzo Yokusinda
Lolu cwaningo lwango-2006 lwenza izihloko, naphezu kwesifo sokwelapha, ngenxa yemiphumela yokusinda. Naphezu kokuthi abesifazane abangu-42% kuphela eqenjini labakwa-intraperitoneal bakwazi ukuthola zonke izindlela zokwelashwa, ukuqhubeka kokungena mahhala (isikhathi sokuphila ngaphambi kokuba umdlavuza uqhubeke) kwakuyizinyanga ezingu-5 1/2 ezinde isikhathi seqembu le-intraperitoneal chemotherapy. Okuhlaba umxhwele nakakhulu kwakuyi-data jikelele yokusinda. Abesifazane abathola i-intraperitoneal chemotherapy babenokuphila okusinda isikhathi esingangezinyanga ezingu-16 kunabesifazane abathola imithi yokwelashwa emithanjeni kuphela - izinyanga ezingu-65.6 uma kuqhathaniswa nezinyanga ezingu-49.7.
Ngokusekelwe kakhulu emiphumeleni yalolu cwaningo, kanye nakwezinye izivivinyo ezimbili zesigaba III, iNational Cancer Institute yanikezela isimemezelo esingavamile seKliniki sincoma ukuthi ukusetshenziswa kwe-intraperitoneal chemotherapy kufanele kubhekwe ngokuqinile iziguli ezifanelekile.
Ukucabangela Okusebenzayo
Ukuthola i-chemotherapy ye-intraperitoneal akuyona yonke into enomdlavuza we-ovarian, noma kunjalo. Khumbula, ngokusekelwe ekutadisheni okubalulekile, siyazi kuphela ukuthi kuzuzisa abesifazane abanesifo sesigaba sesi-III abaye baba nokuhlinzekwa okuhle kakhulu kwe- cytoreductive (ayikho isisindo esilalayo esingaphezu kuka-1 cm esashiywa ngemva kokuhlinzwa).
Ukuze ube ne-intraperitoneal chemotherapy, i-catheter ye-intraperitoneal (port) kufanele ifakwe emdongeni wesisu nge-oncologist yegazi. Uma ungafakwa ngesikhathi sokuhlinzwa kokuqala, ingabekwa kamuva, kwindlela ehlukile yokuhlinzekwa yi-oncologist yezinkinga zomzimba noma i-radiologist yangenelela. Abahlengikazi abaphatha i-chemotherapy ngalesi sikhungo kumele babe nekhono futhi bakhululekile ngale ndlela. I-catheter ingase ivuza noma ivinjelwe. Ukuphathwa kwemiphumela emibi kudinga i-oncologist yezokwelapha enekhono noma i-oncologist yezinkinga zokubeletha ezinolwazi kulolu hlobo lwezokwelapha.
I-Follow Up
Ucwaningo lwamuva lukaDkt. Wright nozakwabo, olwanyatheliswa kuyi-Journal of Clinical Oncology, lwabonisa ukuthi akubona bonke abesifazane abafanelekile ukuthola i-intraperitoneal chemotherapy bayayithola. Ithimba lakhe lafunda abesifazane abangu-823 ababenesigaba se-III ovarian noma i-fallopian tube noma i-primary peritoneal carcinoma. Laba besifazane baphathwe izikhungo zomdlavuza ezikhulu eziyisithupha eziyingxenye ye National National Comprehensive Cancer Network, kuhlanganise noMkhandlu Wethemba, uDana-Farber / Brigham nabesifazane, iFox Chase, i-Ohio State University, iNyuvesi yaseTexas, i-University of Anderson, kanye ne-Cancer Center. i-University of Michigan.
Iqembu likaDkt. Wright lithola ukuthi abesifazane abangaphansi kwama-50% abafanelekile ukuthola imithi ye-intraperitoneal chemotherapy empeleni bayitholile. Ukutadisha kwabo kuqinisekisile ukuthi abesifazane abathola i-intraperitoneal chemotherapy bahlala isikhathi eside kunalabo abathola imithi yokwelapha kuphela.
Umlayezo Wasekhaya Wokuthatha
Amakhemikhali e-intraperitoneal for umdlavuza we-ovarian noma umdlavuza wokuqala we-peritoneal iyithuluzi elibalulekile ekwelapheni kwalezi zifo, ngezinga eliphakeme lokusinda iziguli ezingathola lesi srapy. Kodwa-ke, kungaba ukwelashwa okunzima ngemiphumela emibi kakhulu kune-chemotherapy engokwemvelo. Uma usanda kutholakala ukuthi unomdlavuza we-ovarian ohamba phambili noma umdlavuza wokuqala we-peritoneal, kufanelekile ukuba nengxoxo ne-oncologist yakho ukuthi ngabe le ndlela ikulungele yini.
> Imithombo:
> Armstrong DK, uBundy B, Wenzel L, et al. I-cisplatin ntraperitoneal ne-paclitaxel emdlalweni we-ovarian. N Engl J Med . 2006; 354 (1): 34-43.
> Isimemezelo seMitholampilo se-NCI , 2006. https://ctep.cancer.gov/highlights/docs/clin_annc_010506.pdf.
> Wright AA, uCronin A, uMilne DE, et al. Ukusetshenziswa nokusebenza kwamakhemikhali e-intraperitoneal ekwelapheni umdlavuza we-ovarian. J Clin Oncol . 2015 Aug 3. Epub ngaphambi kokuphrinta.