Kudzivirira kudzoka kwegomarara remapapu, kudzivirira kudzokazve mushure mekuvhiyiwa kenza yemapapu, nzira yekudzivirira kudzoka kwekenza yemapapu, nzira yekudzivirira kudzoka kwekenza yemapapu.
Kenza yemaperembudzi ndiyo honzeri inokonzera kufa kwevanhu vane hukama nekenza pasirese. Kune varwere vane yekutanga (nhanho I uye II) isiri-diki kenza yemapapu kenza (NSCLC) uye vamwe varwere vakaringana vane munzvimbo dzakasimukira (danho IIIA) isina-diki kenza yemapapu kenza, yakakwana yekuvhiya resection yemamota maronda ndiyo yakanyanya nzira yekurapa nzira. Kunyangwe kufambira mberi kwakaitwa mukutanga kuongororwa uye kurapwa uye kwakanyatso kuvandudza mwero wekupona, kudzoka shure kwekuvhiya kunoramba kuri nyaya yakakosha.
After surgical resection, 30% -75% of kenza yemapapu patients will relapse, including about 15% of patients with stage I lung cancer. Most recurrent tumors occur in distant lesions, and more than 80% of recurrent lung cancers occur within the first two years after resection.
Kudzokororazve chikonzero chakakosha chekutadza kwevarwere vazhinji vegomarara remapapu kurwisa kenza. Maitiro ekudzivirira kudzoka mushure mekuvhiyiwa inyaya yekunetsekana kune wese murwere uye mhuri.
Chii chinonzi kenza kudzokorora?
Kanzuru inodzokororwa inotsanangurwa sekudzokororwa kwegomarara mune anorapwa kenza anorapwa mushure menguva yekuregererwa kana pasina zviratidzo zvegomarara. Cancers iyo inowanikwa mukati memwedzi mitatu yeiyo yekutanga kuongororwa inowanzoonekwa secancer kufambira mberi. Cancer metastasis inoreva chiitiko icho chegomarara nyama dzinosanganisa kubva pazvironda zvekutanga mumapapu kuenda kune dzimwe nhengo, uye kukura nekukura munhengo.
Kudzokorodza kunogona kuve kwakakamurwa kuita matatu kesi zvichienderana nenzvimbo dzakasiyana dzekudzokorora:
1. Yemunharaunda yekudzokororazve-iyo ronda ichiri mumapapu, padhuze nepakutanga ronda;
2. Regional recurrence-when the lesion recurs in the lymph nodes near the original tumarara;
3. Distal recurrence-when a lung cancer relapses in the bones, brain, adrenal glands or liver.
Ndezvipi zvikonzero zvegomarara remapapu rinodzokazve?
Mukana wemukenza wemapapu unodzokororwa unoenderana nezvinhu zvakawanda, zvinosanganisira mhando yekenza yemapapu, nhanho yekenza yemapapu painowanikwa, uye kurapwa kwekenza yekutanga.
Mushure mekuonekwa kwegomarara remapapu, marapirwo ekutanga anoita basa rakakosha, sekuvhiyiwa uye radiotherapy, inoonekwa sekurapa kwenzvimbo, iyo inogona kurapa cancer iripo yakatenderedza nzvimbo yekutanga bundu. Dzimwe nguva maseru ari mubundu rekutanga anopararira achipfuura nemuropa kana lymphatic nzira, asi masero aya madiki kuti aonekwe nekufungidzira. Chemotherapy kurapwa kwakarongeka kunonyanya kubata maseru egomarara anogona kunge aripo mumuviri wese. Nehurombo, chemotherapy ine hombe mhedzisiro uye inokonzeresa kuramba zvinodhaka. Kunyangwe nekemotherapy, masero ekenza anogona kurarama uye kuramba achikura mune ramangwana.
Ndezvipi zviratidzo zvegomarara remapapu rinodzokazve?
Zviratidzo zvekenza yemapapu inodzokororwa zvinoenderana nekenza yekenza painodzokazve. Kana iko kudzokororwa kwemuno, kana mune lymph node padhuze nebundu repakutanga, zviratidzo zvinogona kusanganisira kukosora, hemoptysis, kufema kwekufema, kufema, kana mabayo. Kudzokazve kwehuropi kunogona kukonzera dzungu, kuderera kwemaonero kana kuona kaviri, kushaya simba kana kurasikirwa kwekubatana kune rumwe rutivi rwemuviri. Kudzokerazve muchiropa kunogona kukonzera kurwadziwa kwemudumbu, jaundice (yero yeganda kuita yero), kuvaviwa kana kuvhiringidzika. Kudzoka kwepfupa kunowanzoitika nekurwadziwa kwakadzika mubhokisi, musana, mapendekete, kana makumbo. Zvimwe zviratidzo zvakajairika senge kuneta uye kusatarisika kurasikirwa uremu kunogona kuve kufungidzira kwekudzoka kwekenza.
Nzira yekudzivirira kudzokazve kwekenza yemapapu?
Kuongorora kwenguva nenguva
Sezvo kenza yemapapu isina zviratidzo zvakavimbika uye zvakafanofungidzirwa zvekudzokazve uye metastasis, kuitira kuti uone kudzokororazve kana metastasis kutanga, kutarisa padyo nekutevera kwechirwere kunodiwa.
Kazhinji kutaura, gore rekutanga mushure mekuvhiya kunoongororwa mwedzi mitatu yega yega; gore rechipiri, kuvhiya kwacho kunodzokororwa mwedzi mitanhatu yega yega, uye kuongororwa kwekutenderera kunoenderera.
Kunyatsotevera mazano echiremba uye kuongorora nguva dzose uye nenguva. Kana murwere ane zviratidzo, chifuva chinoenderana nedumbu CT, craniocerebral CT kana MRI, bone scan, fiberoptic bronchoscopy, nezvimwewo.
Mushure mekurapwa, varwere vane gomarara remapapu vanogona kukura matambudziko kana zvimwe zviratidzo nekuda kwemamiriro avo uye zvimwe zvikonzero. Naizvozvo, ongororo yakajairwa haifanire kufuratirwa uye inofanira kupihwa hanya huru.
Biomarker kuona
Chishandiso chakakosha chekufanotaura njodzi yekudzokororwa ndiko kushandiswa kwehunyanzvi hwemamolecular biology. Kenza yemapapu ibundu rinopinda zvakanyanya. Pathological classification (histological differentiation, vascular infiltration, lymphatic infiltration, uye pleural infiltration), tumor TNM stage, uye genotyping zvose zvine hukama nekufungidzira. Kuongororwa kweGenetic uye immunohistochemistry inogona kusanganiswa kushandisa genetic mutations, senge KRAS chimiro, uye CEA uye Ki-67 kutaura mazinga kufanotaura njodzi yekudzokazve.
Simbisa chikafu uye kudzivirira dzihwa
Kune varwere vane gomarara remapapu, chikafu chinofanirwa kuvimbiswa kudzivirira dzihwa, uye kutarisisa kunofanirwa kubhadharwa kuchikafu. Sarudzo dzekudya dzinofanirwa kuve dzakapfuma uye dzakasiyana, nemichero nemiriwo mitsva. Kune varwere vakura, kudya yakawanda porridge uye sobho zvekudya zvichave zviri nani kugaya. Panguva imwecheteyo, isu tinofanirwa kuteedzera kune zvinovaka muviri garandi uye yemhando yepamusoro mapuroteni kudya.
Varwere vane kenza yemapapu vanofanirwa kutarisisa kudziya, kudzivirira dzihwa uye kudzivirira hutachiona. Kunyangwe iri hutachiona kana hutachiona hutachiona, zvinoita kuti hutachiona hwemuviri huderere, uye zviri nyore kuti maseru ekenza awedzere uye adzokere zvakare.
Natsiridza mararamiro ako uye gara uchifara
Rega doro, rega doro, rega doro, zvinhu zvakakosha zvinotaurwa katatu, unofanira kusiya doro. Mukuwedzera, usasvuta, usashanda zvakapfurikidza, teerera kukudzora ndangariro, uye chengeta chimiro chendangariro chokufara.
Kudzidzira kwakakodzera, mwedzi 2-3 mushure mekuvhiyiwa, unogona kuita zvinyoro zvishoma, zvakadai sokufamba, uye zvishoma nezvishoma kuwedzera kubva pamaminitsi gumi nemashanu kusvika kumaminitsi makumi mana; iwe unogona zvakare kurovedza muviri qigong, Tai Chi, maekisesaizi eredhiyo uye mamwe maekisesaizi akapfava.
Kunyanya kutariswa kunofanirwa kubhadharwa kuchikafu, usadye chikafu chakaumbwa, bhengi, bhekoni, tofu uye zvimwe zvekudya zvine nitrite, uye usadye mishonga yechinyakare yechiChinese uye zvigadzirwa zvehutano.
Kurapa kwekenza yemapapu
Surgery
Nzira yakanakisa yekurapa kenza yemapapu ndeyekubvisa maronda anodzokorodza kuzadzisa chinangwa chekurapa kwakanyanya. Kana nzira dzekuvhiya dzikasangana, mamota ese anogona kubviswa nekuvhiya.
Kana paine maronda mazhinji, iyo inopinda nzvimbo iri yakakura, kana metastases iri kure, bundu resection inogona kusarudzwa zvinoenderana nemamiriro ezvinhu. Muchiitiko chekuti bhenefiti yekuvhiya haina kuvimbiswa, dzimwe nzira dzekurapa dzinogona kusarudzwa.
Proton therapy yekurapa kenza yemapapu
Radiotherapy is an adjuvant treatment for many patients with postoperative lung cancer. However, in traditional radiotherapy, X-rays or photon beams are inevitably transmitted to the tumor site and the surrounding healthy tissues. This can damage nearby healthy tissue and can cause serious side effects. Proton therapy inogona kudzivirira zvakakwana izvi mhedzisiro.
Kusiyana neizvi, proton therapy inoshandisa proton beam irradiation uye inogona kumira panzvimbo yebundu isina kusiya mushonga wemwaranzi kuseri kwebundu, saka hazvigone kukuvadza nyama ine hutano iri pedyo. Dzimwe nyanzvi dzinotenda kuti proton therapy yakachengeteka pane yechinyakare radiation therapy.
Varwere veCancer vane hutachiona hwakadzika, kudzvinyirira kwakanyanya kwemwaranzi kunogona kukonzera kukuvara kunhengo dzakajairika, kukonzeresa kukuvara kwakakomba, uye kuunza mutoro wakakomba kumutumbi unenge usisina kusimba. Kunyanya yekenza yemapapu, maronda emota ari padyo nenhengo zhinji dzakakosha, senge chiropa, moyo, esophagus, nezvimwewo, pamwe nehuropi metastases inowanzoitika kune gomarara remapapu. Kusarudza kurapwa kweproton kunogona kunyatso kudzivirira kukuvara kune akakomberedza matishu ane hutano uye kuwana zvakafanana kuuraya maitiro senge echinyakare radiotherapy.
Lung Cancer Zvinodhaka Kurapa
Targeted therapy
With the continuous advancement of precision medicine and the continuous advent of various targeted drugs, the front-line treatment of isina-diki kenza yemapapu kenza (NSCLC) has changed from chemotherapy to the preferred targeted treatment.
Aya nhanhatu akakosha ekuchinja kwemajini mune isiri-diki kenza yemapapu yakanangana nemishonga: EGFR (exon 19/21), ALK, BRAF V600E, ROS1, RET, uye NTRK yakakosha kuvarwere vane kenza yemapapu nekuti ivo vatova nemishonga yakanangwa. inogona kushandiswa pakurapa, kutsiva yechinyakare chemotherapy.
EGFR shanduko-yakanaka kenza yemapapu:
Sarudzo yekutanga-line yekurapa zvinodhaka: gefitinib, erlotinib, afatinib, dacotinib, ositinib, uye ectinib (epamba mishonga).
Kutevera-sarudzo dzekurapa: Oxitinib.
ALK rearrangement-yakanaka kenza yemapapu:
Yekutanga-tambo yekurapa sarudzo: crizotinib, ceritinib, aletinib, uye bugatinib.
Kutevera-kurapwa: Aletinib, Bugatinib, Ceritinib, Lauratinib.
ROS1 rearrangement-yakanaka kenza yemapapu:
Chekutanga-mutsara sarudzo dzemishonga: ceritinib, crizotinib, emtricinib.
BRAF V600E mutation-positive kenza yemapapu:
Yekutanga-tambo yekurapa sarudzo: Dalafenib + Trametinib
Kutevera-kurapwa: Dalafenib + Trametinib
NTRK gene fusion yakanaka kenza yemapapu:
Yekutanga-tambo yekurapa sarudzo: Larotinib, Emtricinib.
Kutevera-kurapwa: Larotinib, Emtricinib.
Pane here zvakawanda kuwanda zvinangwa izvo kenza yemapapu inogona kuona? Zvirokwazvo kwete. Pamusoro pezvo, kune zvimwe zvinomuka zvikaita shanduko senge MET, RET, HER2, nezvimwewo TMB iri kuitawo chiratidzo chekufungidzira immunotherapy. Kana izvi zvikaitika shanduko zvichionekwa, unogona kusarudza inoenderana yakanangwa mishonga yekurapa (ona tafura pazasi)).
Kubuda kwemajini zvinangwa uye zvakanangwa zvinodhaka zveiyo isiri-diki kenza yemapapu kenza
| Kuchinja chinangwa | Inowanikwa yakanangwa zvinodhaka |
| MET kukwidziridzwa kana exon 14 shanduko | Crizotinib (NCCN); Vapfana, Tepotinib (ASCO) |
| RET kuronga patsva | Cabozantinib, Vandetanib (NCCN); LOXO292, BLU667 (ASCO) |
| HER2 (ERBB2) shanduko | Trastuzumab-Metasin conjugate (NCCN) |
| TMB (bundu mutation mutoro) | Nivolumab + Ipilimumab, Nivolumab (NCCN)
|
Kusarudzwa kwezvinodhaka kwekenza yemapapu kana pasina chibereko chekuchinja
Kune varwere vane isiri-diki kenza yemapapu isina genetic mutations, yakakosha biomarker ichiri kuda kuonekwa, inova PD-L1. PD-L1 yakasimudzwa-yakagadziriswa mumaseru mazhinji emamota. 1 musanganiswa, unogona kutadzisa kuwanda uye kushandiswa kweT masero, kuita masero eT mune isingaite, uye pakupedzisira kuitisa immune kupukunyuka, tumorigenesis uye budiriro.
Iyo FDA-inogamuchirwa PD-L1 inofambidzana nzira yekuongorora inogona kutungamira paimumab mukurapa kwevarwere veNSCLC, zvichibva pachikamu chemuviri chikamu (TPS). TPS ndiyo chikamu cheanoshanda mamota maseru anoratidza kukwana kana kuzere membrane inokanganisa pane chero kusimba.
Isiri-diki kenza yemapapu kenza ine PD-L1 kutaura kweTPS ≥1%
Yekutanga-tambo yekurapa sarudzo:
Paimumab monotherapy
2. Isiri-squamous cell carcinoma: (carboplatin / cisplatin) + pemetrexed + paimumab
3. Non-squamous cell carcinoma: carboplatin + paclitaxel + bevacizumab + atejuzumab
4. Squamous cell carcinoma: (carboplatin / cisplatin) + (paclitaxel / albumin paclitaxel) + paimumab
Kana ese maviri magene ekuchinjika akaonekwa uye PD-L1 expression yakakwidziridzwa, inotarisirwa mishonga yekurapa inosarudzwa.
Chekutanga-mutsara wekusarudzwa kwezvinodhaka kune squamous isiri-diki kenza yemapapu kenza (hapana magene anochinja, hapana immune contraindication, PD mamakisi 0-1)
| PD-L1 TPS (bundu reshiyo chikamu) | Yekutanga-mutsara marapirwo sarudzo | Chikamu cheuchapupu | Yakakurudzirwa simba |
| ≥50% | K chinodhaka chimwe chinodhaka | yakakwirira | simba |
| ≥50% | K zvinodhaka + carboplatin + paclitaxel kana albumin paclitaxel | in | simba |
| ≥50% | Hapana humwe humbowo hwekudzivirira immune immune inhibitors inosanganiswa neyekutanga-mutsara chemotherapy | yakakwirira | simba |
| 0,1-49% | K zvinodhaka + carboplatin + paclitaxel kana albumin paclitaxel | in | simba |
| 0,1-49% | Zviratidzo zvemuviri, kurapwa kweplatinamu zvinogoneka | yakakwirira | simba |
| 0,1-49% | Immune contraindication, isina kukodzera kurapwa kweplatinamu, isiri-platinamu maviri-mumiririri chemotherapy inogona kusarudzwa | in | kushaya simba |
| 0,1-49% | Ramba K mushonga wakasanganiswa chemotherapy, asi K mushonga mumwe chete | yakaderera | kushaya simba |
Mhinduro: K chinodhaka paimumab, T chinodhaka chiri atezumab, ese madhiragi akatengeswa muChina
Chekutanga-mutsara mutsara wekusarudza zvinodhaka kune vasina-squamous n
on-diki kenza yemapapu kenza (hapana magene kuchinja, hapana immune contraindications, PD mamakisi 0-1)
| PD-L1 TPS (bundu reshiyo chikamu) | Yekutanga-mutsara marapirwo sarudzo | Chikamu cheuchapupu | Yakakurudzirwa simba |
| ≥50% | K chinodhaka chimwe chinodhaka | yakakwirira | simba |
| ≥50% | K mushonga + carboplatin + pemetrexed | yakakwirira | simba |
| ≥50% | K zvinodhaka + carboplatin + paclitaxel + bevacizumab | in | in |
| ≥50% | T zvinodhaka + carboplatin + albumin paclitaxel | yakaderera | kushaya simba |
| ≥50% | Hapana humwe humbowo hwekudzivirira immune immune inhibitors inosanganiswa neyekutanga-mutsara chemotherapy | yakakwirira | simba |
| 0,1-49% | K mushonga + carboplatin + pemetrexed | yakakwirira | simba |
| 0,1-49% | T ku + carboplatin + paclitaxel + bevacizumab | in | in |
| 0,1-49% | K mushonga + carboplatin + albumin paclitaxel | in | in |
| 0,1-49% | Ramba immunotherapy, platinum-ine maviri-zvinodhaka chemotherapy | yakakwirira | simba |
| 0,1-49% | Zviratidzo zvemuviri, zvisina kukodzera kurapwa kune platinamu, isiri-platinamu mbiri-chemushonga chemotherapy inosarudzika | in | kushaya simba |
| 0,1-49% | Ramba K mushonga wakasanganiswa chemotherapy, asi K mushonga mumwe chete | yakaderera | kushaya simba |
Mhinduro: K chinodhaka paimumab, T chinodhaka chiri atezumab, ese madhiragi akatengeswa muIndia.
Mushonga wekenza wemapapu
Muna 2008, Cimavax-EGF, mushonga wekutanga weprotein-peptide wepasi rose wekurapa girafu III ne IV kenza yemapapu, yakagadziriswa. muna 2012, Kiyuba vakabudirira kugadzira mushonga wechipiri wegomarara remapapu, Vaxira.
Yekutanga kutengeswa kweprotein peptide vaccine-Cimavax-EGF
Chiratidzo: IIIB, IV isiri-diki kenza yemapapu kenza.
Nguva yekutengesa: 2011 (yakanyorwa mu Kiyuba)
Mushure memakore makumi maviri neshanu ekutsvaga, Cuban vaongorori vakabudirira kugadzira mushonga unokwanisa kumisa kufambira mberi kwekenza yemapapu.
Kwayedza Dhata:
CIMAvax-EGF mune varwere vane advanced NSCLC (Phase III kiriniki yekuyedza) inoratidza kuti mushonga uyu wakachengeteka uye unoshanda kune varwere vane advanced NSCLC.
Muchikamu chechitatu chechitatu, makore mashanu ekupona evakadzivirirwa aive 5%, zvichienzaniswa ne14.4% chete muboka rinodzora, zvakapetwa kaviri!
Inokodzera varwere:
Lung majekiseni egomarara are not effective in all patients. The most suitable population is: only for patients with advanced non-small cell lung cancer lung cancer, lung cancer patients with stable disease after first-line chemoradiation and no brain metastases If the patient is in advanced disease, the vaccine is not suitable.
Vatsvagiri vane chivimbo chekuti mumwe muvashanu vevarwere ava achabudirira. Mazhinji mamota akanyangarika, uye vamwe varwere vakanyangarika zvachose! 23% yevarwere vakapona anopfuura makore mashanu. Kunyangwe ivo vari vemberi gomarara remapapu, mushure mekugamuchira mushonga wekudzivirira, vanogona kushanda nekugara zvakajairika, uye hupenyu hwavo hwakanyanya kwazvo, zvichinyatso kunonoka kufambira mberi kwechirwere.
Ziva, zvisinei, kuti CimaVax EGF haigone kumisa kukura kwegomarara, ndoda kuirapa. Pane kudaro, nzira yakatangwa, kuburikidza nekukura kusingadzoreki uye kupatsanurwa kwemaseru ekenza kwakaganhurirwa, zvichibva zvashandura kenza yemapapu yakakwira kuita chirwere chisingaperi. Parizvino, yeCuban yekudzivirira cancer yemapapu yakabvumidzwa munyika dzinopfuura makumi masere pasirese, uye varwere vekumba vanogona zvakare kunyorera kuti vatenge vaccine yekurapa kubva. Kiyuba nekudana + 91 96 1588 1588.
