Nyanzvi kubva CancerFax inogona kubatsira varwere mukubvunzana zvakananga nenyanzvi munzvimbo huru dzeproton kuona kukodzera kwevarwere kurapwa kweproton. Panguva imwecheteyo, vanogona kubatsira varwere mukuongorora mamiriro avo uye kusarudza dzimwe nzira dzekurapa dzakadai sekuvhiya, chemotherapy, immunotherapy, uye biological cell therapy.
Muzvinafundo Bachtiary, chiremba mukuru weGerman RPTC (Munich Proton Center) akambosimbisa mubvunzurudzo yedu kuti kune marudzi matatu emamota anofanirwa kupihwa pamberi peproton radiotherapy. Yokutanga inonzi nasopharyngeal carcinoma. Ini ndinotenda kuti maproton anogona kuwana kurapa mhedzisiro.
XKmed (ina Kang Changrong) yakasarudza akati wandei enyaya dzekurapa dzine kukosha pakati pehuwandu hukuru hwekenza yenasopharyngeal inorapwa nemaproton kunze kwenyika, uye yakarongedza kune varwere nenyanzvi dzekurapa.
Basic mamiriro:
Chirwere: Nasopharyngeal cancer (kudzokazve)
Zvepabonde: Murume
Zera: 52 makore
Kusunungurwa nguva: Chivabvu 2012
Nzvimbo yekutanga: kurudyi nasopharynx
Tumor inopararira: kurudyi posterior madziro eanopharyngeal mhango, inopinda kurudyi mhasuru refu, dehenya base, cavernous sinus
Chiremba nhoroondo uye kurapwa:
Makore maviri mushure mekupera kwekurapa muna 2014, VaH vakangoerekana vanzwa diplopia muziso ravo repamusoro rekurudyi uye chiveve mumuromo wavo wepamusoro wekurudyi. Akaongororwazve kuWest China Hospital yeSichuan University uye akaita yakawedzerwa MRI scan yenasopharynx nemutsipa, ichiratidza nasopharynx Gomarara rinodzoka, richibatanidza chigadziko chedehenya kumusoro.
Nekuda kweiyo yakawanda ye radiation radiation yakamboitwa uye kubatanidzwa kwedehenya base, zvinonetsa kuti mudzimba zvakajairwa kurapwa kuti ubudirire zvekare. Mr. H. kupererwa vakatanga kutsvaga nzira dzekurapa dzenyika dzese.
Akawana nzira yepamusoro kwazvo yekurapa kenza kuburikidza neinternet-proton therapy. Naizvozvo, VaH vakawana Chang Kang Evergreen, chinzvimbo chekurapa mhiri kwemakungwa chinoongorora kurapwa kweproton, uye vakaita chirwere chekutanga. Akatenda kuti H yaive yakanakira kurapwa kweproton.
Kurapa kweproton kwakakurumidza kutanga munaGunyana 2014, uye izvozvi maronda aVaH H nasopharyngeal adzikira, uye bvunzo dzekutevera dzakaratidza mhedzisiro yekurapa.
Mhedzisiro yemhedzisiro:
Nonkeratotic squamous cell carcinoma
Immunohistochemistry:
PCK (-), P63 (+), S-100 ingangoita 25% (+); in situ kusanganiswa: EBER nuclei (+)
Chiremba nhoroondo uye kurapwa:
Chivabvu 18, 2012-Chikunguru 5, 2012
33 nguva dze nasopharyngeal uye yemutsipa radiotherapy: 69.96Gy / 2.12Gy / 33F
Yakakwira-njodzi chirongwa chakanangwa nzvimbo: 59.4Gy / 1.80Gy / 33F
Yakadzika-njodzi chirongwa chakanangwa nzvimbo: 56.10Gy
Panguva imwe chete chemotherapy: 2 makosi e carboplatin 150mg, matatu makosi e cetuximab. Erbitux 3 mg, 600 mg, uye 400 mg yakapihwa muna Chivabvu 400, Chivabvu 23, uye Chikumi 29, zvichiteerana.
Chikunguru 23, 2012-Chikunguru 27, 2012
Yekuwedzera radiotherapy yeakasara emamosi node mushure me5 nguva dze pharynx: 10Gy / 5F
Pakutanga kwaChikunguru 2014, akanzwa kusagadzikana mune rake repamusoro kurudyi kaviri kuona, kushaya simba kwemuromo wake wekurudyi wekumusoro, asina musoro, uye asina mutsipa. MRI yakawedzera scan, nasopharyngeal carcinoma yakadzokazve, inosanganisira dehenya pasi kumusoro, uye hapana akawedzera lymph node akaonekwa mumutsipa.
Proton Center muMunich, Jerimani:
Gunyana 23, 2014 PET-CT
Iyo chaiyo nasopharyngeal carcinoma yakadzokororazve, bundu rakapinda mukati meyepfupa bone uye dehenya chigadziko, ndokukudziridza rakatenderedza yepakati tempiro lobe muuropi, kumanikidza iyo carotid arteri uye kurudyi optic nerve, uye kurudyi mastoid effusion.
GTV: bundu vhoriyamu mushure mePET-CT chemotherapy
CTV: GTV1 + yekutanga bundu inopararira
PTV: CTV1 + 3mm kuchengetedza nzvimbo
Gumiguru 2-Gumiguru 31, 2014
Proton radiotherapy dose: PTV, 40 * 1.50Gy (RBE), kaviri pazuva, maawa matanhatu akaparadzaniswa, yakazara muyero: 6Gy.
Panguva imwecheteyo, kushandiswa kwevhiki nevhiki kweplatinum-cis-chemotherapy.
Kushivirira panguva yekurapa kweproton:
Diplopia, kudzikira kwekunzwa kurudyi, uye chiveve mumuromo wepamusoro wekumusoro wakawedzera. 1 degree radial erythema uye radiation mucositis yakaonekwa padenga repamusoro kurudyi, uye osteonecrosis yakaonekwa kurudyi kwemukanwa wakaoma. Panguva imwecheteyo chemotherapy yakarambidzwa, uye kungoitika kwega kwemudumbu kwakaitika.
Kuchengeta uye kuenzanisa kwekuongorora mhedzisiro (mifananidzo) usati uye mushure mekurapwa:
Kukadzi 5, 2015: Mucositis uye radiotherapy erythema yakagadziriswa zvachose.
Ongororo yekutanga mushure mekurapa kweproton:
Zvichienzaniswa neMRI yakawedzeredzwa scan musi waNdira 28, 2015 ichienzaniswa naAugust 1, 2014, bundu vhoriyamu rerudyi nasopharyngeal rusvingo rwakaderedzwa, uye pakanga pasina shanduko yakakura mune mamwe ese. Pakange pasina lymphadenopathy pakati peiyo fascias yemutsipa, kurudyi otitis media, uye sphenoid sinusitis.
Ongororo yekutanga mushure mekurapa kweproton, Ndira 28, 2015 MRI yakawedzera scan yakaratidza: saizi yesophopharyngeal carcinoma bundu rakadzikiswa zvishoma pasina kuenderera mberi kana metastasis.
Murwere nyaya:
Mr. H chiremba mune chimwe chipatara muChengdu. Semudzidzisi wechiremba, ane hunyanzvi hwepamusoro pakudzidza, basa rakabudirira, uye mhuri inofara. Iyo template inoyemurika yehupenyu hunofadza. Zvisinei, zvinhu hazvifungidziriki. Muna Chivabvu 2012, ndakangoerekana ndanzwa kusagadzikana kurudyi kwemhino uye ndakawedzera nhengo dzemukoko mumutsipa wepamusoro. Ndakaenda kukiriniki yekunze yeWest China Hospital yeSichuan University kune nasopharyngoscopy. Mhedzisiro yacho yakaratidza kuti munyama weiyo chaiyo pharyngeal crypt wakakwenenzverwa, tsinga dzeropa dzakawedzeredzwa, uye mamwe ma pseudomembranes akabatwa nyore kuti ubude ropa. Yaifungidzirwa se nasopharyngeal carcinoma. Iyo biopsy pathology mushumo yakasimbiswa kuve iri: (kurudyi pharyngeal crypt) isiri-keratotic squamous cell carcinoma. Immune phenotype: PCK (-), P63 (+), S-100 ingangoita 25% (+); in situ kusanganiswa: EBER nuclei (+). MRI uye muviri wese -Pet-CT yakaonekwa se nasopharyngeal carcinoma ine metastasis kune yakadzika yechiberekero lymph node (T2N1M0).
Mushure mekubvumidzwa, makumi matatu nematatu anotungamirwa-akasimba-akagadziriswa maradhi ekurapa akaitwa, achiteverwa nemaviri macircotherapy eechemotherapy uye chemotherapy, uye matatu macircuit eakanangwa kurapwa Gare gare, nekuda kwekukanganisa kwakanyanya kweiyo oropharyngeal mucosa uye kusagadzikana kwesisitimu, synchronous chemotherapy uye yakanangwa kurapwa yakamiswa. Mushure mekurapa, iyo MRI ye nasopharynx yakaitwa zvakare, uye chironda chakadzikiswa. Nekudaro, paive nemakasara emamosi node mune yekumashure pharynx uye ma lymph node munzvimbo yekurudyi yemutsipa IIb. Izvo zvakatemwa kupa yemuno kusundira kurapwa kweparapharyngeal maronda pane muyero we33 cGy / 1000f. Wongorora nguva nenguva mushure mekubuda.
Makore maviri mushure mekuguma kwekurapwa, VaH vakangoerekana vanzwa kuona zvakapetwa muziso ravo rekurudyi uye kugwinha mumuromo wavo wepamusoro wekurudyi. Akave akaongororwazve kuWest China Hospital yeSichuan University. Akave akagadziridzwa MRI scan yemasopharynx nemutsipa, zvichiratidza kudzokororwa kwekenza nasopharyngeal, Kubatanidza dehenya pasi kumusoro.
Mushumo waVaH wekutevera kurapwa
Nekuda kweiyo yakawanda ye radiation radiation yakamboitwa uye kubatanidzwa kwedehenya base, zvinonetsa kuti mudzimba zvakajairwa kurapwa kuti ubudirire zvekare. Mr. H. kupererwa vakatanga kutsvaga nzira dzekurapa dzenyika dzese.
VaH murairidzi wezvechiremba anozivikanwa, Tao Li Man Tianxia, uye vadzidzi vake vanobatsirawo kutsvaga nzira dzekurapa pasi rese. Mumwe wevadzidzi aive muBeijing, uye akawana nzira yekurapa cancer yemhando yepamusoro, proton therapy, kuburikidza neInternet. Naizvozvo, VaH vakawana Chang Kang Evergreen, chipatara chemhiri kwemakungwa chinoshanda neproton therapy, uye vakaita preliminary pathological diagnosis. Akatenda kuti H yaive yakakodzera kurapwa kweproton.
Mushure mekuenzanisa uye kunzwisisa, VaH vakasarudza kusarudza iyo RPTC Proton Center muMunich, Germany ine tekinoroji yepamusoro uye kudhura kwemitengo yevanorapa
t. Ndisati ndaenda, ndinotaurirana nevashandi vane basa mazuva ese, kusanganisira muyero wemwaranzi, zvinokurudzirwa nechipatara, uye zvipfeko, chikafu, pekugara, uye chekufambisa mushure mekunge ndasvika kuGerman.
Muna September 2014, VaH vakasvika kuGermany. Achiperekedzwa nevashandi vomunzvimbomo, akatanga kujairana nemhoteredzo yakapoteredza, achifara kutenga, achifarira zvokudya, uye kuitisa ongororo yokutanga yazvo yokurapa. Kupererwa nekufunganya kwaVaH zvakabva zvagadzikana zvishoma nezvishoma. Akati: “Ndinonzwa ndichiona chiedza murima.” Mushure memazuva matatu ekuongororwa kwemuviri, vhiki imwe gare gare, iyo chaiyo yakagadziriswa mold yakapedzwa uye Mr. H's proton therapy rwendo rwakatanga.
Nekuda kwekuoma kwakaita mamiriro aVaH, chikamu chebundu chakakanganisa tsinga yemaziso yeziso rekurudyi. Chipatara cheGerman chakagadzira chirongwa chakadzama chemwenje, makumi mana emirazvo, kashanu pavhiki. Mushure mekugamuchira marapirwo akati wandei eproton, vanachiremba kuGerman Proton Center vakapa rairo kana vachigona kusanganiswa nekemotherapy kuti vawane zvirinani. Saka VaH vakaronga chipatara chinoshanda nezve chemotherapy kuProton Center. Nehunyanzvi hwekushandisa pakurapa uye kurapa kwepedyo, VaH H vakanzwa kugadzikana.
Mushure mekurapwa, VaH nemukadzi wavo vakafamba vachitenderera kuMunich uye vakaita mabiko anofara neshamwari dzeGerman. Kwapera mwedzi miviri, VaH vakabva kuGermany ndokudzokera kumba. Iye zvino anorarama aine hutano uye anofara.
