Chii chinonzi sarcoma?
Sarcoma ibundu risingawanzo kubatanidza matishu, saka sarcoma inogona kupinda chero chikamu chemuviri wedu. Aya mapundu anosanganisira liposarcoma, neurosarcoma, osteosarcoma, tendon sarcoma, tsandanyama uye ganda sarcoma. Ivo vanoverengera ingangoita 1% yeese magomarara evakuru uye angangoita 15% yemamota ehuduku. Pamusoro pehuvepo hwakatekeshera hwezvingangove nzvimbo dzakakura uye nzvimbo dzisingawanzo, kune anopfuura 80 mamota ane zvakasanganiswa zvikamu zvine akasiyana histological subtypes. Sarcoma imhando yegomarara. Sarcoma—Bundu rinokuvadza rinoumbwa nekanzura mapfupa, shwashwa, mafuta, tsandanyama, tsinga dzeropa, uye nyama.
Zvitatu zvezvinhu izvi zvinoita kuti kurapwa kwesarcoma kuome zvakanyanya. Naizvozvo, zvakakosha kuti varwere veSarcoma varapwe neboka rine ruzivo rwakasiyana siyana. Chikwata chinoda kusanganisira vanachiremba vanovhiya, vezvirwere, vema radiologist, ve oncologists, vanamukoti vehunyanzvi, varapi vemuviri uye vemishonga. .
Kuongororwa kwesarcoma
Kuti usimbise kuongororwa, biopsy inodiwa kusimbisa kuvepo uye chaiyo subtype ye sarcoma. Nekuti mabundu aya haashoma uye akasanganiswa, zvakakosha kuti chiremba ane ruzivo aongorore biopsy samples. Yekutanga diagnostic radiation bvunzo yaisanganisira CT scans uye MRI scans kuona nzvimbo uye rudzi rwe sarcoma.
Kurapa kwesarcoma
Mushonga mukuru we sarcoma yemuno unosanganisira kuvhiyiwa kwakakwana kwakasanganiswa neradiotherapy kana kusarapwa neradiotherapy. Kudiwa kwechiremba ane ruzivo kuti aite basa rinokosha zvikuru, nokuti kushandiswa kwekuvhiyiwa kusina kunaka kunogona kuva nemigumisiro pamigumisiro yekurapa.
Nhamba huru yemakiriniki ekuedzwa yakasimbisa kuti preoperative kana postoperative radiotherapy ine mabhenefiti ari pachena kune sarcoma yeruoko netsoka uye chifuva madziro sarcoma. Ichangobva kuitika yepasi rose randomized kiriniki yekuedza yakaongorora basa repreoperative radiotherapy mukurapa retroperitoneal sarcoma.
Mune chaiwo sarcoma subtype mavhiki, akawanda-agent chemotherapy chikamu chakakosha chekurapa kurapwa; idzi subtypes dzinosanganisira Ewing's sarcoma, osteosarcoma, uye rhabdomyosarcoma. Kuunzwa kweaya masubtypes e-multi-agent chemotherapy uye kuvhiyiwa kwekununura nhengo kwave kubudirira kukuru mumunda wekurapa cancer mumakore makumi mana apfuura.
Kufungidzira kwesarcoma
Nehurombo, kunyangwe iko kushandiswa kwakakwana kwehutano hwekuzara kwekuvhiya resection, ingangoita 50% yevarwere vane wepakati / epamberi sarcoma vanodzokorora zvakare / metastatic tumors. Metastasis inowanzopararira kuburikidza nemidziyo yeropa, uye mapapu ndiyo nzvimbo yakajairika yechirwere chemastastatic.
Kufungidzira mhedzisiro yevarwere vane metastatic sarcoma kazhinji varombo munguva yakapfuura, uye kune mashoma marapirwo sarudzo. Nekudaro, dhata dzazvino dzinoratidza kuti hupenyu hwepakati nepakati hwevarwere vane metastatic soft tishu sarcoma yakawedzera kubva pamwedzi ingangoita gumi nemaviri kusvika kumwedzi gumi nemitanhatu iripo. Ikozvino kune mamwe marongero ehurongwa hwekurapa kwevarwere vane metastatic sarcoma.
Kune varwere vane inononoka-kukura histological subtypes, kutarisa kwediki / asymptomatic metastatic maronda isarudzo. Kuvhiya resection kunoonekwa kana murwere aine chironda chakasiyana chemetastatic, kunyanya kana chironda chiri mumapapu. Dzimwe nzira dzekurapa dzemunharaunda dzinogonawo kutariswa dzinosanganisira radiotherapy, radiofrequency ablation uye embolization.
Sarudzo yekurapa maronda emastastatic anogona kunge akaomesesa, uye tinosimbisa zvakare kuti izvi zvinoda timu ine ruzivo rwakasiyana siyana. Kune vazhinji varwere vane metastatic sarcoma, kurapwa kukuru kunoenderana nehurongwa hwekurapa, kunyanya chemotherapy.
Targeted therapy mu sarcoma
Mishonga yakanangwa yekurapa yakaunzwa mune subtype yeakapfava tishu sarcoma inonzi gastrointestinal stromal tumor (GIST), iyo yave muenzaniso wekunangwa kurapa kwemamota akasimba. Mamota mazhinji emudumbu stromal (GIST) ane KIT uye PDGFRA gene mutation maitiro. Nekuda kwekuiswa kweiyi tyrosine kinase inhibitors, kufungidzira kwevarwere vane metastatic gastrointestinal stromal tumors (GIST) kwakagadziridzwa zvakanyanya.
Uye zvakare, imatinib yakagamuchirwa senzira yekurapa mamota ane njodzi huru mushure mekugadziriswa. Imatinib yave ichishandiswawo zvinobudirira pakurapa mamwe ma sarcoma subtypes (anonzi dermatofibrosarcoma protuberances (DFSP)).
Doxorubicin inogona kushandiswa yoga kana kusanganiswa nefosfamide ichiri nzira yekutanga kurapwa kwemasastatic soft tishu sarcoma. Mumakore mashoma apfuura, mhedzisiro yezvikamu zvitatu zvepasi rose chikamu chechitatu chemakiriniki miedzo yakaburitswa kana kuburitswa.
Chekutanga kiriniki yekuyedza yakasarudzika varwere kuti vagamuchire doxorubicin kana doxorubicin uye ifosfamide. Iyi kiriniki kuyedzwa yakaratidza kuti hapana musiyano muhuwandu hwekupona kwehuwandu hwemaoko maviri, asi varwere vekurapa kwakasanganiswa vaive nehurefu hwekuenderera-husina kupona uye zvakanyanya zvakanyanya mhinduro dzemitero.
Yechipiri kiriniki yekuyedza yakasarudzika varwere kuti vagamuchire doxorubicin uye ifosfamide analogs (palifosfamide) kana doxorubicin pamwe ne placebo. Iyi kiriniki kuyedzwa yakaratidza kuti bvunzo mhedzisiro yemaoko maviri anga asina kunyanya kusiyana. Yechitatu kiriniki yekuyedza yakasarudzika varwere kuti vagamuchire imwechete dosi ye doxorubicin kana gemcitabine / docetaxel. Hapana musiyano wakakosha mumhedzisiro wakaonekwa pakati pemaoko maviri aya.
Mukuwedzera, chirongwa chekliniki chisinganzwisisiki chakafananidza gemcitabine / docetaxel uye gemcitabine monotherapy kuti iite purogiramu yekununura inoshanda kunyanya pakurapa leiomyosarcoma uye isina kukoshesa polymorphic sarcoma.
Muna 2007, marine-yakatorwa mukomboni trabectedin yakatenderwa kuti ishandiswe muEuropean Union. Kubvumidzwa kwaive kwakavakirwa pamhedzisiro yematanho maviri akasiyana echirimo mune yakasarudzika chikamu II kiriniki kutongwa. Shure kwaizvozvo, chikamu chechitatu chekiriniki yekutongwa chakaratidza kuti varwere vane advanced / metastatic liposarcoma uye leiomyosarcoma vakasarudzika kuti vagamuchire trabectedin kana diazolid (varwere vakagamuchira Huihuan antitumor zvinodhaka uye imwe imwe antitumor kurapwa vasati vanyoreswa).
Iyi kiriniki kuyedzwa yakaratidza kuti varwere vakagamuchira trabectedin vakaratidza kwakanyanya kureba kufambira mberi-kusununguka kupona pane avo vakagamuchira diazolid. Izvi zvakatungamira mukubvumidzwa kwekushandiswa kwetrabectedin neU.S.Food uye Drug Administration munaNovember 2015.
Oral tyrosine kinase inhibitor pazotinib yakabvumidzwa zvichibva pane zvakabuda muongororo yekiriniki yevarwere vane nyoro nyoro sarcoma vanowana pazotinib kana placebo. Uyu muyedzo wekiriniki wakaratidza kuti boka re pazotinib rakave nekuvandudzwa kwakakura mukupona-pasina kusununguka, asi pakanga pasina musiyano wakakosha mukupona kwese.
Muna 2016, iyo yegungwa inobvisa microtubule inhibitor eribulin yakagamuchirwa neU.S.Food uye Drug Administration yekurapa yepamusoro liposarcoma. Iko kubvumidzwa kwakavakirwa pane yakasarudzika kiriniki kuyedzwa kwevarwere vane nhanho III yepamusoro / metastatic liposarcoma uye leiomyosarcoma inogamuchira eribulin kana dacrabzine. Iyi kiriniki yekuyedzwa yakaratidza kuti ruoko rweeubulin rune nguva yakanyanya kureba yekupona kupfuura iyo dacarbzaine ruoko.
mhedziso
Mukupedzisa, sarcomas iboka rekenza dzisingawanzo nemusanganiswa wezvinhu, uye vanosangana nematambudziko akakura pakurapa nekusimudzira zvinodhaka. Kuunzwa kwe tyrosine kinases mukurapa kwematumbo stromal tumors (GIST) watove muenzaniso mune yakanangwa kurapwa kweakasimba mamota.
Uye zvakare, mumakore mashoma apfuura, mamwe matsva systemic ekurapa vamiririri akawedzerwa kune sarudzo dziripo dzekurapa sarcoma yepamusoro, kusanganisira pazopanib, trabectedin, uye eribulin. Kubatana kwepasi rose pakati penzvimbo dzakakura dzevatsvagiri vekiriniki uye masayendisiti ekutanga aramba achisimudzira kufambira mberi kwenzira dzekurapa gomarara remusanganiswa yezvinhu izvi.
