Ukuvimbela ukuphindelela komdlavuza wamaphaphu, ukuvimbela ukuphindeka ngemva kokuhlinzwa komdlavuza wamaphaphu, indlela yokuvimbela ukuphindelela komdlavuza wamaphaphu, indlela yokuvimbela ukuphindelela komdlavuza wamaphaphu.
Umdlavuza wamaphaphu uyimbangela ehamba phambili yokufa okuhlobene nomdlavuza emhlabeni jikelele. Ezigulini ezinomdlavuza wamangqamuzana weselula wokuqala (wesigaba I no-II) ongewona omncane (i-NSCLC) kanye nezinye iziguli ezifanele ezinomdlavuza wamaphaphu ongeyona omncane othuthukile (isigaba IIIA) esingeyona encane, umdlavuza wamaphaphu wesifo esingeyona encane, indlela ephelele yokwelashwa. Yize intuthuko yenziwe ekuxilongweni nasekwelashweni kokuqala futhi ithuthukise ngempumelelo amazinga okusinda, ukuphindaphinda kwangemva kokuhlinzwa kuhlala kuyindaba ebalulekile.
After surgical resection, 30% -75% of umdlavuza wamaphaphu 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.
Ukuphindaphinda kuyisizathu esibalulekile sokuhluleka kweziguli eziningi ezinomdlavuza wamaphaphu ukulwa nomdlavuza. Ungakugwema kanjani ukuphindeka ngemuva kokuhlinzwa yisihloko esikhathaza sonke isiguli nomndeni.
Kuyini ukuphindaphinda komdlavuza?
Ukuphindaphinda komdlavuza kuchazwa njengokuphindeka komdlavuza esigulini somdlavuza eselaphekile ngemuva kwesikhathi sokuxolelwa noma ukungabikho kwempawu zomdlavuza. Umdlavuza otholakala ezinyangeni ezintathu zokutholakala kokuqala ubhekwa njengomdlavuza. I-Cancer metastasis ibhekisa esimweni lapho izicubu zomdlavuza zihlangana nezilonda eziyinhloko emaphashini ziye kwezinye izitho, futhi zikhule futhi zande ezithweni.
Ukuphindaphinda kungahlukaniswa ngamacala amathathu ngokuya ngezindawo ezahlukahlukene zokuphindeka:
1. Ukuphindeka kwendawo-isilonda sisesemaphashini, eduze kwesilonda sokuqala;
2. Regional recurrence-when the lesion recurs in the lymph nodes near the original isisu;
3. Distal recurrence-when a lung cancer relapses in the bones, brain, adrenal glands or liver.
Ziyini izimbangela zokuphindaphinda komdlavuza wamaphaphu?
Ithuba lomdlavuza wamaphaphu elivela njalo lincike ezicini eziningi, kufaka phakathi uhlobo lomdlavuza wamaphaphu, isigaba somdlavuza wamaphaphu lapho kutholakala, nokwelashwa komdlavuza wokuqala.
Ngemuva kokutholakala komdlavuza wamaphaphu, izindlela zokwelapha zokuqala zidlala indima ebalulekile, njengokuhlinzwa kanye ne-radiotherapy, okubhekwa njengokwelashwa kwasendaweni, okungelapha imidlavuza ekhona endaweni yokuqala yesimila. Ngezinye izikhathi amangqamuzana esimila sangempela asakazekela kude ngomzila wegazi noma we-lymphatic, kodwa lawa maseli mancane kakhulu ukuthi angabonwa ngesithombe. I-Chemotherapy iyindlela yokwelapha ehlelekile ephatha amangqamuzana omdlavuza okungenzeka abe khona kuwo wonke umzimba. Ngeshwa, i-chemotherapy inemiphumela emibi emikhulu futhi ijwayele ukumelana nezidakamizwa. Ngisho nange-chemotherapy, amangqamuzana omdlavuza angase asinde futhi aqhubeke ekhula esikhathini esizayo.
Ziyini izimpawu zokuphindeka komdlavuza wamaphaphu?
Izimpawu zokuphindeka komdlavuza wamaphaphu zincike lapho umdlavuza ubuyela khona. Uma kungukuphindeka kwendawo, noma ku-lymph node eseduze kwesimila sokuqala, izimpawu zingabandakanya ukukhwehlela, i-hemoptysis, ukuphefumula okuncane, ukuvunguza noma i-pneumonia. Ukuphinda ubuchopho kungadala isizungu, ukwehla kombono noma ukubona kabili, ubuthakathaka noma ukulahleka kokuhlangana ngakolunye uhlangothi lomzimba. Ukuphindeka esibindini kungadala ubuhlungu besisu, i-jaundice (ukuphuzi kwesikhumba kube phuzi), ukulunywa noma ukudideka. Ukuphindaphinda kwamathambo kuvame kakhulu ngobuhlungu obujulile esifubeni, emuva, emahlombe, noma emilenzeni. Izimpawu ezivame kakhulu njengokukhathala kanye nokwehla kwesisindo okungalindelekile nakho kungaba ukubikezela kokuphindaphinda komdlavuza.
Ungakuvimbela kanjani ukuphindeka komdlavuza wamaphaphu?
Ukubuyekeza ngezikhathi ezithile
Njengoba umdlavuza wamaphaphu ungenazimpawu ezinokwethenjelwa nezisheshe zabikezelwa zokuphindaphinda kanye ne-metastasis, ukuze kutholakale ukuphindaphinda noma i-metastasis kusenesikhathi, ukuqapha okusondele nokulandelwa kwalesi sifo kuyadingeka.
Ngokuvamile, unyaka wokuqala ngemuva kokuhlinzwa ubuyekezwa njalo ezinyangeni ezintathu; unyaka wesibili, ukuhlinzwa kuyaphindwa njalo ezinyangeni eziyisithupha, bese kuhlolwa ukuhlolwa komjikelezo.
Landela ngokuqinile iseluleko sikadokotela futhi ubuyekeze njalo nangesikhathi. Uma isiguli sinezimpawu, isifuba esihambisanayo nesisu se-CT, i-craniocerebral CT noma i-MRI, i-bone scan, i-fiberoptic bronchoscopy, njll.
Ngemuva kokwelashwa, iziguli ezinomdlavuza wamaphaphu zingaba nezinkinga noma ezinye izimpawu ngenxa yezimo zazo nezinye izizathu. Ngakho-ke, ukubuyekeza njalo akufanele kunganakwa futhi kufanele kunakwe kakhulu.
Ukutholwa kwe-Biomarker
Ithuluzi elibalulekile lokubikezela ingozi yokuphindaphinda ukusetshenziswa kwamasu ebhayoloji yamangqamuzana. Umdlavuza wamaphaphu uyisimila esihlasela kakhulu. Ukuhlukaniswa kwe-pathological (ukuhlukaniswa kwe-histological, ukungena kwemithambo, ukungena kwe-lymphatic, nokungena kwe-pleural), isigaba se-tumor TNM, kanye ne-genotyping konke kuhlobene eduze ne-prognosis. Ukuhlolwa kofuzo kanye ne-immunohistochemistry kungahlanganiswa ukuze kusetshenziswe ukuguqulwa kofuzo, njengesimo se-KRAS, kanye namazinga enkulumo ye-CEA kanye ne-Ki-67 ukuze kubikezelwe ingozi yokuphindeka.
Qinisa umsoco futhi uvimbele imikhuhlane
Ezigulini ezinomdlavuza wamaphaphu, ukudla okunomsoco kufanele kuqinisekiswe ukugwema imikhuhlane, futhi kufanele kunakwe ngokukhethekile ekudleni. Ukukhetha kokudla kufanele kube okunothile futhi okuhlukahlukene, ngezithelo nemifino emisha. Ezigulini esezikhulile, ukudla uphuthu oluningi nesobho kuzogaywa kangcono. Ngasikhathi sinye, kufanele sinake isiqinisekiso sokudla okunempilo nokudla kwamaprotheni okusezingeni eliphakeme.
Iziguli ezinomdlavuza wamaphaphu kufanele zinake ukuzigcina zifudumele, ukuvimbela imikhuhlane nokugwema ukutheleleka. Noma ngabe ukutheleleka ngegciwane noma ngamagciwane, kuzodala ukuthi amasosha omzimba anciphe, futhi kulula ukuthi amangqamuzana omdlavuza ande futhi abuyele emuva.
Thuthukisa indlela ophila ngayo futhi uhlale ujabule
Yeka utshwala, yeka utshwala, yeka utshwala, izinto ezibalulekile zishiwo kathathu, kufanele uyeke utshwala. Ngaphezu kwalokho, ungabhemi, ungasebenzi ngokweqile, naka ukulawulwa kwemizwelo, futhi ugcine isimo sengqondo esijabulisayo.
Ukuzivocavoca okufanele, izinyanga ezingu-2-3 ngemva kokuhlinzwa, ungenza izivivinyo ezithambile, njengokuhamba, futhi kancane kancane ukwandisa kusuka kumaminithi angu-15 kuya kumaminithi angu-40; ungakwazi futhi ukuzivocavoca i-qigong, i-Tai Chi, izivivinyo zomsakazo nezinye izivivinyo ezithambile.
Ukunakekelwa okukhethekile kufanele kukhokhelwe ekudleni, ungadli ukudla okubunjiwe, i-barbecue, i-bacon, i-tofu nokunye ukudla okuqukethe i-nitrite, futhi ungadli umuthi wendabuko nemikhiqizo yezempilo yase-China.
Ukwelashwa komdlavuza wamaphaphu
Ukuhlinzwa
Indlela engcono kakhulu yokwelapha umdlavuza wamaphaphu ukususa izilonda eziphindaphindayo ukufeza inhloso yokwelashwa okunamandla. Uma izindlela zokuhlinza zihlangatshezwa, zonke izicubu zingasuswa ngokuhlinzwa.
Uma kunezilonda eziningi, indawo yokuhlasela inkulu kakhulu, noma ama-metastases akude, ukukhishwa kwesimila kungakhethwa ngokwesimo. Endabeni yokuthi inzuzo yokuhlinzwa ayiqinisekisiwe, ezinye izindlela zokwelashwa zingakhethwa.
Ukwelashwa kwe-Proton yokwelashwa komdlavuza wamaphaphu
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 ingagwema ngokuphelele le miphumela engemihle.
Ngokuphambene, ukwelashwa kwe-proton kusebenzisa i-proton beam irradiation futhi ingama endaweni yesimila ngaphandle kokushiya umthamo wemisebe ngemuva kwesimila, ngakho-ke mancane amathuba okuthi kulimaze izicubu ezinempilo eziseduze. Abanye ochwepheshe bakholelwa ukuthi ukwelashwa kwe-proton kuphephile kunokwelashwa ngemisebe yendabuko.
Iziguli ezinomdlavuza zinokuzivikela okuncane, ukutholakala kwemisebe enamandla kakhulu kungadala ukulimala ezithweni ezijwayelekile, kudale ukusabela okubi kakhulu, futhi kulethe umthwalo omkhulu emzimbeni osuvele ubuthakathaka. Ikakhulukazi ngomdlavuza wamaphaphu, izilonda zesimila ziseduze kwezitho eziningi ezibalulekile, ezinjengesibindi, inhliziyo, imiphakathi, njll, kanye nemastastases obuchopho ajwayelekile kumdlavuza wamaphaphu. Ukukhetha ukwelashwa kwe-proton kungagwema ngempumelelo ukulimala kwezicubu ezinempilo futhi kufinyelele nomphumela ofanayo wokubulala njenge-radiotherapy yendabuko.
Ukwelashwa Kwezidakamizwa Zomdlavuza Wamaphaphu
Ukwelapha okuhlosiwe
With the continuous advancement of precision medicine and the continuous advent of various targeted drugs, the front-line treatment of umdlavuza wamaphaphu weselula ongewona omncane (NSCLC) has changed from chemotherapy to the preferred targeted treatment.
Lezi zinguquko eziyisithupha ezibalulekile zezakhi zofuzo emithini eqondiswe kumdlavuza wamaphaphu okungewona omncane: i-EGFR (exon 19/21), i-ALK, i-BRAF V600E, i-ROS1, i-RET, ne-NTRK ibalulekile ezigulini ezinomdlavuza wamaphaphu ngoba kakade zinemithi ehlosiwe esebenza Kakhulu. ingasetshenziselwa ukwelashwa, esikhundleni se-chemotherapy yendabuko.
Umdlavuza we-EGFR-mutation-positive cancer:
Ukukhethwa kwemithi yokwelashwa komugqa wokuqala: gefitinib, erlotinib, afatinib, dacotinib, ositinib, ne-ectinib (izidakamizwa zasekhaya).
Izinketho zokwelashwa okulandelwayo: i-Oxitinib.
Umdlavuza we-ALK wokuhlelwa kabusha kabusha kwamaphaphu:
Izinketho zokwelashwa komugqa wokuqala: i-crizotinib, i-ceritinib, i-aletinib, ne-bugatinib.
Ukwelashwa kokulandelela: Aletinib, Bugatinib, Ceritinib, Lauratinib.
Umdlavuza wamaphaphu omuhle we-ROS1:
Ukukhethwa kwezidakamizwa zomugqa wokuqala: ceritinib, crizotinib, emtricinib.
I-BRAF V600E umdlavuza wamaphaphu wokuguqula ukuguquka:
Izinketho zokwelashwa komugqa wokuqala: Dalafenib + Trametinib
Ukwelashwa kokulandelela: Dalafenib + Trametinib
Umdlavuza omuhle wamaphaphu we-NTRK:
Izinketho zokwelashwa komugqa wokuqala: Larotinib, Emtricinib.
Ukwelashwa kokulandelela: Larotinib, Emtricinib.
Ingabe kunezinhloso eziningi zokuguqulwa komdlavuza ezitholwa ngumdlavuza wamaphaphu? Vele akunjalo. Ngaphezu kwalokho, kunezinguquko ezithile ezivelayo eziqondiwe ezifana neMET, RET, HER2, njll. immunotherapy. Uma lezi zinguquko eziqondayo ezivelayo zitholwa, ungakhetha ukwelashwa okuqondisiwe kwezidakamizwa (bheka ithebula elingezansi)).
Okuhlosiwe kofuzo okuqhamukayo nezidakamizwa ezihlosiwe zomdlavuza wamangqamuzana ongewona omncane
| Ukuguqulwa kwezinguquko | Izidakamizwa ezihlosiwe ezitholakalayo |
| Ukukhulisa i-MET noma ukuphuma kwe-exon 14 | ICrizotinib (NCCN); I-Capmatinib, Tepotinib (ASCO) |
| Hlela kabusha ukuhlela kabusha | ICabozantinib, iVandetanib (NCCN); I-LOXO292, BLU667 (ASCO) |
| Ukuguqulwa kwe-HER2 (ERBB2) | I-Trastuzumab-Metasin conjugate (NCCN) |
| I-TMB (umthwalo wokuguqula isimila) | I-Nivolumab + Ipilimumab, Nivolumab (NCCN)
|
Ukukhethwa kwezidakamizwa komdlavuza wamaphaphu lapho kungekho kuguquka kwezakhi zofuzo
Ezigulini ezinomdlavuza wamaphaphu ongewona omncane ngaphandle kokuguqulwa kofuzo, i-biomarker ebalulekile isadinga ukutholwa, okuyi-PD-L1. I-PD-L1 ilawulwa phezulu kumaseli amaningi wesimila. 1 inhlanganisela, ingavimbela ukwanda nokusebenza kwamaseli e-T, yenze amaseli e-T abe esimweni sokungasebenzi, futhi ekugcineni yenze ukubaleka komzimba, i-tumorigenesis kanye nentuthuko.
Indlela yokuhlola yokuhambisana nomlingani we-PD-L1 evunyelwe yi-FDA ingahola i-paimumab ekwelapheni iziguli ze-NSCLC, ngokuya ngesilinganiso se-tumor proportion (TPS). I-TPS iphesenti lamangqamuzana e-tumor asebenzayo abonisa ukungcola okuyingxenye noma okugcwele kokugcwala nganoma yikuphi ukuqina.
Umdlavuza wamangqamuzana ongewona omncane nge-PD-L1 expression ye-TPS ≥1%
Izinketho zokwelashwa komugqa wokuqala:
Ukwelashwa nge-Paimumab monotherapy
2. I-non-squamous cell carcinoma: (carboplatin / cisplatin) + pemetrexed + paimumab
3. Non-squamous cell carcinoma: carboplatin + paclitaxel + bevacizumab + atejuzumab
I-4Squamous cell carcinoma: (carboplatin / cisplatin) + (paclitaxel / albumin paclitaxel) + paimumab
Uma kutholakala ukuguquka kwezakhi zofuzo zombili futhi inkulumo ye-PD-L1 iphakanyisiwe, kunconywa ukwelashwa kwezidakamizwa okuhlosiwe.
Ukukhethwa kwezidakamizwa zomugqa wokuqala womdlavuza wesifo samangqamuzana esingeyona esincane (akukho ukuguquka kwezakhi zofuzo, akukho ukuphikiswa komzimba, inani le-PD 0-1)
| I-PD-L1 TPS (isilinganiso sesilinganiso sesigaxa) | Izinketho zemithi yomugqa wokuqala | Izinga lobufakazi | Amandla anconyiwe |
| ≥50% | K isidakamizwa esisodwa | high | Strong |
| ≥50% | K izidakamizwa + i-carboplatin + paclitaxel noma i-albhamuin paclitaxel | in | Strong |
| ≥50% | Abukho obunye ubufakazi bama-immune checkpoint inhibitors ahlanganiswe ne-chemotherapy yomugqa wokuqala | high | Strong |
| 0,1-49% | K izidakamizwa + i-carboplatin + paclitaxel noma i-albhamuin paclitaxel | in | Strong |
| 0,1-49% | Ukuphikisana komzimba, ukwelashwa okuqukethe i-platinum kungenzeka | high | Strong |
| 0,1-49% | Ukuphikisana kwamagciwane omzimba, okungakulungele ukwelashwa kweplatinamu, i-non-platinum ekhiqiza amakhemikhali amabili angakhethwa | in | buthakathaka |
| 0,1-49% | Yenqaba i-chemotherapy ehlangene yamakhemikhali, kepha isidakamizwa esisodwa se-K | Phansi | buthakathaka |
Amazwi: Umuthi we-K yi-paimumab, umuthi we-T yi-atezumab, zombili lezi zidakamizwa zithengisiwe eChina
Ukukhethwa kwezidakamizwa zomugqa wokuqala kwabangewona abenoganga n
umdlavuza wamaphaphu weseli oncane (akukho ukuguquka kwezakhi zofuzo, akukho ukuphikiswa komzimba, isilinganiso se-PD 0-1)
| I-PD-L1 TPS (isilinganiso sesilinganiso sesigaxa) | Izinketho zemithi yomugqa wokuqala | Izinga lobufakazi | Amandla anconyiwe |
| ≥50% | K isidakamizwa esisodwa | high | Strong |
| ≥50% | K isidakamizwa + i-carboplatin + pemetrexed | high | Strong |
| ≥50% | K isidakamizwa + i-carboplatin + paclitaxel + bevacizumab | in | in |
| ≥50% | I-T drug + carboplatin + i-albhamuin paclitaxel | Phansi | buthakathaka |
| ≥50% | Abukho obunye ubufakazi bama-immune checkpoint inhibitors ahlanganiswe ne-chemotherapy yomugqa wokuqala | high | Strong |
| 0,1-49% | K isidakamizwa + i-carboplatin + pemetrexed | high | Strong |
| 0,1-49% | + I-carboplatin + paclitaxel + bevacizumab | in | in |
| 0,1-49% | K umuthi + i-carboplatin + i-albhamuin paclitaxel | in | in |
| 0,1-49% | Yenqaba i-immunotherapy, i-platinum equkethe izidakamizwa ezimbili zamakhemikhali | high | Strong |
| 0,1-49% | Ukuphikisana komzimba, okungakulungele ukwelashwa okuqukethe i-platinum, i-non-platinum dual-drug chemotherapy kungakhethwa | in | buthakathaka |
| 0,1-49% | Yenqaba i-chemotherapy ehlangene yamakhemikhali, kepha isidakamizwa esisodwa se-K | Phansi | buthakathaka |
Amazwi: Umuthi we-K yi-paimumab, umuthi we-T yi-atezumab, zombili izidakamizwa sezithengisiwe eNdiya.
Umuthi wokugomela umdlavuza wamaphaphu
Ngo-2008, iCimavax-EGF, umuthi wokugoma wokuqala wamaprotheni-peptide wokwelapha umdlavuza wamaphaphu wesigaba III no-IV, yathuthukiswa ngempumelelo; ngo-2012, Cuba wasungula ngempumelelo umuthi wesibili wokugomela umdlavuza wamaphaphu, i-Vaxira.
Umuthi wokugoma wamaphrotheni wokuqala omakethwa emhlabeni-i-Cimavax-EGF
Inkomba: IIIB, IV umdlavuza wamaphaphu weseli ongewona omncane.
Isikhathi sokumaketha: 2011 (okubalwe ku- Cuba)
Ngemuva kweminyaka engama-25 yocwaningo, I-Cuban abacwaningi baphumelele ukulungisa umuthi wokugoma ongamisa ukuqhubeka komdlavuza wamaphaphu.
Idatha Yokuhlola:
I-CIMAvax-EGF ezigulini ezine-NSCLC esezingeni eliphezulu (Isigaba III sesilingo somtholampilo) ifakazela ukuthi umuthi wokugoma uphephile futhi uyasebenza ezigulini ezine-NSCLC esezingeni eliphezulu.
Esivivinyweni sesigaba III, izinga lokusinda kweminyaka emihlanu yezihloko ezigonyiwe laliyi-5%, uma kuqhathaniswa ne-14.4% kuphela eqenjini lokulawula, cishe liphindwe kabili!
Ifanele iziguli:
Lung imithi yokugoma umdlavuza 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.
Abaphenyi banesiqiniseko sokuthi isiguli esisodwa kwezihlanu sizophumelela. Izimila eziningi zanyamalala, kanti ezinye iziguli zanyamalala ngokuphelele! Iziguli ezingama-23% zisinde ngaphezu kweminyaka emihlanu. Yize benomdlavuza wamaphaphu osezingeni eliphezulu, ngemuva kokuthola ukwelashwa kokugoma, bangasebenza futhi baphile ngokujwayelekile, futhi izinga labo lempilo liphakeme kakhulu, libambezela ngempumelelo ukuqhubeka kwesifo.
Qaphela, nokho, ukuthi i-CimaVax EGF ayikwazi ukunqanda ukukhula komdlavuza, ingasaphathwa eyokuwelapha. Esikhundleni salokho, kwaqalwa indlela, okwathi ngayo ukukhula okungalawuleki nokuhlukaniswa kwamangqamuzana omdlavuza kwaba nemingcele, ngaleyo ndlela kwashintsha umdlavuza wamaphaphu ohlaselayo othuthukile waba isifo esingamahlalakhona. Njengamanje, umuthi wokugomela umdlavuza wamaphaphu waseCuba usuvunyiwe emazweni angaphezu kwama-80 emhlabeni jikelele, futhi iziguli ezifuywayo zingafaka isicelo sokuthenga lo mgomo wokwelashwa. Cuba ngokubiza ku- + 91 96 1588 1588.
