Ochwepheshe abavela ICancerFax ingasiza iziguli ekubonisaneni ngqo nochwepheshe ezikhungweni ezinkulu ze-proton ukuthola ukufaneleka kweziguli ekwelapheni i-proton. Ngesikhathi esifanayo, bangakwazi ukusiza iziguli ekuhloleni isimo sazo futhi zikhethe ezinye izindlela zokwelapha ezinjengokuhlinzwa, i-chemotherapy, i-immunotherapy, kanye ne-biological cell therapy.
USolwazi Bachtiary, udokotela omkhulu we-German RPTC (Munich Proton Center) wake wakugcizelela engxoxweni yethu ukuthi kunezinhlobo ezintathu zezimila okufanele zinikezwe kuqala ukwelashwa ngemisebe ye-proton. Owokuqala yi-nasopharyngeal carcinoma. Ngikholwa ukuthi ama-proton angafeza imiphumela yokwelapha.
UXKmed (noKang Changrong) ukhethe amacala amaningi ezokwelapha anenani lesethenjwa phakathi kwenani elikhulu lamacala omdlavuza we-nasopharyngeal elashwa ngamaphrotoni aphesheya, futhi awahlelela iziguli kanye nabasebenza kwezokwelapha.
Isimo esiyisisekelo:
Isifo: Umdlavuza weNasopharyngeal (ukubuyela emuva)
Ubulili: Male
Ubudala: iminyaka engu-52 ubudala
Isikhathi sokukhishwa: Meyi 2012
Indawo yokuqala: i-nasopharynx yangakwesokudla
Isimila sisakazeka: udonga lwangakwesokudla lwangemuva lomgodi we-nasopharyngeal, luhlasela imisipha emide elungile, isisekelo sokhakhayi, isinus cavernous
Umlando wezokwelapha nokwelashwa:
Eminyakeni emibili ngemva kokuphela kokwelashwa ngo-2014, uMnu. H wavele wezwa i-diplopia esweni lakhe elingaphezulu kwesokudla kanye nokuba ndikindiki odebeni lwakhe olungenhla lwesokudla. Waphinde wahlolwa eSibhedlela saseWest China saseSichuan University futhi wenza i-MRI scan ethuthukisiwe yenkanka nentamo, ebonisa i-nasopharynx Umdlavuza uyabuya, okuhlanganisa isisekelo sogebhezi ukuya phezulu.
Ngenxa yenani elikhulu lokwelashwa ngemisebe okwenziwe phambilini kanye nokubandakanyeka kogebhezi, kunzima ukwelashwa okuvamile kwasekhaya ukuthi kuphumelele. UMnu. H. ngokuphelelwa yithemba waqala ukufuna izindlela zokwelashwa zomhlaba wonke.
Uthole indlela esezingeni eliphakeme kakhulu yokwelapha umdlavuza ngokusebenzisa i-Internet-proton therapy. Ngakho-ke, uMnu H wathola uChang Kang Evergreen, isikhungo sezokwelapha phesheya kwezilwandle esisebenza ngokukhethekile ngemithi yokwelapha i-proton, futhi wenza nesifo sokuqala sezifo. Wayekholelwa ukuthi uH wayekulungele kakhulu ukwelashwa kwe-proton.
Imithi yokwelapha iProton yasheshe yaqalwa ngoSepthemba 2014, kanti manje izilonda zikaMnu H's nasopharyngeal zinciphile, kanti izivivinyo zokulandelela zikhombise imiphumela emihle kakhulu yokwelashwa.
Imiphumela yokugula:
I-Nonkeratotic squamous cell carcinoma
I-Immunohistochemistry:
I-PCK (-), i-P63 (+), i-S-100 cishe ngama-25% (+); in hybridization: I-EBER nuclei (+)
Umlando wezokwelapha nokwelashwa:
Meyi 18, 2012-Julayi 5, 2012
Izikhathi ezingama-33 ze-nasopharyngeal nentamo ye-radiotherapy: 69.96Gy / 2.12Gy / 33F
Indawo ebhekiswe engcupheni ephezulu: 59.4Gy / 1.80Gy / 33F
Indawo eqondiswe kuhlelo lobungozi obuncane: 56.10Gy
Ukwelashwa ngamakhemikhali kanyekanye: Izifundo ezi-2 ze-carboplatin 150mg, izifundo ezi-3 ze-cetuximab. I-Erbitux 600 mg, 400 mg, ne-400 mg yanikezwa ngoMeyi 23, Meyi 29, noJuni 5, ngokulandelana.
Julayi 23, 2012-Julayi 27, 2012
I-radiotherapy eyengeziwe yama-lymph node asalayo ngemuva kwezikhathi ezi-5 ze-pharynx: 10Gy / 5F
Ekuqaleni kukaJulayi 2014, wezwa ukungakhululeki kumbono wakhe ophakeme ongakwesokudla, ukuba ndikindiki komlomo wakhe wangakwesokudla, akukho khanda, futhi kungekho nentamo. I-MRI ithuthukise ukuskena, i-nasopharyngeal carcinoma yaphindeka, ifaka isisekelo skull phezulu, futhi awekho ama-lymph node akhulisiwe abonakala entanyeni.
Isikhungo seProton eMunich, eJalimane:
Septhemba 23, 2014 PET-CT
I-nasopharyngeal carcinoma yesokudla yaphindeka, isimila sangena emathanjeni esikhashana nasekhakhayini, sathuthuka saya ngasengxenyeni ephakathi yesikhashana ebuchosheni, sicindezela umthambo we-carotid kanye ne-optic nerve efanele, kanye ne-mastoid effusion efanele.
I-GTV: ivolumu yesimila ngemuva kwe-PET-CT chemotherapy
I-CTV: Ukusabalala kwesimila sokuqala kwe-GTV1 +
I-PTV: CTV1 + 3mm ibanga lokuphepha
Okthoba 2-Okthoba 31, 2014
Umthamo we-Proton radiotherapy: PTV, 40 * 1.50Gy (RBE), kabili ngosuku, ukuhlukaniswa kwamahora angu-6, inani eliphelele: 60.00Gy.
Ngasikhathi sinye, ukusetshenziswa kwamasonto onke kwe-platinum-cis-chemotherapy.
Ukubekezelelana ngesikhathi sokwelashwa kwe-proton:
IDiplopia, kwehle ukuzwa ohlangothini lwesokunene, nokuba ndikindiki kudebe langaphezulu kwesokudla kwaba kubi. I-1 degree radial erythema kanye ne-radiation mucositis kwavela esihlathini esingenhla kwesokudla, kwathi i-osteonecrosis yavela ngasohlangothini lwesokunene lwenkalakahla eqinile. Ukwelashwa ngamakhemikhali ngasikhathi sinye kwakubekezeleleka kahle, futhi kwaba nokusabela okuthile emathunjini kuphela.
Ukulandelela nokuqhathanisa imiphumela yokuhlola (izithombe) ngaphambi nangemva kokwelashwa:
NgoFebhuwari 5, 2015: I-Mucositis ne-radiotherapy erythema ixazululwe ngokuphelele.
Ukubuyekezwa kokuqala ngemuva kokwelashwa kwe-proton:
Uma kuqhathaniswa neskena esithuthukisiwe se-MRI ngoJanuwari 28, 2015 uma kuqhathaniswa no-Agasti 1, 2014, ivolumu yesigaxa sodonga lwangakwesokudla lwe-nasopharyngeal lancishiswa, futhi alukho ushintsho oluphawulekayo kokunye. Kwakungekho i-lymphadenopathy phakathi kwe-fascias yentamo, i-otitis media yangakwesokudla, ne-sphenoid sinusitis.
Ukubuyekezwa kokuqala ngemuva kokwelashwa kwe-proton, ngoJanuwari 28, 2015 I-MRI ithuthukise ukuskena kukhombisile: ubukhulu be-nasopharyngeal carcinoma tumor bancipha kancane ngaphandle kokuqhubeka noma i-metastasis
Indaba yesineke:
UMnu H ungudokotela esibhedlela eChengdu. Njengomfundisi wobudokotela, unesizinda esihle kakhulu kwezemfundo, umsebenzi ophumelelayo, nomndeni ojabulayo. Kuyisifanekiso esithandekayo sokuphila okujabulisayo. Kodwa-ke, izinto azilindelekile. Ngo-May 2012, ngazizwa ngingaphilile kahle engxenyeni yangakwesokudla yekhala nama-lymph node akhulisiwe entanyeni engenhla. Ngiye emtholampilo wabangalaliswanga esibhedlela iWest China Hospital yaseSichuan University ngenzela i-nasopharyngoscopy. Imiphumela ikhombise ukuthi isicubu se-crypt pharyngeal crypt sasikhuthukile, imithambo yegazi yanda, futhi amanye ama-pseudomembranes athinteka kalula ukopha. Kwakubhekwa njenge-nasopharyngeal carcinoma. Umbiko we-biopsy pathology waqinisekiswa ukuthi: (kwesokudla i-pharyngeal crypt) engeyona i-keratotic squamous cell carcinoma. I-immune phenotype: I-PCK (-), i-P63 (+), i-S-100 cishe ngama-25% (+); in situ hybridization: I-EBER nuclei (+). I-MRI nomzimba wonke wePet-CT kutholakale njenge-nasopharyngeal carcinoma ene-metastasis kuma-lymph node ajulile omlomo wesibeletho (T2N1M0).
Ngemuva kokungeniswa, kwenziwa imishanguzo yokwelashwa ngemisebe eqondiswe emandleni e-33, kwalandelwa imijikelezo emibili ye-radiotherapy kanye ne-chemotherapy, kanye nemijikelezo emithathu yokwelashwa okuqondisiwe. Kamuva, ngenxa yokusabela okunzima kwe-oropharyngeal mucosa nokungahambi kahle kwesistimu, ukwelashwa ngamakhemikhali okuvumelanayo nokwelashwa okuqondisiwe kwamiswa. Ngemuva kokwelashwa, i-MRI ye-nasopharynx yenziwa futhi, futhi lesi sifo sancipha. Kodwa-ke, kwakukhona ama-lymph node asalayo ku-posterior pharynx nakuma-lymph node endaweni yentamo yesokudla i-IIb. Kwanqunywa ukuthi kunikezwe ukwelashwa kwasendaweni kwezilonda ze-parapharyngeal ngomthamo we-1000 cGy / 5f. Buyekeza njalo ngemuva kokukhishwa.
Eminyakeni emibili ngemuva kokuphela kokwelashwa, uMnu H ngokuzumayo wezwa ukubona okuphindwe kabili esweni lakhe langakwesokudla nangokuphahluka endebeni yangaphezulu yangakwesokudla. Wabuye wahlolwa kabusha eWest China Hospital yaseSichuan University. Wathola ukuskena okwenziwe ngcono kwe-MRI kwe-nasopharynx nentamo, kukhombisa ukuphindeka komdlavuza we-nasopharyngeal, Ukubandakanya isisekelo sokhakhayi phezulu.
Umbiko wokwelashwa okulandelwayo kukaMnu
Ngenxa yenani elikhulu lokwelashwa ngemisebe okwenziwe phambilini kanye nokubandakanyeka kogebhezi, kunzima ukwelashwa okuvamile kwasekhaya ukuthi kuphumelele. UMnu. H. ngokuphelelwa yithemba waqala ukufuna izindlela zokwelashwa zomhlaba wonke.
UMnu. H unguthisha owaziwayo wobudokotela, uTao Li Man Tianxia, futhi abafundi bakhe basiza ekutholeni izindlela zokwelapha emhlabeni wonke. Omunye wabafundi wayeseBeijing, futhi wathola indlela yokwelapha umdlavuza ethuthuke kakhulu, i-proton therapy, nge-inthanethi. Ngakho-ke, uMnu H wathola u-Chang Kang Evergreen, isikhungo sezokwelapha saphesheya kwezilwandle esisebenza ngokukhethekile ekwelashweni kwe-proton, futhi wenza ukuxilongwa kokuqala kwe-pathological. Wayekholelwa ukuthi i-H ilungele kakhulu ukwelashwa kwe-proton.
Ngemuva kokuqhathanisa nokuqonda, uMnu H uthathe isinqumo sokukhetha i-RPTC Proton Center eMunich, eJalimane ngobuchwepheshe obuphambili nokusebenza kwezindleko eziphakeme kwabelapha
t. Ngaphambi kokuba ngihambe, ngixhumana nezisebenzi eziphethe nsuku zonke, kufaka phakathi umthamo wemisebe, izincomo zesibhedlela, nezingubo, ukudla, indawo yokuhlala nezinto zokuhamba ngemuva kokufika eJalimane.
Ngo-September 2014, uMnumzane H wafika eJalimane. Ephelezelwa izisebenzi zendawo, waqala wazijwayeza indawo ezungezile, ethenga ngenjabulo, ejabulela ukudla, futhi ehlola udokotela. Ukuphelelwa ithemba nokukhathazeka kukaMnu. H kancane kancane kwahlala. Wathi: “Nginomuzwa wokubona ukukhanya ebumnyameni.” Ngemuva kwezinsuku ezintathu zokuhlolwa komzimba, isonto elilodwa kamuva, isikhunta esinembayo esilungisiwe saqedwa futhi uhambo lukaMnu H lwe-proton therapy lwaqala.
Ngenxa yokuxakaniseka kwesimo sikaMnu. H, ingxenye ethile yalesi simila isilimaze imizwa ye-optic yeso langakwesokudla. Isibhedlela saseJalimane senze uhlelo olunemininingwane ngemisebe, imisebeyi engama-40 isiyonke, kahlanu ngesonto. Ngemuva kokuthola ukwelashwa okuningi kwe-proton, odokotela baseGerman Proton Center banikeze iseluleko uma bengahlanganiswa nekhemotherapy ukuthola imiphumela engcono. Ngakho-ke uMnu. H wahlela isibhedlela esisebenza ngokukhethekile ngamakhemikhali eProton Centre. Ngemishini yezokwelapha efanelekile kanye nokwelashwa okusondelene, uMnu. H wazizwa ekhululekile.
Ngemuva kokwelashwa, uMnu H nomkakhe bavakasha eMunich futhi baba nedili elijabulisayo nabangane baseJalimane. Ezinyangeni ezimbili kamuva, uMnu. H wasuka eJalimane wabuyela ekhaya. Manje uphila enempilo futhi ejabule.
