Iyini i-sarcoma?
I-Sarcoma iyithumba elingavamile lezicubu ezixhumeneyo, ngakho i-sarcoma ingahlasela noma iyiphi ingxenye yomzimba wethu. Lezi zimila zihlanganisa i-liposarcoma, i-neurosarcoma, i-osteosarcoma, i-tendon sarcoma, i-muscle sarcoma yesikhumba. Babalelwa cishe i-1% yawo wonke umdlavuza wabantu abadala kanye ne-15% yezimila zezingane. Ngaphezu kokusabalala kwezindawo ezingaba ezinkulu nezindawo eziyivelakancane, kunamathumba angaphezu kuka-80 anezingxenye ezixubene kakhulu ezinezinhlobo ezahlukene ze-histological. I-Sarcoma wuhlobo lomdlavuza. I-Sarcoma—Isimila esiyingozi esakhiwe amathambo, uqwanga, amafutha, izicubu, imithambo yegazi nezicubu.
Izintathu zalezi zinto zenza ukwelashwa kwe-sarcoma kube nzima kakhulu. Ngakho-ke, kubaluleke kakhulu ukuthi iziguli ze-sarcoma ziphathwe yithimba elinolwazi olunhlobonhlobo. Ithimba lidinga ukufaka odokotela abahlinzayo, odokotela bezifo, ama-radiologists, oncologists, abahlengikazi abangochwepheshe, abelaphi bomzimba kanye nosokhemisi. .
Ukuxilongwa kwe-sarcoma
In order to confirm the diagnosis, biopsy is needed to confirm the presence and specific subtype of sarcoma. Because these tumors are very rare and mixed, it is vital that an experienced pathologist examine biopsy samples. The initial diagnostic radiation tests included CT scans and MRI scans to determine the location and type of sarcoma.
Ukwelashwa kwe-sarcoma
The mainstream treatment for localized sarcoma includes complete surgery combined with radiotherapy or no radiotherapy. The need for an experienced surgeon to perform the operation is very important, because the implementation of improper surgery may have an impact on the treatment outcome.
A large number of randomized clinical trials have confirmed that preoperative or postoperative radiotherapy has obvious benefits for sarcoma of the hand and foot and chest wall sarcoma. A recent international randomized clinical trial evaluated the role of preoperative radiotherapy in the treatment of retroperitoneal sarcoma.
In specific sarcoma subtype weeks, multi-agent chemotherapy is an important part of treatment management; these subtypes include Ewing’s sarcoma, osteosarcoma, and rhabdomyosarcoma. The introduction of these subtypes of multi-agent chemotherapy and limb salvage surgery has become a great success in the field of cancer treatment in the past 40 years.
Isibikezelo se-sarcoma
Ngeshwa, yize kusetshenziswa ukwelashwa okulungile kokuqedwa okuphelele kokuhlinzwa, cishe iziguli ezingama-50% ezine-sarcoma ephakathi / esezingeni eliphakeme zithuthukisa izicubu ezibuyela emuva / ze-metastatic. I-Metastasis ivame ukusakazeka ngemithambo yegazi, futhi amaphaphu ayindawo ejwayelekile kakhulu yesifo se-metastatic.
Imiphumela yokubikezela yeziguli ezine-metastatic sarcoma ngokuvamile ayibi esikhathini esedlule, futhi kunezinketho ezimbalwa zokwelashwa. Kodwa-ke, idatha yakamuva ikhombisa ukuthi ukusinda okuphakathi kweziguli ezine-metastatic soft tissue sarcoma kukhuphukile kusuka cishe ezinyangeni eziyi-12 kuye ezinyangeni eziyi-18 zamanje. Kukhona izinketho zokwelashwa ezikhona zesistimu zeziguli ezine-metastatic sarcoma.
For patients with slow-growing histological subtypes, the monitoring of small / asymptomatic metastatic lesions is an option. Surgical resection is considered when the patient has a separate metastatic lesion, especially when the lesion is in the lungs. Other local treatment strategies may also be considered including radiotherapy, radiofrequency ablation and embolization.
Isinqumo sokwelapha izilonda ze-metastatic singaba nzima kakhulu, futhi siyakugcizelela futhi ukuthi lokhu kudinga iqembu elinolwazi olunhlobonhlobo. Ezigulini eziningi ezine-metastatic sarcoma, ukwelashwa okuyinhloko kuncike ekwelashweni kwesistimu, ikakhulukazi i-chemotherapy.
Ukwelashwa okubhekiswe ku-sarcoma
Targeted therapy drugs have been introduced in the subtype of soft tissue sarcoma called gastrointestinal stromal tumor (GIST), which has become an example of targeted therapy for solid tumors. Most gastrointestinal stromal tumors (GIST) have KIT and PDGFRA gene mutation characteristics. Due to the introduction of these tyrosine kinase inhibitors, the prognosis of patients with metastatic gastrointestinal stromal tumors (GIST) has been greatly improved.
Ngaphezu kwalokho, i-imatinib ivunyelwe njengokwelashwa kwezicubu ezinobungozi obukhulu ngemuva kokuvuselelwa. I-Imatinib nayo isetshenziswe ngempumelelo ekwelapheni amanye ama-sarcoma subtypes (abizwa nge-dermatofibrosarcoma protuberances (DFSP)).
I-Doxorubicin ingasetshenziswa yodwa noma ihlanganiswe ne-ifosfamide kuseyindlela ejwayelekile yokwelashwa komugqa wokuqala we-metastatic soft tissue sarcoma. Eminyakeni embalwa edlule, kushicilelwe noma kwashicilelwa imiphumela yokuhlolwa kwemitholampilo yesigaba III samazwe omhlaba jikelele.
Isivivinyo sokuqala somtholampilo sakhetha iziguli ukuthi zithole i-doxorubicin noma i-doxorubicin ne-ifosfamide. Lokhu kuhlolwa komtholampilo akubikanga mehluko emazingeni okusinda okuphelele kuzo zombili izingalo, kepha iziguli ezithola ukwelashwa okuhlanganisiwe bezinokusinda okuqhubekayo okude kakhulu namazinga okuphendula aphezulu kakhulu.
Isivivinyo sesibili somtholampilo sakhetha ngezikhathi ezithile iziguli ukuthi zithole i-doxorubicin kanye ne-ifosfamide analogs (palifosfamide) noma i-doxorubicin kanye ne-placebo. Lokhu kuhlolwa komtholampilo kukhombisile ukuthi imiphumela yokuhlolwa yezingalo zombili ibingahlukile kakhulu. Isivivinyo somtholampilo sesithathu sineziguli ezingahleliwe ukuthola umthamo owodwa we-doxorubicin noma i-gemcitabine / i-docetaxel. Akukho mehluko omkhulu emiphumeleni obonwe phakathi kwalezi zingalo zombili.
Ngaphezu kwalokho, ukuhlolwa komtholampilo okungahleliwe kwaqhathanisa i-gemcitabine / i-docetaxel ne-gemcitabine monotherapy ukusungula uhlelo olusebenzayo lokutakula ikakhulukazi ekwelashweni kwe-leiomyosarcoma kanye ne-polymorphic sarcoma.
Ngo-2007, i-trabectedin eyakhiwe ngolwandle yagunyazwa ukuthi isetshenziswe e-European Union. Ukugunyazwa bekususelwa emiphumeleni yezikhathi ezibekiwe ezimbili zomuthi esivivinyweni somtholampilo sesigaba II esingahleliwe. Ngemuva kwalokho, isilingo somtholampilo sesigaba III sikhombise ukuthi iziguli ezine-liposarcoma esezingeni eliphakeme / le-metastatic ne-leiomyosarcoma zenziwa ngokungahleliwe ukuthola i-trabectedin noma i-diazolid (iziguli zathola izidakamizwa ze-Huihuan antitumor kanye nokunye ukwelashwa ngaphambi kokubhaliswa).
Lokhu kuhlolwa komtholampilo kukhombisile ukuthi iziguli ezithola i-trabectedin zikhombise ukusinda okuqhubekayo ngaphandle kwesikhathi eside kunalezo ezathola i-diazolid. Lokhu kuholele ekwamukelweni kokusetshenziswa kwe-trabectedin yi-US Food and Drug Administration ngoNovemba 2015.
The oral tyrosine kinase inhibitor pazotinib has been approved based on the results of a randomized clinical trial of patients with soft tissue sarcoma receiving pazotinib or placebo. This clinical trial showed that the pazotinib group had a significant improvement in progression-free survival, but there was no significant difference in overall survival.
Ngo-2016, ukukhishwa kolwandle kwe-microtubule inhibitor eribulin kwamukelwa yi-US Food and Drug Administration ekwelapheni i-liposarcoma esezingeni eliphezulu. Imvume isuselwa esivivinyweni somtholampilo esingahleliwe seziguli ezinesigaba III esithuthukile / se-metastatic liposarcoma kanye ne-leiomyosarcoma ethola i-eribulin noma i-dacrabzine. Lokhu kuhlolwa komtholampilo kukhombisile ukuthi ingalo ye-eribulin inesikhathi eside ngokwengeziwe sokusinda kunengalo ye-dacarbzaine.
Isiphetho
Ekuphetheni, ama-sarcomas ayiqembu lomdlavuza ongandile onenhlanganisela yezithako, futhi abhekene nezinselelo ezinkulu ekwelashweni nasekuthuthukisweni kwezidakamizwa. Ukwethulwa kwe-tyrosine kinases ekwelapheni izicubu zomzimba emathunjini (i-GIST) sekuvele kuyisibonelo ekwelapheni okuhlosiwe kwezicubu eziqinile.
Ngaphezu kwalokho, eminyakeni embalwa edlule, kunezelwe ezinye izindlela zokwelapha ezihlelekile ezinkethweni ezitholakalayo zokwelashwa kwe-sarcoma esezingeni eliphakeme, kufaka phakathi i-pazopanib, i-trabectedin, ne-eribulin. Ukubambisana kwamazwe omhlaba phakathi kobubanzi obubanzi babacwaningi bemitholampilo nososayensi abayisisekelo kuqhubekile nokukhuthaza ukuthuthukiswa kwezindlela zokwelashwa komdlavuza we-hybrid zalezi zithako.
