{"id":7802,"date":"2017-11-02T07:56:16","date_gmt":"2017-11-02T00:56:16","guid":{"rendered":"https:\/\/yhoccongdong.org\/ung-thu\/dieu-tri-ung-thu-phoi-te-bao-nho\/"},"modified":"2024-03-12T14:54:36","modified_gmt":"2024-03-12T07:54:36","slug":"dieu-tri-ung-thu-phoi-te-bao-nho","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/ung-thu\/dieu-tri-ung-thu-phoi-te-bao-nho\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb Ung th\u01b0 ph\u1ed5i t\u1ebf b\u00e0o nh\u1ecf"},"content":{"rendered":"

T\u1ed5ng quan<\/h2>\n

Ung th\u01b0 ph\u1ed5i \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh hai nh\u00f3m c\u01a1 b\u1ea3n: Ung th\u01b0 ph\u1ed5i t\u1ebf b\u00e0o nh\u1ecf<\/strong> (UTPTBN) v\u00e0 ung th\u01b0 ph\u1ed5i kh\u00f4ng ph\u1ea3i t\u1ebf b\u00e0o nh\u1ecf<\/strong> (UTPKTBN) d\u1ef1a tr\u00ean h\u00ecnh d\u1ea1ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o ung th\u01b0 d\u01b0\u1edbi k\u00ednh hi\u1ec3n vi v\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a c\u0103n b\u1ec7nh.\u00a0UTPTBN chi\u1ebfm kho\u1ea3ng 15% t\u1ed5ng s\u1ed1 ung th\u01b0 ph\u1ed5i, c\u00f2n l\u1ea1i l\u00e0 ung th\u01b0 ph\u1ed5i kh\u00f4ng ph\u1ea3i t\u1ebf b\u00e0o nh\u1ecf.<\/p>\n

UTPTBN x\u1ea3y ra ch\u1ee7 y\u1ebfu \u1edf ng\u01b0\u1eddi h\u00fat thu\u1ed1c l\u00e1, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi h\u00fat thu\u1ed1c n\u1eb7ng, v\u00e0 nh\u1eefng ng\u01b0\u1eddi \u0111\u00e3 t\u1eebng h\u00fat thu\u1ed1c. N\u00f3 th\u01b0\u1eddng l\u00e0 m\u1ed9t lo\u1ea1i ung th\u01b0 \u201chung b\u1ea1o\u201d c\u00f3 xu h\u01b0\u1edbng ph\u00e1t tri\u1ec3n v\u00e0 l\u00e2y lan nhanh ch\u00f3ng.\u00a0Do \u0111\u00f3, ph\u1eabu thu\u1eadt ch\u1ec9 h\u1eefu \u00edch cho m\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n ung th\u01b0 lo\u1ea1i n\u00e0y.<\/p>\n

Ph\u00e2n lo\u1ea1i Ung th\u01b0 ph\u1ed5i t\u1ebf b\u00e0o nh\u1ecf<\/h2>\n

\u201cGiai \u0111o\u1ea1n\u201d\/Stage<\/strong> c\u1ee7a ung th\u01b0 l\u00e0 th\u00f4ng tin v\u1ec1 ph\u00e2n lo\u1ea1i ch\u00ednh th\u1ee9c m\u1ee9c \u0111\u1ed9 b\u1ec7nh c\u1ee7a m\u1ed7i b\u1ec7nh nh\u00e2n. M\u1ed9t lo\u1ea1t x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh nh\u01b0 CT, MRI, PET, x\u1ea1 h\u00ecnh x\u01b0\u01a1ng,\u2026 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 kh\u1ea3o s\u00e1t s\u1ef1 lan t\u1ecfa\/di c\u0103n c\u1ee7a ung th\u01b0. \u0110\u00f4i khi, sinh thi\u1ebft b\u1ed5 sung l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 ch\u1ee9ng minh hay lo\u1ea1i b\u1ecf s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a ung th\u01b0 t\u1ea1i m\u1ed9t \u0111\u1ecba \u0111i\u1ec3m c\u1ee5 th\u1ec3. Giai \u0111o\u1ea1n c\u1ee7a ung th\u01b0 l\u00e0 r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p nh\u1ea5t cho t\u1eebng b\u1ec7nh nh\u00e2n.<\/p>\n

UTPTBN th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo truy\u1ec1n th\u1ed1ng l\u00e0 b\u1ec7nh giai \u0111o\u1ea1n gi\u1edbi h\u1ea1n ho\u1eb7c giai \u0111o\u1ea1n lan r\u1ed9ng. Nhi\u1ec1u chuy\u00ean gia khuy\u1ebfn c\u00e1o r\u1eb1ng UTPTBN n\u00ean \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i b\u1eb1ng c\u00f9ng m\u1ed9t h\u1ec7 th\u1ed1ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng cho ung th\u01b0 ph\u1ed5i kh\u00f4ng ph\u1ea3i t\u1ebf b\u00e0o nh\u1ecf, v\u1edbi s\u1ef1 ph\u00e2n lo\u1ea1i nh\u01b0 giai \u0111o\u1ea1n I, II, III, ho\u1eb7c IV, \u0111\u1ec3 cung c\u1ea5p m\u1ed9t \u0111\u00e1nh gi\u00e1 chi ti\u1ebft h\u01a1n v\u1ec1 m\u1ee9c \u0111\u1ed9 b\u1ec7nh t\u1eadt.<\/p>\n

UTPTBN giai \u0111o\u1ea1n gi\u1edbi h\u1ea1n<\/h3>\n

\u0110\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 giai \u0111o\u1ea1n m\u00e0 ung th\u01b0 xu\u1ea5t hi\u1ec7n ch\u1ec9 \u1edf m\u1ed9t b\u00ean ph\u1ed5i\u00a0v\u00e0\/ho\u1eb7c trong c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft (h\u1ea1ch lympho) \u1edf trung th\u1ea5t (v\u00f9ng \u1edf gi\u1eefa ng\u1ef1c, gi\u1eefa hai ph\u1ed5i). Giai \u0111o\u1ea1n n\u00e0y t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi giai \u0111o\u1ea1n I, II, ho\u1eb7c III n\u1ebfu s\u1eed d\u1ee5ng h\u1ec7 th\u1ed1ng ph\u00e2n k\u1ef3 chi ti\u1ebft h\u01a1n.<\/p>\n

Kho\u1ea3ng 1\/3 b\u1ec7nh nh\u00e2n UTPTBN \u1edf giai \u0111o\u1ea1n gi\u1edbi h\u1ea1n v\u00e0o th\u1eddi \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n. Tuy nhi\u00ean, trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, ung th\u01b0 \u0111\u00e3 lan ra ngo\u00e0i v\u00f9ng ng\u1ef1c nh\u01b0ng kh\u00f4ng th\u1ea5y \u0111\u01b0\u1ee3c tr\u00ean t\u1ea5t c\u1ea3 c\u00e1c x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh hi\u1ec7n c\u00f3.<\/p>\n

H\u1ea7u h\u1ebft nh\u1eefng ng\u01b0\u1eddi b\u1ecb UTPTBN giai \u0111o\u1ea1n gi\u1edbi h\u1ea1n \u0111\u1ec1u \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng h\u00f3a tr\u1ecb k\u1ebft h\u1ee3p v\u1edbi x\u1ea1 tr\u1ecb chi\u1ebfu v\u00e0o kh\u1ed1i u trong ng\u1ef1c. Sau \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u n\u00e0y, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng \u0111\u01b0\u1ee3c x\u1ea1 tr\u1ecb ti\u1ebfp v\u00e0o n\u00e3o \u0111\u1ec3 ng\u0103n ng\u1eeba s\u1ef1 xu\u1ea5t hi\u1ec7n di c\u0103n n\u00e3o v\u00e0 c\u1ea3i thi\u1ec7n kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb b\u1ec7nh giai \u0111o\u1ea1n n\u00e0y l\u00e0 ch\u1eefa kh\u1ecfi h\u1eb3n<\/strong> ung th\u01b0.<\/p>\n

M\u1eb7c d\u00f9 r\u1ea5t hi\u1ebfm, m\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n khi \u1edf giai \u0111o\u1ea1n s\u1edbm (giai \u0111o\u1ea1n I), khi ch\u1ec9 c\u00f3 m\u1ed9t kh\u1ed1i u trong ph\u1ed5i. Khi \u0111\u00f3, ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t v\u00e0 b\u1ec7nh nh\u00e2n th\u01b0\u1eddng s\u1ebd ti\u1ebfp t\u1ee5c h\u00f3a tr\u1ecb sau m\u1ed5, k\u00e8m theo ho\u1eb7c kh\u00f4ng k\u00e8m theo x\u1ea1 tr\u1ecb (h\u00ecnh 1<\/a>).<\/p>\n

UTPTBN giai \u0111o\u1ea1n lan r\u1ed9ng<\/h3>\n

\u0110\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 giai \u0111o\u1ea1n m\u00e0 ung th\u01b0 \u0111\u00e3 lan sang ph\u00eda b\u00ean kia ng\u1ef1c (ph\u1ed5i b\u00ean kia) ho\u1eb7c lan \u0111\u1ebfn c\u00e1c v\u1ecb tr\u00ed xa h\u01a1n trong c\u01a1 th\u1ec3. C\u00e1c v\u1ecb tr\u00ed di c\u0103n ph\u1ed5 bi\u1ebfn bao g\u1ed3m ph\u1ed5i, gan, tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn, x\u01b0\u01a1ng ho\u1eb7c n\u00e3o.<\/p>\n

H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n UTPTBN \u1edf giai \u0111o\u1ea1n lan r\u1ed9ng t\u1ea1i th\u1eddi \u0111i\u1ec3m ch\u1ea9n \u0111o\u00e1n.<\/p>\n

Nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb UTPTBN giai \u0111o\u1ea1n n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng h\u00f3a tr\u1ecb; ph\u1eabu thu\u1eadt kh\u00f4ng c\u00f2n l\u00e0 l\u1ef1a ch\u1ecdn. B\u1ec7nh giai \u0111o\u1ea1n n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c coi l\u00e0 c\u00f3 th\u1ec3 ch\u1eefa l\u00e0nh, v\u00e0 m\u1ee5c \u0111\u00edch \u0111i\u1ec1u tr\u1ecb l\u00e0 l\u00e0m gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng<\/strong> do ung th\u01b0 g\u00e2y ra v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng<\/strong>.\u00a0Nh\u1eefng ng\u01b0\u1eddi c\u00f3 \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi h\u00f3a tr\u1ecb c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u1ea1 tr\u1ecb v\u00e0o n\u00e3o \u0111\u1ec3 ng\u0103n ng\u1eeba s\u1ef1 xu\u1ea5t hi\u1ec7n di c\u0103n n\u00e3o, v\u00e0 c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c x\u1ea1 tr\u1ecb v\u00e0o ng\u1ef1c. X\u1ea1 tr\u1ecb c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c v\u00f9ng kh\u00e1c c\u1ee7a c\u01a1 th\u1ec3 \u0111\u1ec3 l\u00e0m gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng do di c\u0103n.<\/p>\n

H\u00f3a tr\u1ecb<\/h2>\n

H\u00f3a tr\u1ecb l\u00e0 ph\u01b0\u01a1ng ph\u00e1p s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c \u0111\u1ec3 ti\u00eau di\u1ec7t ho\u1eb7c l\u00e0m ng\u1eebng s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a t\u1ebf b\u00e0o ung th\u01b0. N\u00f3 l\u00e0 tr\u1ee5 c\u1ed9t c\u1ee7a \u0111i\u1ec1u tr\u1ecb UTPTBN. Ho\u00e1 tr\u1ecb t\u00e1c d\u1ee5ng b\u1eb1ng c\u00e1ch can thi\u1ec7p v\u00e0o kh\u1ea3 n\u0103ng ph\u00e2n chia ho\u1eb7c sinh s\u1ea3n c\u1ee7a c\u00e1c t\u1ebf b\u00e0o t\u0103ng sinh nhanh (nh\u01b0 t\u1ebf b\u00e0o ung th\u01b0). V\u00ec h\u1ea7u h\u1ebft c\u00e1c t\u1ebf b\u00e0o b\u00ecnh th\u01b0\u1eddng c\u1ee7a ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh kh\u00f4ng t\u0103ng sinh nhanh, ch\u00fang kh\u00f4ng b\u1ecb \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u b\u1edfi h\u00f3a tr\u1ecb, ngo\u1ea1i tr\u1eeb t\u1ee7y x\u01b0\u01a1ng (n\u01a1i t\u1ea1o ra c\u00e1c t\u1ebf b\u00e0o m\u00e1u), nang l\u00f4ng, v\u00e0 ni\u00eam m\u1ea1c \u1ed1ng ti\u00eau h\u00f3a (d\u1ea1 d\u00e0y, ru\u1ed9t,\u2026). \u1ea2nh h\u01b0\u1edfng c\u1ee7a h\u00f3a tr\u1ecb tr\u00ean nh\u1eefng m\u00f4 n\u00e0y v\u00e0 c\u00e1c m\u00f4 l\u00e0nh kh\u00e1c g\u00e2y ra t\u00e1c d\u1ee5ng ph\u1ee5 khi \u0111i\u1ec1u tr\u1ecb.<\/p>\n

M\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c h\u00f3a tr\u1ecb \u0111ang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb UTPTBN, v\u00e0 nhi\u1ec1u thu\u1ed1c m\u1edbi \u0111ang \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng. Nh\u1eefng b\u1ec7nh nh\u00e2n UTPTBN c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ch\u1ec9 b\u1eb1ng m\u1ed9t lo\u1ea1i thu\u1ed1c h\u00f3a tr\u1ecb, m\u1eb7c d\u00f9 vi\u1ec7c k\u1ebft h\u1ee3p hai thu\u1ed1c h\u00f3a tr\u1ecb l\u00e0 ph\u1ed5 bi\u1ebfn h\u01a1n v\u00e0 th\u01b0\u1eddng c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n trong vi\u1ec7c t\u0103ng c\u01a1 h\u1ed9i l\u00e0m gi\u1ea3m kh\u1ed1i u (g\u1ecdi l\u00e0 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb) v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n. H\u00f3a tr\u1ecb th\u01b0\u1eddng \u0111\u01b0\u1ee3c ti\u00eam v\u00e0o t\u0129nh m\u1ea1ch, m\u1eb7c d\u00f9 m\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng qua \u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n

N\u00f3i chung, h\u00f3a tr\u1ecb \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong kho\u1ea3ng th\u1eddi gian t\u1eeb m\u1ed9t \u0111\u1ebfn ba ng\u00e0y v\u00e0 th\u01b0\u1eddng l\u1eb7p l\u1ea1i sau m\u1ed7i ba tu\u1ea7n. Th\u1eddi gian ch\u1edd\/ngh\u1ec9 v\u00e0i tu\u1ea7n \u0111\u00f3 l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 \u1ea3nh h\u01b0\u1edfng c\u1ee7a thu\u1ed1c l\u00ean c\u00e1c m\u00f4 b\u00ecnh th\u01b0\u1eddng gi\u1ea3m d\u1ea7n tr\u01b0\u1edbc khi b\u1eaft \u0111\u1ea7u chu k\u1ef3 \u0111i\u1ec1u tr\u1ecb m\u1edbi.<\/p>\n

\"H\u00ecnh<\/p>\n

H\u00ecnh 2. Minh h\u1ecda chu k\u1ef3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Carcoplatin k\u1ebft h\u1ee3p v\u1edbi Etoposide. M\u0169i t\u00ean v\u00e0ng \u0111\u00e1nh d\u1ea5u ng\u00e0y c\u00f3 ti\u00eam t\u0129nh m\u1ea1ch c\u00e1c thu\u1ed1c n\u00e0y. M\u1ed9t chu k\u1ef3 l\u00e0 21 ng\u00e0y, b\u1eaft \u0111\u1ea7u b\u1eb1ng 3 ng\u00e0y truy\u1ec1n thu\u1ed1c v\u00e0 c\u00e1c ng\u00e0y c\u00f2n l\u1ea1i ngh\u1ec9 ch\u1edd t\u1edbi chu k\u1ef3 k\u1ebf ti\u1ebfp.<\/em><\/p>\n

Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb <\/strong>– Kho\u1ea3ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u c\u1ee7a h\u00f3a tr\u1ecb ban \u0111\u1ea7u \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb v\u00e0 vi\u1ec7c dung n\u1ea1p \u0111i\u1ec1u tr\u1ecb. Th\u00f4ng th\u01b0\u1eddng, c\u00e1c b\u00e1c s\u0129 khuy\u00ean theo 4-6 chu k\u1ef3 h\u00f3a tr\u1ecb ban \u0111\u1ea7u. C\u00e1c chu k\u1ef3 h\u00f3a tr\u1ecb b\u1ed5 sung (\u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 h\u00f3a tr\u1ecb b\u1ea3o tr\u00ec) kh\u00f4ng cho th\u1ea5y c\u1ea3i thi\u1ec7n r\u00f5 r\u1ec7t th\u1eddi gian s\u1ed1ng ho\u1eb7c ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.<\/p>\n

B\u1ec7nh giai \u0111o\u1ea1n gi\u1edbi h\u1ea1n <\/strong>– S\u1ef1 k\u1ebft h\u1ee3p thu\u1ed1c h\u00f3a tr\u1ecb ph\u1ed5 bi\u1ebfn nh\u1ea5t cho giai \u0111o\u1ea1n n\u00e0y l\u00e0 cisplatin (Platinol) v\u00e0 etoposide (VP-16). Do t\u1ef7 l\u1ec7 c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 li\u00ean quan \u0111\u1ebfn cisplatin l\u00e0 kh\u00e1 cao, m\u1ed9t lo\u1ea1i thu\u1ed1c \u201cb\u00e0 con\u201d c\u00f3 t\u00ean carboplatin (Paraplatin) \u00edt t\u00e1c d\u1ee5ng ph\u1ee5 h\u01a1n nh\u01b0ng hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 thay th\u1ebf.<\/p>\n

B\u1ec7nh giai \u0111o\u1ea1n lan r\u1ed9ng <\/strong>– B\u1ec7nh nh\u00e2n \u1edf giai \u0111o\u1ea1n n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng cisplatin\/carboplatin k\u1ebft h\u1ee3p v\u1edbi etoposide ho\u1eb7c irinotecan (Camptosar). \u1ede b\u1ec7nh nh\u00e2n l\u00e0 ng\u01b0\u1eddi Nh\u1eadt, irinotecan c\u00f3 v\u1ebb c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n etoposide. Ng\u01b0\u1ee3c l\u1ea1i, \u1edf c\u00e1c b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi da tr\u1eafng, hai lo\u1ea1i thu\u1ed1c n\u00e0y c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nh\u01b0ng etoposide \u00edt g\u00e2y t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng h\u01a1n.<\/p>\n

T\u00e1c d\u1ee5ng ph\u1ee5 <\/strong>– H\u00f3a tr\u1ecb \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ebf b\u00e0o b\u00ecnh th\u01b0\u1eddng c\u0169ng nh\u01b0 c\u00e1c t\u1ebf b\u00e0o ung th\u01b0, d\u1eabn \u0111\u1ebfn m\u1ed9t lo\u1ea1t c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 ti\u1ec1m \u1ea9n. Trong khi h\u00f3a tr\u1ecb, b\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd v\u1ec1 nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0y.<\/p>\n

T\u00e1c d\u1ee5ng ph\u1ee5 quan tr\u1ecdng nh\u1ea5t c\u1ee7a h\u00f3a tr\u1ecb l\u00e0 s\u1ef1 gi\u1ea3m t\u1ea1m th\u1eddi s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u, h\u1ed3ng c\u1ea7u ho\u1eb7c\/v\u00e0 ti\u1ec3u c\u1ea7u v\u00ec t\u00e1c d\u1ee5ng c\u1ee7a h\u00f3a tr\u1ecb l\u00e0m \u1ee9c ch\u1ebf t\u1ee7y x\u01b0\u01a1ng.\u00a0\u0110i\u1ec1u n\u00e0y th\u01b0\u1eddng x\u1ea3y ra m\u1ed9t \u0111\u1ebfn hai tu\u1ea7n sau khi truy\u1ec1n thu\u1ed1c. Trong th\u1eddi gian n\u00e0y, b\u1ec7nh nh\u00e2n ho\u1eb7c ng\u01b0\u1eddi th\u00e2n n\u00ean b\u00e1o c\u00e1o cho b\u00e1c s\u0129\/nh\u00f3m \u0111i\u1ec1u tr\u1ecb khi c\u00f3 b\u1ea5t k\u1ef3 c\u01a1n s\u1ed1t ho\u1eb7c \u1edbn l\u1ea1nh n\u00e0o. T\u00ecnh tr\u1ea1ng s\u1ed1 b\u1ea1ch c\u1ea7u gi\u1ea3m c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 b\u1ecb b\u1ec7nh nhi\u1ec5m tr\u00f9ng, nh\u01b0 vi\u00eam ph\u1ed5i, c\u00f3 th\u1ec3 \u0111e do\u1ea1 \u0111\u1ebfn t\u00ednh m\u1ea1ng.<\/p>\n

C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00e1c c\u1ee7a h\u00f3a tr\u1ecb bao g\u1ed3m m\u1ec7t m\u1ecfi, r\u1ee5ng t\u00f3c, bu\u1ed3n n\u00f4n, n\u00f4n m\u1eeda, t\u00ea ho\u1eb7c \u0111au \u1edf ng\u00f3n tay v\u00e0 ng\u00f3n ch\u00e2n, m\u1ea5t th\u00ednh gi\u00e1c, ti\u00eau ch\u1ea3y, lo\u00e9t mi\u1ec7ng, gi\u1ea3m \u0103n, thay \u0111\u1ed5i kh\u1ea9u v\u1ecb v\u00e0 suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n

X\u1ea1 tr\u1ecb<\/h2>\n

X\u1ea1 tr\u1ecb th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb k\u1ebft h\u1ee3p trong qu\u00e1 tr\u00ecnh h\u00f3a tr\u1ecb \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb UTPTBN giai \u0111o\u1ea1n gi\u1edbi h\u1ea1n. \u0110\u00e2y l\u00e0 ph\u01b0\u01a1ng ph\u00e1p s\u1eed d\u1ee5ng tia X n\u0103ng l\u01b0\u1ee3ng cao t\u1eadp trung v\u00e0o c\u00e1c v\u1ecb tr\u00ed c\u1ee5 th\u1ec3 c\u1ee7a kh\u1ed1i u \u0111\u1ec3 di\u1ec7t t\u1ebf b\u00e0o ung th\u01b0. Tia X \u0111\u01b0\u1ee3c b\u1eafn ra t\u1eeb m\u00e1y (g\u1ecdi l\u00e0 m\u00e1y gia t\u1ed1c tuy\u1ebfn t\u00ednh) n\u1eb1m ngo\u00e0i c\u01a1 th\u1ec3 b\u1ec7nh nh\u00e2n; m\u1ed7i l\u1ea7n \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng ng\u1eafn (10 \u0111\u1ebfn 15 ph\u00fat) v\u00e0 kh\u00f4ng g\u00e2y \u0111au.<\/p>\n

\u1ea2nh h\u01b0\u1edfng c\u1ee7a tia x\u1ea1 l\u00e0 c\u00f3 t\u00ednh t\u00edch l\u0169y (gia t\u0103ng) v\u00e0 m\u1ed9t l\u01b0\u1ee3ng x\u1ea1 nh\u1ea5t \u0111\u1ecbnh ph\u1ea3i \u0111\u01b0\u1ee3c chi\u1ebfu \u0111\u1ec3 c\u00e1c t\u1ebf b\u00e0o ung th\u01b0 b\u1ecb h\u01b0 h\u1ea1i \u0111\u1ebfn ch\u1ebft. X\u1ea1 tr\u1ecb th\u01b0\u1eddng \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh hai l\u1ea7n m\u1ed9t ng\u00e0y, k\u00e9o d\u00e0i trong ba tu\u1ea7n. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, x\u1ea1 tr\u1ecb \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n m\u1ed9t l\u1ea7n m\u1ed9t ng\u00e0y (\u1edf li\u1ec1u cao h\u01a1n). Tia x\u1ea1 \u0111\u01b0\u1ee3c chi\u1ebfu v\u00e0o c\u00e1c v\u00f9ng b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi ung th\u01b0 tr\u00ean c\u01a1 th\u1ec3. Do \u0111\u00f3, kh\u00e1c v\u1edbi h\u00f3a tr\u1ecb l\u00e0 \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n, x\u1ea1 tr\u1ecb l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u1ee5c b\u1ed9\/t\u1ea1i ch\u1ed7, v\u00e0 c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 n\u00f3i chung ch\u1ec9 x\u1ea3y ra \u1edf khu v\u1ef1c nh\u1eadn chi\u1ebfu x\u1ea1.<\/p>\n

X\u1ea1 tr\u1ecb v\u00f9ng ng\u1ef1c <\/strong>– C\u00e1c nghi\u00ean c\u1ee9u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n UTPTBN giai \u0111o\u1ea1n gi\u1edbi h\u1ea1n \u0111\u00e3 cho th\u1ea5y x\u1ea1 tr\u1ecb v\u00f9ng ng\u1ef1c c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 ung th\u01b0 t\u00e1i ph\u00e1t \u1edf ng\u1ef1c sau \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u. H\u01a1n n\u1eefa, vi\u1ec7c s\u1eed d\u1ee5ng ph\u00f3ng x\u1ea1 t\u0103ng c\u01a1 h\u1ed9i ch\u1eefa kh\u1ecfi h\u1eb3n b\u1ec7nh ung th\u01b0.<\/p>\n

H\u00f3a tr\u1ecb v\u00e0 x\u1ea1 tr\u1ecb th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u c\u00f9ng l\u00fac (g\u1ecdi l\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1ed3ng th\u1eddi). X\u1ea1 tr\u1ecb v\u00f9ng ng\u1ef1c \u0111\u00f4i khi \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh sau khi k\u1ebft th\u00fac\/ho\u00e0n th\u00e0nh h\u00f3a tr\u1ecb (g\u1ecdi l\u00e0 \u0111i\u1ec1u tr\u1ecb theo tr\u00ecnh t\u1ef1), \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 kh\u1ed1i u r\u1ea5t l\u1edbn ho\u1eb7c b\u1ecb b\u1ec7nh n\u1eb7ng khi nh\u1eadn ch\u1ea9n \u0111o\u00e1n ung th\u01b0.<\/p>\n

Khi x\u1ea1 tr\u1ecb \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n c\u00f9ng l\u00fac v\u1edbi h\u00f3a tr\u1ecb (h\u00f3a x\u1ea1 tr\u1ecb \u0111\u1ed3ng th\u1eddi), c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 c\u1ee7a c\u1ea3 hai ph\u01b0\u01a1ng ph\u00e1p th\u01b0\u1eddng \u0111\u01b0\u1ee3c xu\u1ea5t hi\u1ec7n r\u00f5 r\u1ec7t h\u01a1n (v\u00ed d\u1ee5, \u1ee9c ch\u1ebf t\u1ee7y x\u01b0\u01a1ng). Tuy nhi\u00ean, l\u1ee3i \u00edch c\u1ee7a h\u00f3a tr\u1ecb v\u00e0 x\u1ea1 tr\u1ecb th\u01b0\u1eddng l\u1edbn h\u01a1n khi ch\u00fang \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111\u1ed3ng th\u1eddi so v\u1edbi vi\u1ec7c l\u00e0m theo tr\u00ecnh t\u1ef1.<\/p>\n

X\u1ea1 tr\u1ecb v\u00e0o ng\u1ef1c c\u0169ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n giai \u0111o\u1ea1n lan r\u1ed9ng c\u00f3 ph\u1ea3n \u1ee9ng t\u1ed1t v\u1edbi h\u00f3a tr\u1ecb ban \u0111\u1ea7u nh\u01b0ng v\u1eabn c\u00f2n kh\u1ed1i u trong ph\u1ed5i ho\u1eb7c h\u1ea1ch b\u1ea1ch huy\u1ebft.<\/p>\n

T\u00e1c d\u1ee5ng ph\u1ee5 li\u00ean quan \u0111\u1ebfn x\u1ea1 tr\u1ecb xu\u1ea5t hi\u1ec7n d\u1ea7n d\u1ea7n qua c\u00e1c tu\u1ea7n \u0111i\u1ec1u tr\u1ecb. Ch\u00fang bao g\u1ed3m m\u1ec7t m\u1ecfi, da \u0111\u1ecf nh\u1eb9 \u1edf ng\u1ef1c v\u00e0 l\u01b0ng, nu\u1ed1t kh\u00f3 ho\u1eb7c \u0111au do vi\u00eam th\u1ef1c qu\u1ea3n. C\u00e1c tri\u1ec7u ch\u1ee9ng \u1edf th\u1ef1c qu\u1ea3n n\u00e0y c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c gi\u1ea3m \u0111au th\u00edch h\u1ee3p. T\u00e1c d\u1ee5ng ph\u1ee5 l\u00e2u d\u00e0i c\u00f3 th\u1ec3 x\u1ea3y ra nhi\u1ec1u th\u00e1ng sau khi k\u1ebft th\u00fac x\u1ea1 tr\u1ecb, bao g\u1ed3m vi\u00eam v\u00e0\/ho\u1eb7c t\u1ea1o s\u1eb9o \u1edf m\u00f4 ph\u1ed5i b\u00ecnh th\u01b0\u1eddng xung quanh kh\u1ed1i u d\u1eabn \u0111\u1ebfn ho, kh\u00f3 th\u1edf v\u00e0 ra \u0111\u1eddm nhi\u1ec1u.<\/p>\n

X\u1ea1 tr\u1ecb v\u00e0o n\u00e3o <\/strong>– N\u00e3o l\u00e0 m\u1ed9t trong nh\u1eefng v\u1ecb tr\u00ed m\u00e0 UTPTBN hay di c\u0103n t\u1edbi. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n giai \u0111o\u1ea1n gi\u1edbi h\u1ea1n kh\u00f4ng c\u00f3 di c\u0103n n\u00e3o sau \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u (h\u00f3a tr\u1ecb ho\u1eb7c h\u00f3a x\u1ea1 tr\u1ecb k\u1ebft h\u1ee3p), x\u1ea1 tr\u1ecb v\u00e0o n\u00e3o c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 nguy c\u01a1 di c\u0103n n\u00e3o v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng s\u00f3t. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 x\u1ea1 tr\u1ecb d\u1ef1 ph\u00f2ng (prophylactic cranial irradiation, PCI). B\u00e1c s\u0129 th\u01b0\u1eddng g\u1ee3i \u00fd ph\u01b0\u01a1ng ph\u00e1p n\u00e0y n\u1ebfu ung th\u01b0 \u1edf c\u00e1c ph\u1ea7n c\u00f2n l\u1ea1i c\u1ee7a c\u01a1 th\u1ec3 \u0111\u00e3 \u0111\u00e1p \u1ee9ng m\u1ed9t ph\u1ea7n ho\u1eb7c ho\u00e0n to\u00e0n \u0111\u1ed1i v\u1edbi h\u00f3a tr\u1ecb ho\u1eb7c ho\u00e1 x\u1ea1 tr\u1ecb ban \u0111\u1ea7u.<\/p>\n

Vai tr\u00f2 c\u1ee7a x\u1ea1 tr\u1ecb d\u1ef1 ph\u00f2ng \u1edf b\u1ec7nh nh\u00e2n giai \u0111o\u1ea1n lan r\u1ed9ng v\u1eabn c\u00f2n g\u00e2y tranh c\u00e3i. M\u1eb7c d\u00f9 n\u00f3 l\u00e0m gi\u1ea3m nguy c\u01a1 xu\u1ea5t hi\u1ec7n di c\u0103n n\u00e3o, t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh r\u00f5 r\u00e0ng. M\u1ed9t nghi\u00ean c\u1ee9u v\u1ec1 x\u1ea1 tr\u1ecb n\u00e3o d\u1ef1 ph\u00f2ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n \u0111\u00e3 cho th\u1ea5y s\u1ef1 c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t, trong khi m\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c l\u1ea1i g\u1ee3i \u00fd r\u1eb1ng gi\u00e1m s\u00e1t k\u1ef9 (close surveillance) s\u1ef1 xu\u1ea5t hi\u1ec7n di c\u0103n n\u00e3o b\u1eb1ng vi\u1ec7c ch\u1ee5p \u1ea3nh kh\u1ea3o s\u00e1t n\u00e3o th\u01b0\u1eddng xuy\u00ean c\u00f3 th\u1ec3 c\u00f3 \u00edch t\u01b0\u01a1ng \u0111\u01b0\u01a1ng. Do \u0111\u00f3, nh\u1eefng l\u1ee3i \u00edch v\u00e0 nguy c\u01a1 ti\u1ec1m \u1ea9n c\u1ee7a x\u1ea1 tr\u1ecb n\u00e3o d\u1ef1 ph\u00f2ng c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc k\u1ef9 l\u01b0\u1ee1ng \u1edf t\u1eebng b\u1ec7nh nh\u00e2n UTPTBN giai \u0111o\u1ea1n lan r\u1ed9ng.<\/p>\n

V\u1edbi c\u00e1c k\u1ef9 thu\u1eadt hi\u1ec7n \u0111\u1ea1i, x\u1ea1 tr\u1ecb n\u00e3o d\u1ef1 ph\u00f2ng g\u00e2y ra c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 ng\u1eafn h\u1ea1n c\u00f3 th\u1ec3 ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c, bao g\u1ed3m \u0111\u1ecf da, ng\u1ee9a da \u0111\u1ea7u, m\u1ec7t m\u1ecfi v\u00e0 r\u1ee5ng t\u00f3c. T\u1ea5t c\u1ea3 th\u01b0\u1eddng c\u1ea3i thi\u1ec7n trong v\u00e0i tu\u1ea7n ho\u1eb7c v\u00e0i th\u00e1ng sau khi chi\u1ebfu x\u1ea1. T\u00e1c d\u1ee5ng ph\u1ee5 l\u00e2u d\u00e0i l\u00e0 hi\u1ebfm, nh\u01b0ng c\u00f3 th\u1ec3 bao g\u1ed3m c\u00e1c r\u1ed1i lo\u1ea1n v\u1ec1 th\u1ea7n kinh v\u00e0 tr\u00ed tu\u1ec7 nh\u01b0 m\u1ea5t tr\u00ed nh\u1edb ng\u1eafn h\u1ea1n, kh\u00f3 t\u1eadp trung, v\u00e0 kh\u00f3 gi\u1eef th\u0103ng b\u1eb1ng. V\u00ec nh\u1eefng ph\u1ea3n \u1ee9ng ph\u1ee5 n\u00e0y th\u01b0\u1eddng x\u1ea3y ra \u1edf b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i, nguy c\u01a1 v\u00e0 l\u1ee3i \u00edch c\u1ee7a x\u1ea1 tr\u1ecb n\u00e3o d\u1ef1 ph\u00f2ng c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t k\u1ef9 l\u01b0\u1ee1ng \u1edf nh\u1eefng ng\u01b0\u1eddi tr\u00ean 70 tu\u1ed5i v\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 c\u00e1c v\u1ea5n \u0111\u1ec1 th\u1ea7n kinh ti\u1ec1m \u1ea9n. Nguy c\u01a1 x\u1ea3y ra c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 l\u00e2u d\u00e0i s\u1ebd gi\u1ea3m \u0111i khi x\u1ea1 tr\u1ecb n\u00e3o d\u1ef1 ph\u00f2ng v\u00e0 h\u00f3a tr\u1ecb \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n v\u00e0o c\u00e1c th\u1eddi \u0111i\u1ec3m kh\u00e1c nhau.<\/p>\n

\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 di c\u0103n n\u00e3o, x\u1ea1 tr\u1ecb v\u00e0o n\u00e3o th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb \u0111\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.<\/p>\n

Vai tr\u00f2 c\u1ee7a ph\u1eabu thu\u1eadt trong UTPTBN<\/h2>\n

V\u00ec UTPTBN lan nhanh, ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf kh\u1ed1i u ph\u1ed5i th\u01b0\u1eddng kh\u00f4ng l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng hay th\u1eddi gian s\u1ed1ng s\u00f3t c\u1ee7a b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, n\u00f3 c\u00f3 th\u1ec3 c\u00f3 \u00edch trong m\u1ed9t s\u1ed1 \u00edt (<5%) b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n r\u1ea5t s\u1edbm. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y, ph\u1eabu thu\u1eadt \u0111i k\u00e8m h\u00f3a tr\u1ecb sau \u0111\u00f3 c\u00f3 th\u1ec3 gi\u00fap t\u0103ng t\u1ec9 l\u1ec7 s\u1ed1ng s\u00f3t 5 n\u0103m l\u00ean \u0111\u1ebfn 35-40%.<\/p>\n

Ph\u1eabu thu\u1eadt c\u00f3 v\u1ebb h\u1eefu \u00edch nh\u1ea5t cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t kh\u1ed1i u duy nh\u1ea5t gi\u1edbi h\u1ea1n \u1edf m\u1ed9t th\u00f9y ph\u1ed5i m\u00e0 kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u di c\u0103n\/lan t\u1edbi c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft ho\u1eb7c n\u01a1i kh\u00e1c. Do \u0111\u00f3, tr\u01b0\u1edbc khi c\u00e2n nh\u1eafc ph\u1eabu thu\u1eadt, m\u1ed9t th\u1ee7 thu\u1eadt g\u1ecdi l\u00e0 \u201cN\u1ed9i soi trung th\u1ea5t\u201d th\u01b0\u1eddng \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ec3 kh\u1ea3o s\u00e1t v\u00f9ng trung th\u1ea5t. N\u1ebfu c\u00e1c h\u1ea1ch b\u1ea1ch huy\u1ebft v\u00f9ng n\u00e0y kh\u00f4ng ch\u1ee9a b\u1ea5t k\u1ef3 t\u1ebf b\u00e0o ung th\u01b0 n\u00e0o, ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf ung th\u01b0 ph\u1ed5i s\u1ebd \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh, theo sau \u0111\u00f3 l\u00e0 h\u00f3a tr\u1ecb, \u0111i k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m theo x\u1ea1 tr\u1ecb.<\/p>\n

Hi\u1ec7u qu\u1ea3 c\u1ee7a \u0111i\u1ec1u tr\u1ecb UTPTBN<\/h2>\n

H\u00f3a tr\u1ecb c\u00f3 l\u1ee3i \u00edch r\u00f5 r\u00e0ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n UTPTBN, c\u1ea3i thi\u1ec7n c\u1ea3 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng v\u00e0 th\u1eddi gian s\u1ed1ng. N\u1ebfu kh\u00f4ng h\u00f3a tr\u1ecb, th\u1eddi gian s\u1ed1ng trung b\u00ecnh c\u1ee7a b\u1ec7nh nh\u00e2n UTPTBN th\u01b0\u1eddng ch\u1ec9 t\u00ednh b\u1eb1ng tu\u1ea7n. M\u1eb7c d\u00f9 UTPTBN l\u00e0 m\u1ed9t b\u1ec7nh n\u1eb7ng, n\u00f3 \u0111\u00e1p \u1ee9ng t\u1ed1t v\u1edbi h\u00f3a tr\u1ecb ban \u0111\u1ea7u v\u00e0 x\u1ea1 tr\u1ecb. M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb cho nh\u1eefng ng\u01b0\u1eddi b\u1ecb UTPTBN giai \u0111o\u1ea1n gi\u1edbi h\u1ea1n l\u00e0 ch\u1eefa kh\u1ecfi h\u1eb3n, \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf 20-25% tr\u01b0\u1eddng h\u1ee3p. Trong giai \u0111o\u1ea1n gi\u1edbi h\u1ea1n, kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng v\u1edbi h\u00f3a tr\u1ecb v\u00e0 x\u1ea1 tr\u1ecb l\u00e0 cao, v\u1edbi 80-100% ca b\u1ec7nh c\u00f3 kh\u1ed1i u thu nh\u1ecf \u0111\u00e1ng k\u1ec3, v\u00e0 kho\u1ea3ng 50% ca b\u1ec7nh c\u00f3 kh\u1ed1i u bi\u1ebfn m\u1ea5t ho\u00e0n to\u00e0n qua c\u00e1c x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh. Tuy nhi\u00ean, kh\u00f4ng may l\u00e0 h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n s\u1ebd b\u1ecb t\u00e1i ph\u00e1t v\u00e0 kh\u00f4ng c\u00f2n \u0111\u00e1p \u1ee9ng thu\u1ed1c h\u00f3a tr\u1ecb sau \u0111\u00f3.<\/p>\n

UTPTBN giai \u0111o\u1ea1n lan r\u1ed9ng kh\u00f4ng \u0111\u01b0\u1ee3c coi l\u00e0 b\u1ec7nh c\u00f3 th\u1ec3 ch\u1eefa kh\u1ecfi. M\u1ee5c ti\u00eau c\u1ee7a \u0111i\u1ec1u tr\u1ecb l\u00e0 l\u00e0m gi\u1ea3m tri\u1ec7u ch\u1ee9ng, duy tr\u00ec ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng, v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng. H\u00f3a tr\u1ecb v\u1eabn c\u00f3 t\u1ef7 l\u1ec7 ph\u1ea3n \u1ee9ng cao, v\u1edbi 60-80% b\u1ec7nh nh\u00e2n c\u00f3 kh\u1ed1i u thu nh\u1ecf \u0111\u00e1ng k\u1ec3 v\u00e0 10-15% c\u00f3 kh\u1ed1i u bi\u1ebfn m\u1ea5t ho\u00e0n to\u00e0n.<\/p>\n

M\u1eb7c cho nh\u1eefng k\u1ebft qu\u1ea3 kh\u1ea3 quan n\u00e0y, UTPTBN c\u00f3 xu h\u01b0\u1edbng t\u00e1i ph\u00e1t ho\u1eb7c l\u1eddn thu\u1ed1c trong v\u00f2ng 1-2 n\u0103m \u1edf \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n. Khi \u0111\u00f3, h\u00f3a tr\u1ecb v\u1edbi thu\u1ed1c kh\u00e1c c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m nh\u1eb9 tri\u1ec7u ch\u1ee9ng v\u00e0 c\u1ea3i thi\u1ec7n th\u1eddi gian s\u1ed1ng m\u1ed9t c\u00e1ch khi\u00eam t\u1ed1n. Nh\u1eefng thu\u1ed1c h\u00f3a tr\u1ecb \u0111\u00e3 ch\u1ee9ng minh \u0111\u01b0\u1ee3c m\u1ed9t s\u1ed1 l\u1ee3i \u00edch cho b\u1ec7nh nh\u00e2n UTPTBN t\u00e1i ph\u00e1t bao g\u1ed3m topotecan, paclitaxel v\u00e0 temozolomide. C\u00e1c lo\u1ea1i thu\u1ed1c trong li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch gi\u00fap n\u00e2ng cao kh\u1ea3 n\u0103ng ch\u1ed1ng ung th\u01b0 c\u1ee7a h\u1ec7 mi\u1ec5n d\u1ecbch \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 l\u1ee3i \u00edch ti\u1ec1m n\u0103ng \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n. Tuy nhi\u00ean, v\u00ec l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c h\u00f3a tr\u1ecb (c\u00e1c ph\u00e1c \u0111\u1ed3 ti\u1ebfp \u0111\u00f3) \u0111\u1ed1i v\u1edbi UTPTBN t\u00e1i ph\u00e1t l\u00e0 h\u1ea1n ch\u1ebf, vi\u1ec7c tham gia v\u00e0o m\u1ed9t s\u1ed1 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng lu\u00f4n l\u00e0 l\u1ef1a ch\u1ecdn kh\u1ea3 d\u0129.<\/p>\n

\u1ea2nh h\u01b0\u1edfng c\u1ee7a vi\u1ec7c h\u00fat thu\u1ed1c<\/h2>\n

B\u1ec7nh nh\u00e2n UTPTBN n\u00ean ng\u1eebng h\u00fat thu\u1ed1c. L\u00fd do th\u1ee9 nh\u1ea5t l\u00e0 nguy c\u01a1 b\u1ecb th\u00eam ung th\u01b0 ph\u1ed5i v\u00ec ti\u1ebfp t\u1ee5c h\u00fat thu\u1ed1c l\u00e1. L\u00fd do th\u1ee9 hai, v\u00ec h\u00f3a tr\u1ecb, x\u1ea1 tr\u1ecb v\u00e0 ph\u1eabu thu\u1eadt c\u00f3 th\u1ec3 g\u00e2y t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i, vi\u1ec7c gi\u1eef ch\u1ee9c n\u0103ng ph\u1ed5i c\u00f2n l\u1ea1i t\u1ed1t nh\u1ea5t c\u00f3 th\u1ec3 b\u1eb1ng vi\u1ec7c b\u1ecf thu\u1ed1c l\u00e1 l\u00e0 r\u1ea5t quan tr\u1ecdng.<\/p>\n

\u0110\u00e2y c\u0169ng l\u00e0 c\u01a1 h\u1ed9i quan tr\u1ecdng \u0111\u1ec3 khuy\u1ebfn kh\u00edch gia \u0111\u00ecnh v\u00e0 b\u1ea1n b\u00e8 ng\u1eebng h\u00fat thu\u1ed1c. C\u00f3 nh\u1eefng y\u1ebfu t\u1ed1 di truy\u1ec1n di truy\u1ec1n l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng b\u1ecb ung th\u01b0 ph\u1ed5i, \u0111\u1eb7c bi\u1ec7t n\u1ebfu ng\u01b0\u1eddi c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 di truy\u1ec1n n\u00e0y h\u00fat thu\u1ed1c l\u00e1 ho\u1eb7c sinh ho\u1ea1t g\u1ea7n nh\u1eefng ng\u01b0\u1eddi h\u00fat thu\u1ed1c.<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n
    \n
  1. www.nlm.nih.gov\/medlineplus\/lungcancer.html<\/a><\/li>\n
  2. www.cancer.net\/portal\/site\/patient<\/a><\/li>\n
  3. www.cancerGRACE.org\/lung<\/a><\/li>\n
  4. www.lungcanceralliance.org<\/a><\/li>\n
  5. https:\/\/www.uptodate.com\/<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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