{"id":7805,"date":"2017-11-05T02:29:43","date_gmt":"2017-11-04T19:29:43","guid":{"rendered":"https:\/\/yhoccongdong.org\/ung-thu\/dieu-tri-ung-thu-dai-truc-trang-di-can\/"},"modified":"2024-04-29T17:58:56","modified_gmt":"2024-04-29T10:58:56","slug":"dieu-tri-ung-thu-dai-truc-trang-di-can","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/ung-thu\/dieu-tri-ung-thu-dai-truc-trang-di-can\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb Ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng di c\u0103n"},"content":{"rendered":"<h2 style=\"text-align: justify\">T\u1ed5ng quan v\u1ec1 Ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/h2>\n<p style=\"text-align: justify\"><strong>Ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/strong> (UT\u0110TT) l\u00e0 lo\u1ea1i ung th\u01b0 x\u1ea3y ra \u1edf ph\u1ea7n cu\u1ed1i c\u1ee7a h\u1ec7 ti\u00eau h\u00f3a: \u0111\u1ea1i tr\u00e0ng (c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ru\u1ed9t gi\u00e0, ru\u1ed9t k\u1ebft, k\u1ebft tr\u00e0ng) v\u00e0 tr\u1ef1c tr\u00e0ng (<a href=\"https:\/\/www.uptodate.com\/contents\/image?imageKey=PI%2F58531&amp;topicKey=PI%2F860&amp;rank=3%7E150&amp;source=see_link&amp;search=Colon+cancer+patient\" target=\"_blank\" rel=\"noopener noreferrer\">h\u00ecnh 1<\/a>). Ngay c\u1ea3 khi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm \u0111\u1ec3 lo\u1ea1i b\u1ecf ho\u00e0n to\u00e0n, UT\u0110TT v\u1eabn c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n l\u1ea1i.<\/p>\n<p style=\"text-align: justify\">S\u1ef1 t\u00e1i xu\u1ea5t hi\u1ec7n c\u1ee7a UT\u0110TT sau \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 <strong>t\u00e1i ph\u00e1t<\/strong>.<\/p>\n<p style=\"text-align: justify\">S\u1ef1 t\u00e1i ph\u00e1t c\u00f3 th\u1ec3 l\u00e0 <strong>c\u1ee5c b\u1ed9<\/strong> (ch\u1ec9 \u1edf g\u1ea7n n\u01a1i ung th\u01b0 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n ban \u0111\u1ea7u) ho\u1eb7c <strong>di c\u0103n<\/strong> (xu\u1ea5t hi\u1ec7n \u1edf v\u1ecb tr\u00ed c\u00e1ch xa \u0111\u1ea1i tr\u00e0ng ho\u1eb7c tr\u1ef1c tr\u00e0ng).<\/p>\n<p style=\"text-align: justify\">Khi kh\u1ed1i u \u0111\u00e3 lan \u0111\u1ebfn c\u00e1c v\u1ecb tr\u00ed xa nh\u01b0 gan, ph\u1ed5i, n\u00e3o,\u2026v\u00e0o th\u1eddi \u0111i\u1ec3m \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n, t\u00ecnh tr\u1ea1ng n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 <strong>UT\u0110TT di c\u0103n<\/strong> (giai \u0111o\u1ea1n IV).<\/p>\n<p style=\"text-align: justify\">Vi\u1ec7c ch\u1eefa kh\u1ecfi l\u00e0 kh\u00f4ng kh\u1ea3 thi \u1edf h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n UT\u0110TT di c\u0103n, m\u1eb7c d\u00f9 m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1eefa kh\u1ecfi b\u1eb1ng ph\u1eabu thu\u1eadt n\u1ebfu kh\u1ed1i u di c\u0103n ch\u1ec9 khu tr\u00fa t\u1ea1i m\u1ed9t v\u00e0i c\u01a1 quan nh\u1ea5t \u0111\u1ecbnh (\u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf gan v\u00e0\/ho\u1eb7c ph\u1ed5i). \u0110\u1ed1i v\u1edbi \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n, h\u00f3a tr\u1ecb to\u00e0n th\u00e2n l\u00e0 l\u1ef1a ch\u1ecdn th\u00edch h\u1ee3p nh\u1ea5t v\u00ec ung th\u01b0 \u0111\u00e3 lan nhi\u1ec1u ch\u1ed7. H\u00f3a tr\u1ecb kh\u00f4ng ch\u1eefa l\u00e0nh \u0111\u01b0\u1ee3c ung th\u01b0 di c\u0103n, nh\u01b0ng c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng. \u0110\u00f4i khi, b\u00e1c s\u0129 c\u00f3 th\u1ec3 \u0111\u1ec1 ngh\u1ecb c\u1ea3 h\u00f3a tr\u1ecb v\u00e0 ph\u1eabu thu\u1eadt.<\/p>\n<h2 style=\"text-align: justify\"><strong>\u0110i\u1ec1u tr\u1ecb Ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng c\u1eaft b\u1ecf \u0111\u01b0\u1ee3c<\/strong><\/h2>\n<p style=\"text-align: justify\">\u0110\u00f4i khi ph\u1eabu thu\u1eadt l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn cho b\u1ec7nh nh\u00e2n ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng di c\u0103n \u0111\u1ebfn m\u1ed9t v\u00e0i v\u1ecb tr\u00ed \u1edf gan, ph\u1ed5i ho\u1eb7c m\u1ed9t n\u01a1i c\u00f3 th\u1ec3 c\u1eaft b\u1ecf. C\u00f3 kho\u1ea3ng 30% ca b\u1ec7nh \u0111\u01b0\u1ee3c ch\u1eefa kh\u1ecfi n\u1ebfu di c\u0103n gan c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u1eaft b\u1ecf ho\u00e0n to\u00e0n. Khi c\u00e2n nh\u1eafc ph\u1eabu thu\u1eadt, b\u00e1c s\u0129 ph\u1ea3i c\u00f3 th\u00f4ng tin t\u1eeb c\u00e1c kh\u1ea3o s\u00e1t\/x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o <strong>kh\u00f4ng c\u00f3 di c\u0103n n\u00e0o kh\u00e1c ngo\u00e0i gan<\/strong>, v\u00e0 ph\u1ea3i c\u00f3 <strong>m\u1ed9t l\u01b0\u1ee3ng gan b\u00ecnh th\u01b0\u1eddng c\u00f2n l\u1ea1i<\/strong> <strong>sau ca m\u1ed5<\/strong> \u0111\u1ec3 duy tr\u00ec s\u1ef1 s\u1ed1ng.<\/p>\n<p style=\"text-align: justify\">Hi\u1ec7n v\u1eabn c\u00f2n nhi\u1ec1u tranh c\u00e3i v\u00e0 kh\u00e1c bi\u1ec7t v\u1ec1 vi\u1ec7c n\u00ean xem di c\u0103n gan n\u00e0o l\u00e0 \u201cc\u00f3 th\u1ec3 c\u1eaft b\u1ecf\u201d v\u00e0 \u201ckh\u00f4ng th\u1ec3 c\u1eaft b\u1ecf\u201d. N\u1ebfu \u0111\u01b0\u1ee3c, b\u1ec7nh nh\u00e2n n\u00ean y\u00eau c\u1ea7u\/t\u00ecm th\u00eam \u00fd ki\u1ebfn c\u1ee7a b\u00e1c s\u0129 ph\u1eabu thu\u1eadt gan ho\u1eb7c b\u00e1c s\u0129 ung th\u01b0 ngo\u1ea1i khoa c\u00f3 kinh nghi\u1ec7m khi l\u00ean k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p style=\"text-align: justify\">H\u00f3a tr\u1ecb c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, ngay c\u1ea3 khi di c\u0103n ch\u1ec9 xu\u1ea5t hi\u1ec7n trong gan. H\u00f3a tr\u1ecb tr\u01b0\u1edbc m\u1ed5 (neoadjuvant chemotherapy) c\u00f3 th\u1ec3 gi\u00fap m\u1ed9t s\u1ed1 ca \u0111ang \u201c\u1edf l\u01b0ng ch\u1eebng\u201d ch\u01b0a bi\u1ebft c\u1eaft b\u1ecf \u0111\u01b0\u1ee3c hay kh\u00f4ng (v\u00ec k\u00edch th\u01b0\u1edbc ho\u1eb7c v\u1ecb tr\u00ed kh\u1ed1i u) cu\u1ed1i c\u00f9ng thu nh\u1ecf \u0111\u01b0\u1ee3c kh\u1ed1i u v\u00e0 c\u00f3 th\u1ec3 ph\u1eabu thu\u1eadt th\u00e0nh c\u00f4ng.<\/p>\n<p style=\"text-align: justify\">N\u1ebfu kh\u1ed1i u di c\u0103n gan \u0111\u01b0\u1ee3c c\u1eaft b\u1ecf th\u00e0nh c\u00f4ng, b\u00e1c s\u0129 th\u01b0\u1eddng \u0111\u1ec1 ngh\u1ecb ti\u1ebfn h\u00e0nh th\u00eam h\u00f3a tr\u1ecb sau m\u1ed5 (h\u00f3a tr\u1ecb b\u1ed5 tr\u1ee3, adjuvant chemotherapy) \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t.<\/p>\n<p style=\"text-align: justify\">\u1ede m\u1ed9t s\u1ed1 c\u01a1 s\u1edf, h\u00f3a tr\u1ecb \u0111\u01b0\u1ee3c truy\u1ec1n tr\u1ef1c ti\u1ebfp v\u00e0o gan qua \u0111\u1ed9ng m\u1ea1ch gan k\u00e8m theo ho\u1eb7c kh\u00f4ng k\u00e8m theo h\u00f3a tr\u1ecb truy\u1ec1n qua t\u0129nh m\u1ea1ch. Tuy nhi\u00ean, hi\u1ec7n v\u1eabn ch\u01b0a r\u00f5 c\u00e1ch l\u00e0m n\u00e0y c\u00f3 t\u1ed1t h\u01a1n h\u00f3a tr\u1ecb qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch \u0111\u01a1n thu\u1ea7n hay kh\u00f4ng. Ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 h\u00f3a tr\u1ecb truy\u1ec1n qua t\u0129nh m\u1ea1ch.<\/p>\n<p style=\"text-align: justify\">Ph\u1eabu thu\u1eadt c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n di c\u0103n ph\u1ed5i v\u1edbi s\u1ed1 \u00edt kh\u1ed1i u. Vai tr\u00f2 c\u1ee7a h\u00f3a tr\u1ecb b\u1ed5 tr\u1ee3 sau ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf di c\u0103n ph\u1ed5i v\u1eabn ch\u01b0a r\u00f5 r\u00e0ng.<\/p>\n<h2 style=\"text-align: justify\">\u0110i\u1ec1u tr\u1ecb Ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng kh\u00f4ng c\u1eaft b\u1ecf \u0111\u01b0\u1ee3c<\/h2>\n<p style=\"text-align: justify\">Nh\u01b0 \u0111\u00e3 n\u00f3i \u1edf tr\u00ean, ph\u1eabu thu\u1eadt l\u00e0 c\u00e1ch duy nh\u1ea5t \u0111\u1ec3 ch\u1eefa l\u00e0nh UT\u0110TT di c\u0103n. Trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p, ph\u1eabu thu\u1eadt l\u00e0 kh\u00f4ng kh\u1ea3 thi, v\u00e0 h\u00f3a tr\u1ecb \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb \u0111\u1ec3 gi\u1ea3m nh\u1eb9 c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng. M\u1eb7c d\u00f9 h\u00f3a tr\u1ecb gi\u00fap c\u1ea3i thi\u1ec7n tu\u1ed5i th\u1ecd, n\u00f3 kh\u00f4ng th\u1ec3 ch\u1eefa l\u00e0nh UT\u0110TT di c\u0103n.<\/p>\n<h3 style=\"text-align: justify\">Kh\u00e1i ni\u1ec7m ch\u0103m s\u00f3c li\u00ean t\u1ee5c<\/h3>\n<p style=\"text-align: justify\">\u0110\u1ed1i v\u1edbi h\u1ea7u h\u1ebft c\u00e1c lo\u1ea1i ung th\u01b0 kh\u00f4ng th\u1ec3 ch\u1eefa l\u00e0nh ngo\u00e0i UT\u0110TT, c\u00e1c lo\u1ea1i thu\u1ed1c ho\u1eb7c ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb s\u1ebd \u0111\u01b0\u1ee3c d\u00f9ng li\u00ean t\u1ee5c cho \u0111\u1ebfn khi b\u1ec7nh ung th\u01b0 ng\u1eebng \u0111\u00e1p \u1ee9ng (khi kh\u1ed1i u to th\u00eam v\u00e0\/ho\u1eb7c di c\u0103n th\u00eam ch\u1ed7 m\u1edbi) v\u00e0 sau \u0111\u00f3 b\u00e1c s\u0129 s\u1ebd \u0111\u1ec1 ngh\u1ecb th\u1eed m\u1ed9t ph\u00e1c \u0111\u1ed3 ho\u00e0n to\u00e0n m\u1edbi. Ph\u00e1c \u0111\u1ed3 d\u00f9ng \u0111\u1ea7u ti\u00ean g\u1ecdi l\u00e0 ph\u00e1c \u0111\u1ed3 1 hay ph\u00e1c \u0111\u1ed3 b\u1eadc 1. C\u00e1c ph\u00e1c \u0111\u1ed3 ti\u1ebfp theo g\u1ecdi l\u00e0 ph\u00e1c \u0111\u1ed3 2 ho\u1eb7c 3&#8230;<\/p>\n<p style=\"text-align: justify\">\u1ede UT\u0110TT di c\u0103n, t\u00ecnh h\u00ecnh h\u01a1i kh\u00e1c v\u00ec nhi\u1ec1u lo\u1ea1i thu\u1ed1c ch\u1ed1ng ung th\u01b0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p theo nhi\u1ec1u c\u00e1ch \u0111a d\u1ea1ng. Ngo\u00e0i ra, c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 li\u00ean quan \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3m b\u1edbt b\u1eb1ng c\u00e1ch h\u1ea1n ch\u1ebf s\u1ed1 li\u1ec1u (l\u1ea7n truy\u1ec1n) c\u1ee7a m\u1ed9t v\u00e0i lo\u1ea1i thu\u1ed1c nh\u1ea5t \u0111\u1ecbnh. Do \u0111\u00f3, thay v\u00ec d\u00f9ng ph\u00e1c \u0111\u1ed3 1 cho \u0111\u1ebfn khi kh\u1ed1i u ti\u1ebfn tri\u1ec3n, \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u201cc\u00e1 nh\u00e2n h\u00f3a\u201d theo t\u1eebng t\u00ecnh hu\u1ed1ng c\u1ee5 th\u1ec3.<\/p>\n<ul style=\"text-align: justify\">\n<li>M\u1ed9t s\u1ed1 thu\u1ed1c h\u00f3a tr\u1ecb c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c d\u00f9ng, d\u1eebng, v\u00e0 sau \u0111\u00f3 d\u00f9ng l\u1ea1i, \u0111\u00f4i khi k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c h\u00f3a tr\u1ecb kh\u00e1c.<\/li>\n<li>C\u00e1c giai \u0111o\u1ea1n h\u00f3a tr\u1ecb t\u00edch c\u1ef1c (d\u00f9ng c\u00e1c ph\u00e1c \u0111\u1ed3 m\u1ea1nh) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xen k\u1ebd b\u1edfi nh\u1eefng giai \u0111o\u1ea1n h\u00f3a tr\u1ecb &#8220;duy tr\u00ec&#8221; (d\u00f9ng ph\u00e1c \u0111\u1ed3 nh\u1eb9 h\u01a1n), gi\u00fap b\u1ec7nh nh\u00e2n duy tr\u00ec cu\u1ed9c s\u1ed1ng v\u1edbi ch\u1ea5t l\u01b0\u1ee3ng t\u1ed1t nh\u1ea5t c\u00f3 th\u1ec3 v\u00e0 gi\u1ea3m thi\u1ec3u c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">C\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ti\u1ebfp c\u1eadn \u201cch\u0103m s\u00f3c li\u00ean t\u1ee5c\u201d (&#8220;continuum of care&#8221;).<\/p>\n<h3 style=\"text-align: justify\">H\u00f3a tr\u1ecb th\u01b0\u1eddng quy<\/h3>\n<p style=\"text-align: justify\">C\u00e1c lo\u1ea1i thu\u1ed1c h\u00f3a tr\u1ecb th\u01b0\u1eddng quy (m\u1ed9t s\u1ed1 t\u00e0i li\u1ec7u g\u1ecdi l\u00e0 h\u00f3a tr\u1ecb kinh \u0111i\u1ec3n) \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb UT\u0110TT di c\u0103n bao g\u1ed3m:<\/p>\n<ul style=\"text-align: justify\">\n<li>Fluorouracil (vi\u1ebft t\u1eaft l\u00e0 FU), thu\u1ed1c d\u00f2ng fluoropyrimidine, th\u01b0\u1eddng \u0111\u01b0\u1ee3c truy\u1ec1n v\u00e0o t\u0129nh m\u1ea1ch v\u1edbi m\u1ed9t lo\u1ea1i thu\u1ed1c th\u1ee9 hai c\u00f3 t\u00ean l\u00e0 leucovorin \u0111\u1ec3 gi\u00fap t\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a FU<\/li>\n<li>Capecitabine (th\u01b0\u01a1ng hi\u1ec7u: Xeloda), thu\u1ed1c u\u1ed1ng c\u00f3 t\u00e1c d\u1ee5ng nh\u01b0 FU<\/li>\n<li>Oxaliplatin (th\u01b0\u01a1ng hi\u1ec7u: Eloxatin), ti\u00eam t\u0129nh m\u1ea1ch<\/li>\n<li>Irinotecan (th\u01b0\u01a1ng hi\u1ec7u: Camptosar), ti\u00eam t\u0129nh m\u1ea1ch<\/li>\n<li>Trifluridine-tipiracil (th\u01b0\u01a1ng hi\u1ec7u: Lonsurf), thu\u1ed1c u\u1ed1ng ch\u1ee9a hai th\u00e0nh ph\u1ea7n l\u00e0 trifluridin v\u00e0 tipiracil, m\u1ed7i lo\u1ea1i c\u00f3 \u0111\u1eb7c t\u00ednh kh\u00e1c nhau. Thu\u1ed1c n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 d\u00f9ng qua c\u00e1c ph\u00e1c \u0111\u1ed3 ch\u1ee9a fluoropyrimidine, oxaliplatin, irinotecan v\u00e0 c\u00e1c li\u1ec7u ph\u00e1p nh\u1eafm \u0111\u00edch kh\u00e1c.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">Nh\u1eefng lo\u1ea1i thu\u1ed1c n\u00e0y t\u00e1c d\u1ee5ng b\u1eb1ng c\u00e1ch ng\u0103n ch\u1eb7n 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<h3 style=\"text-align: justify\">Li\u1ec7u ph\u00e1p nh\u1eafm \u0111\u00edch<\/h3>\n<p style=\"text-align: justify\">Nh\u1eefng thu\u1ed1c n\u00e0y ch\u1ed1ng l\u1ea1i UT\u0110TT di c\u0103n b\u1eb1ng c\u00e1c c\u01a1 ch\u1ebf kh\u00e1c. Ch\u00fang l\u00e0 nh\u1eefng thu\u1ed1c \u201cnh\u1eafm \u0111\u00edch\u201d v\u00ec c\u00f3 b\u1ea3n ch\u1ea5t l\u00e0 kh\u00e1ng th\u1ec3 ho\u1eb7c l\u00e0 thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng \u1ee9c ch\u1ebf m\u1ed9t s\u1ed1 protein c\u1ee5 th\u1ec3 quan tr\u1ecdng cho s\u1ef1 ph\u00e1t tri\u1ec3n v\u00e0 s\u1ed1ng c\u00f2n c\u1ee7a c\u00e1c t\u1ebf b\u00e0o ung th\u01b0.<\/p>\n<p style=\"text-align: justify\">V\u00ec thu\u1ed1c nh\u1eafm \u0111\u00edch kh\u00f4ng tr\u1ef1c ti\u1ebfp can thi\u1ec7p v\u00e0o c\u00e1c t\u1ebf b\u00e0o ph\u00e2n chia nhanh, ch\u00fang kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 hay g\u1eb7p \u1edf c\u00e1c thu\u1ed1c h\u00f3a tr\u1ecb th\u01b0\u1eddng quy. Tuy nhi\u00ean, ch\u00fang l\u1ea1i c\u00f3 c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 \u0111\u1eb7c tr\u01b0ng kh\u00e1c, nh\u01b0 m\u00f4 t\u1ea3 chi ti\u1ebft d\u01b0\u1edbi \u0111\u00e2y.<\/p>\n<ul style=\"text-align: justify\">\n<li><strong>Bevacizumab<\/strong> (th\u01b0\u01a1ng hi\u1ec7u: Avastin, thu\u1ed1c truy\u1ec1n t\u0129nh m\u1ea1ch) &#8211; Bevacizumab li\u00ean k\u1ebft v\u1edbi m\u1ed9t protein g\u1ecdi l\u00e0 VEGF (Vascular endothelial growth factor). VEGF li\u00ean quan t\u1edbi qu\u00e1 tr\u00ecnh t\u1ea1o m\u1ea1ch m\u00e1u cung c\u1ea5p cho kh\u1ed1i u \u0111\u1ec3 gi\u00fap kh\u1ed1i u ph\u00e1t tri\u1ec3n v\u00e0 lan r\u1ed9ng. Bevacizumab ng\u0103n ch\u1eb7n qu\u00e1 tr\u00ecnh n\u00e0y v\u00e0 t\u0103ng c\u01b0\u1eddng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a c\u00e1c thu\u1ed1c h\u00f3a tr\u1ecb kh\u00e1c. Bevacizumab kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 khi s\u1eed d\u1ee5ng ri\u00eang, nh\u01b0ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c, nh\u01b0 FU, capecitabine, oxaliplatin, v\u00e0 irinotecan.<\/li>\n<li><strong>Ramucirumab<\/strong> (th\u01b0\u01a1ng hi\u1ec7u: Cyramza, thu\u1ed1c truy\u1ec1n t\u0129nh m\u1ea1ch) &#8211; Ramucirumab l\u00e0 m\u1ed9t protein c\u00f3 kh\u1ea3 n\u0103ng li\u00ean k\u1ebft v\u1edbi c\u1ea3m th\u1ee5 th\u1ec3 c\u1ee7a VEGF (VEGFR2), do \u0111\u00f3 ng\u0103n c\u1ea3n c\u00e1c t\u00edn hi\u1ec7u t\u1ea1o m\u1ea1ch t\u01b0\u01a1ng t\u1ef1 nh\u01b0 t\u00e1c d\u1ee5ng c\u1ee7a bevacizumab. Gi\u1ed1ng nh\u01b0 bevacizumab, ramucirumab t\u0103ng c\u01b0\u1eddng hi\u1ec7u qu\u1ea3 ch\u1ed1ng ung th\u01b0 c\u1ee7a c\u00e1c thu\u1ed1c h\u00f3a tr\u1ecb kh\u00e1c. Ramucirumab th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb c\u00f3 irinotecan, d\u00e0nh cho nh\u1eefng b\u1ec7nh nh\u00e2n tr\u01b0\u1edbc \u0111\u00f3 \u0111\u00e3 d\u00f9ng bevacizumab k\u1ebft h\u1ee3p v\u1edbi ph\u00e1c \u0111\u1ed3 ch\u1ee9a oxaliplatin.<\/li>\n<li><strong>Aflibercept<\/strong> (th\u01b0\u01a1ng hi\u1ec7u: Zaltrap, thu\u1ed1c truy\u1ec1n t\u0129nh m\u1ea1ch) \u2013 Aflibercept l\u00e0 m\u1ed9t protein dung h\u1ee3p (fusion protein) ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch &#8220;b\u1eaby&#8221; VEGF v\u00e0 ng\u0103n kh\u00f4ng cho n\u00f3 k\u00edch ho\u1ea1t c\u1ea3m th\u1ee5 th\u1ec3 t\u01b0\u01a1ng \u1ee9ng tr\u00ean c\u00e1c t\u1ebf b\u00e0o ung th\u01b0. Thu\u1ed1c n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi h\u00f3a tr\u1ecb ch\u1ee9a irinotecan, d\u00e0nh cho nh\u1eefng b\u1ec7nh nh\u00e2n ung th\u01b0 ti\u1ebfn tri\u1ec3n trong khi \u0111ang d\u00f9ng ph\u00e1c \u0111\u1ed3 c\u00f3 ch\u1ee9a oxaliplatin, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 bevacizumab \u0111i k\u00e8m.<\/li>\n<li><strong>Regorafenib<\/strong> (th\u01b0\u01a1ng hi\u1ec7u: Stivarga, thu\u1ed1c u\u1ed1ng) &#8211; Regorafenib ng\u0103n ch\u1eb7n m\u1ed9t s\u1ed1 c\u1ea3m th\u1ee5 th\u1ec3 VEGF c\u0169ng nh\u01b0 c\u00e1c protein \u0111\u1eb7c bi\u1ec7t (kinase) kh\u00e1c. Regorafenib l\u00e0 m\u1ed9t trong s\u1ed1 \u00edt l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb c\u00f2n l\u1ea1i cho b\u1ec7nh nh\u00e2n \u0111\u00e3 d\u00f9ng h\u1ebft c\u00e1c ph\u00e1c \u0111\u1ed3 c\u00f3 ch\u1ee9a fluoropyrimidine, oxaliplatin v\u00e0 irinotecan c\u0169ng nh\u01b0 c\u00e1c thu\u1ed1c nh\u1eafm \u0111\u00edch kh\u00e1c.<\/li>\n<li><strong>Cetuximab<\/strong> (th\u01b0\u01a1ng hi\u1ec7u: Erbitux) &#8211; Cetuximab nh\u1eafm v\u00e0o m\u1ed9t lo\u1ea1i protein kh\u00e1c l\u00e0 EGFR, \u0111\u01b0\u1ee3c t\u00ecm th\u1ea5y trong kho\u1ea3ng 80% UT\u0110TT. Hi\u1ec7u qu\u1ea3 c\u1ee7a cetuximab t\u00f9y thu\u1ed9c v\u00e0o b\u1ea5t th\u01b0\u1eddng di truy\u1ec1n c\u1ee7a kh\u1ed1i u. C\u1ee5 th\u1ec3 h\u01a1n, n\u1ebfu kh\u1ed1i u c\u00f3 \u0111\u1ed9t bi\u1ebfn gen \u1edf RAS ho\u1eb7c BRAF V600E, cetuximab s\u1ebd kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng. Ng\u01b0\u1ee3c l\u1ea1i, n\u1ebfu kh\u1ed1i u <u>kh\u00f4ng c\u00f3 \u0111\u1ed9t bi\u1ebfn<\/u> <strong>\u1edf RAS ho\u1eb7c BRAF V600E<\/strong>, cetuximab c\u00f3 th\u1ec3 c\u00f3 hi\u1ec7u qu\u1ea3. Kh\u00f4ng gi\u1ed1ng bevacizumab, cetuximab c\u00f3 hi\u1ec7u qu\u1ea3 khi k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c kh\u00e1c v\u00e0 ngay c\u1ea3 khi d\u00f9ng \u0111\u01a1n \u0111\u1ed9c.<\/li>\n<\/ul>\n<ul style=\"text-align: justify\">\n<li><strong>Panitumumab<\/strong> (th\u01b0\u01a1ng hi\u1ec7u: Vectibix) &#8211; Gi\u1ed1ng nh\u01b0 cetuximab, panitumumab c\u0169ng nh\u1eafm t\u1edbi EGFR v\u00e0 ch\u1ec9 c\u00f3 hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi c\u00e1c kh\u1ed1i u <u>kh\u00f4ng c\u00f3 \u0111\u1ed9t bi\u1ebfn<\/u> \u0111\u1eb7c hi\u1ec7u \u1edf gen RAS ho\u1eb7c BRAF V600E.<\/li>\n<\/ul>\n<h3 style=\"text-align: justify\">Li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch<\/h3>\n<p style=\"text-align: justify\">Li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch l\u00e0 ph\u01b0\u01a1ng ph\u00e1p k\u00edch th\u00edch ho\u1eb7c \u201cgi\u1ea3i ph\u00f3ng\u201d h\u1ec7 mi\u1ec5n d\u1ecbch c\u1ee7a b\u1ec7nh nh\u00e2n nh\u1eb1m kh\u1edfi \u0111\u1ed9ng t\u1ea5n c\u00f4ng v\u00e0 ti\u00eau di\u1ec7t c\u00e1c t\u1ebf b\u00e0o ung th\u01b0.<\/p>\n<p style=\"text-align: justify\">C\u00f3 m\u1ed9t s\u1ed1 li\u1ec7u ph\u00e1p mi\u1ec5n d\u1ecbch kh\u00e1c nhau. Thu\u1ed1c quan tr\u1ecdng nh\u1ea5t trong \u0111i\u1ec1u tr\u1ecb UT\u0110TT di c\u0103n b\u1eb1ng ph\u01b0\u01a1ng ph\u00e1p n\u00e0y l\u00e0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch (checkpoint inhibitors) c\u00f3 t\u00ean l\u00e0 nivolumab (th\u01b0\u01a1ng hi\u1ec7u: Opdivo) v\u00e0 pembrolizumab (th\u01b0\u01a1ng hi\u1ec7u: Keytruda). Ch\u00fang c\u00f3 th\u1ec3 mang l\u1ea1i l\u1ee3i \u00edch quan tr\u1ecdng cho m\u1ed9t s\u1ed1 \u00edt b\u1ec7nh nh\u00e2n, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ung th\u01b0 (kho\u1ea3ng 5%) c\u00f3 \u0111\u1ed9t bi\u1ebfn gen \u0111\u1eb7c bi\u1ec7t g\u1ecdi l\u00e0 &#8220;mismatch repair-deficient&#8221; (t\u1ea1m d\u1ecbch l\u00e0 \u201ckhi\u1ebfm khuy\u1ebft trong qu\u00e1 tr\u00ecnh s\u1eeda ch\u1eefa b\u1eaft c\u1eb7p sai\u201d). B\u00e1c s\u0129 c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh xem kh\u1ed1i u c\u00f3 t\u00ednh ch\u1ea5t n\u00e0y hay kh\u00f4ng qua x\u00e9t nghi\u1ec7m sinh thi\u1ebft (gi\u1ea3i ph\u1eabu b\u1ec7nh).<\/p>\n<h3 style=\"text-align: justify\">Gi\u00e1m s\u00e1t trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb<\/h3>\n<p style=\"text-align: justify\">\u0110\u00e1p \u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n v\u1edbi h\u00f3a tr\u1ecb \u0111\u01b0\u1ee3c theo d\u00f5i b\u1eb1ng c\u00e1c x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh \u0111\u1ecbnh k\u1ef3 nh\u01b0 ch\u1ee5p c\u1eaft l\u1edbp \u0111i\u1ec7n to\u00e1n (ch\u1ee5p CT) \u0111\u1ec3 xem c\u00e1c kh\u1ed1i u c\u00f3 thay \u0111\u1ed5i k\u00edch th\u01b0\u1edbc hay xu\u1ea5t hi\u1ec7n th\u00eam kh\u00f4ng. C\u00e1c x\u00e9t nghi\u1ec7m n\u00e0y th\u01b0\u1eddng \u0111\u01b0\u1ee3c l\u1eb7p l\u1ea1i sau 6-8 tu\u1ea7n, c\u00f3 th\u1ec3 thay \u0111\u1ed5i t\u00f9y v\u00e0o s\u1ef1 \u1ed5n \u0111\u1ecbnh c\u1ee7a b\u1ec7nh t\u00ecnh. Th\u00eam v\u00e0o \u0111\u00f3, n\u1ed3ng \u0111\u1ed9 trong m\u00e1u c\u1ee7a ch\u1ea5t ch\u1ec9 th\u1ecb ung th\u01b0 (tumor marker) c\u00f3 t\u00ean carcinoembryonic antigen (CEA) th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111o m\u1ed7i 1-3 th\u00e1ng trong su\u1ed1t qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. M\u1ee9c CEA th\u01b0\u1eddng cao \u1edf ng\u01b0\u1eddi b\u1ecb UT\u0110TT ti\u1ebfn tri\u1ec3n; ch\u1ec9 s\u1ed1 CEA t\u0103ng li\u00ean t\u1ee5c c\u00f3 th\u1ec3 \u00e1m ch\u1ec9 r\u1eb1ng b\u1ec7nh \u0111ang ti\u1ebfn tri\u1ec3n v\u00e0 c\u1ea7n thay \u0111\u1ed5i ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p style=\"text-align: justify\">Tuy nhi\u00ean, c\u1ea7n l\u01b0u \u00fd r\u1eb1ng CEA t\u0103ng <u>kh\u00f4ng ph\u1ea3i l\u00e0 b\u1eb1ng ch\u1ee9ng \u0111\u1ee7 \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh<\/u> thay \u0111\u1ed5i chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb. S\u1ef1 ti\u1ebfn tri\u1ec3n c\u1ee7a c\u0103n b\u1ec7nh ph\u1ea3i \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng x\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh (nh\u01b0 ch\u1ee5p CT) v\u00e0\/ho\u1eb7c sinh thi\u1ebft tr\u01b0\u1edbc khi thay \u0111\u1ed5i \u0111i\u1ec1u tr\u1ecb.<\/p>\n<h2 style=\"text-align: justify\">Ph\u00e1c \u0111\u1ed3 1 th\u01b0\u1eddng d\u00f9ng trong Ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng di c\u0103n<\/h2>\n<p style=\"text-align: justify\">Thu\u1ed1c h\u00f3a tr\u1ecb th\u01b0\u1eddng quy v\u00e0 c\u00e1c thu\u1ed1c nh\u1eafm \u0111\u00edch th\u01b0\u1eddng \u0111\u01b0\u1ee3c d\u00f9ng chung cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p m\u1edbi ch\u1ea9n \u0111o\u00e1n, ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb UT\u0110TT di c\u0103n. Thu\u1ed1c h\u00f3a tr\u1ecb th\u01b0\u1eddng quy nh\u01b0 FOLFOX, FOLFIRI ho\u1eb7c XELOX c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb &#8220;n\u1ec1n t\u1ea3ng&#8221; (&#8220;chemotherapy backbone &#8220;), v\u00e0 d\u00f9ng k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c nh\u01b0 bevacizumab, cetuximab hay panitumumab. Nhi\u1ec1u c\u00e1ch k\u1ebft h\u1ee3p kh\u00e1c nhau \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u v\u00e0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb cho \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u (ph\u00e1c \u0111\u1ed3 1 ho\u1eb7c ph\u00e1c \u0111\u1ed3 \u0111\u1ea7u ti\u00ean). Ph\u1ea7n d\u01b0\u1edbi \u0111\u00e2y n\u00f3i s\u01a1 l\u01b0\u1ee3c v\u1ec1 c\u00e1c l\u1ef1a ch\u1ecdn \u0111\u00f3.<\/p>\n<p style=\"text-align: justify\"><img fetchpriority=\"high\" decoding=\"async\" class=\"wp-image-14400 aligncenter\" src=\"https:\/\/yhoccongdong.com\/ung-thu\/wp-content\/uploads\/sites\/2\/2017\/11\/hinh-2-Minh-hoa-phac-do-Folfox-ket-hop-voi-Bevacizumab.jpg\" alt=\"H\u00ecnh 2. Minh h\u1ecda ph\u00e1c \u0111\u1ed3 FOLFOX k\u1ebft h\u1ee3p v\u1edbi Bevacizumab. M\u0169i t\u00ean xanh ch\u1ec9 ng\u00e0y truy\u1ec1n thu\u1ed1c.\" width=\"746\" height=\"245\" \/><\/p>\n<p style=\"text-align: center\"><em>H\u00ecnh 2. Minh h\u1ecda ph\u00e1c \u0111\u1ed3 FOLFOX k\u1ebft h\u1ee3p v\u1edbi Bevacizumab. <\/em><\/p>\n<p style=\"text-align: justify\"><em>M\u0169i t\u00ean xanh ch\u1ec9 ng\u00e0y truy\u1ec1n thu\u1ed1c.<\/em><\/p>\n<p style=\"text-align: justify\"><img decoding=\"async\" class=\"wp-image-14401 aligncenter\" src=\"https:\/\/yhoccongdong.com\/ung-thu\/wp-content\/uploads\/sites\/2\/2017\/11\/hinh-3-Minh-hoa-phac-do-Folfiri-ket-hop-voi-Cetuximab.jpg\" alt=\"H\u00ecnh 3. Minh h\u1ecda ph\u00e1c \u0111\u1ed3 FOLFIRI k\u1ebft h\u1ee3p v\u1edbi Cetuximab. M\u0169i t\u00ean xanh ch\u1ec9 ng\u00e0y truy\u1ec1n thu\u1ed1c.\" width=\"728\" height=\"237\" \/><\/p>\n<p style=\"text-align: center\"><em>H\u00ecnh 3. Minh h\u1ecda ph\u00e1c \u0111\u1ed3 FOLFIRI k\u1ebft h\u1ee3p v\u1edbi Cetuximab. <\/em><\/p>\n<p style=\"text-align: justify\"><em>M\u0169i t\u00ean xanh ch\u1ec9 ng\u00e0y truy\u1ec1n thu\u1ed1c.<\/em><\/p>\n<h3 style=\"text-align: justify\">FOLFOX, FOLFIRI, v\u00e0 XELOX<\/h3>\n<p style=\"text-align: justify\">M\u1ed9t s\u1ed1 ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb g\u1ed3m 2 ho\u1eb7c 3 thu\u1ed1c nh\u01b0 sau c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ec3 l\u00e0m ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb \u201cn\u1ec1n t\u1ea3ng&#8221; trong \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u:<\/p>\n<ul style=\"text-align: justify\">\n<li>Oxaliplatin c\u1ed9ng v\u1edbi fluorouracil (FU) v\u00e0 leucovorin (g\u1ecdi t\u1eaft l\u00e0 FOLFOX)<\/li>\n<li>Irinotecan c\u1ed9ng v\u1edbi FU v\u00e0 leucovorin (g\u1ecdi t\u1eaft l\u00e0 FOLFIRI)<\/li>\n<li>Oxaliplatin c\u1ed9ng capecitabine (g\u1ecdi l\u00e0 XELOX ho\u1eb7c CAPOX)<\/li>\n<\/ul>\n<p style=\"text-align: justify\">V\u1edbi FOLFOX v\u00e0 FOLFIRI, oxaliplatin ho\u1eb7c irinotecan th\u01b0\u1eddng \u0111\u01b0\u1ee3c truy\u1ec1n v\u00e0o t\u0129nh m\u1ea1ch v\u00e0o ng\u00e0y \u0111\u1ea7u ti\u00ean \u0111i\u1ec1u tr\u1ecb (ng\u00e0y 1). Leucovorin v\u00e0 FU \u0111\u01b0\u1ee3c ti\u00eam t\u0129nh m\u1ea1ch v\u1edbi FU truy\u1ec1n li\u00ean t\u1ee5c su\u1ed1t 46 gi\u1edd sau \u0111\u00f3. C\u1ea3 hai ph\u00e1c \u0111\u1ed3 \u0111\u1ec1u y\u00eau c\u1ea7u b\u1ec7nh nh\u00e2n c\u00f3 Catheter (\u1ed1ng th\u00f4ng) t\u0129nh m\u1ea1ch trung t\u00e2m (\u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u201cport\u201d), th\u01b0\u1eddng \u0111\u01b0\u1ee3c m\u1ed9t b\u00e1c s\u0129 ngo\u1ea1i khoa \u0111\u1eb7t v\u00e0o m\u1ed9t trong nh\u1eefng m\u1ea1ch m\u00e1u (t\u0129nh m\u1ea1ch) l\u1edbn \u1edf ng\u1ef1c. Ngo\u00e0i ra, b\u1ec7nh nh\u00e2n c\u00f2n c\u1ea7n m\u1ed9t m\u00e1y b\u01a1m thu\u1ed1c d\u00f9ng t\u1ea1i nh\u00e0. M\u00e1y b\u01a1m n\u00e0y th\u1eadt ra r\u1ea5t nh\u1ecf \u0111\u1ec3 c\u00f3 th\u1ec3 \u0111eo quanh eo kh\u00f4ng \u1ea3nh h\u01b0\u1edfng nhi\u1ec1u t\u1edbi sinh ho\u1ea1t h\u1eb1ng ng\u00e0y. Nhi\u1ec1u n\u01a1i c\u00f3 th\u1ec3 d\u00f9ng b\u00ecnh b\u01a1m (Infusor) kh\u00f4ng c\u00f3 \u0111\u1ed9ng c\u01a1; thu\u1ed1c \u0111\u01b0\u1ee3c ch\u1ee9a trong m\u1ed9t t\u00fai cao su t\u1ef1 x\u1eb9p l\u1ea1i t\u1eeb t\u1eeb \u0111\u1ec3 chuy\u1ec1n h\u1ebft thu\u1ed1c trong \u0111\u00fang th\u1eddi gian thi\u1ebft k\u1ebf.<\/p>\n<p style=\"text-align: justify\">C\u1ea3 FOLFIRI v\u00e0 FOLFOX \u0111\u1ec1u cho k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 khi d\u00f9ng trong ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u ti\u00ean, s\u1ef1 l\u1ef1a ch\u1ecdn th\u01b0\u1eddng d\u1ef1a tr\u00ean c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 d\u1ef1 ki\u1ebfn v\u00e0 \u00fd nguy\u1ec7n c\u1ee7a b\u1ec7nh nh\u00e2n. \u1ede M\u1ef9, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng d\u00f9ng FOLFOX nh\u01b0 l\u00e0 ph\u00e1c \u0111\u1ed3 1, v\u00e0 FOLFIRI \u0111\u1ec3 d\u00e0nh l\u00e0m ph\u00e1c \u0111\u1ed3 2 tr\u1eeb khi b\u1ec7nh nh\u00e2n b\u1ecb \u0111au r\u00e1t ho\u1eb7c t\u00ea tay (b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean) m\u00e0 vi\u1ec7c d\u00f9ng FOLFIRI t\u1eeb \u0111\u1ea7u s\u1ebd t\u1ed1t h\u01a1n.<\/p>\n<p style=\"text-align: justify\">V\u1edbi ph\u00e1c \u0111\u1ed3 XELOX, thu\u1ed1c u\u1ed1ng capecitabine (th\u01b0\u01a1ng hi\u1ec7u: Xeloda) s\u1ebd \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u1edbi oxaliplatin ti\u00eam t\u0129nh m\u1ea1ch. Ph\u00e1c \u0111\u1ed3 n\u00e0y thu\u1eadn ti\u1ec7n h\u01a1n cho b\u1ec7nh nh\u00e2n v\u00ec kh\u00f4ng c\u1ea7n b\u01a1m truy\u1ec1n t\u1ea1i nh\u00e0. Oxaliplatin th\u01b0\u1eddng \u0111\u01b0\u1ee3c ti\u00eam qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch trung t\u00e2m v\u00ec n\u00f3 hay g\u00e2y \u0111au khi truy\u1ec1n qua t\u0129nh m\u1ea1ch \u1edf c\u00e1nh tay.<\/p>\n<p style=\"text-align: justify\">XELOX c\u00f3 th\u1ec3 hi\u1ec7u qu\u1ea3 nh\u01b0 FOLFOX khi d\u00f9ng l\u00e0m ph\u00e1c \u0111\u1ed3 \u0111\u1ea7u ti\u00ean. Tuy nhi\u00ean, m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 ti\u00eau ch\u1ea3y v\u00e0 h\u1ed9i ch\u1ee9ng ch\u00e2n tay (da l\u00f2ng b\u00e0n tay v\u00e0 l\u00f2ng b\u00e0n ch\u00e2n chuy\u1ec3n \u0111\u1ecf, \u0111au, v\u00e0 bong ra) c\u00f3 th\u1ec3 x\u1ea3y ra v\u1edbi XELOX.<\/p>\n<h3 style=\"text-align: justify\">Ph\u00e1c \u0111\u1ed3 1 th\u01b0\u1eddng \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb d\u00f9ng trong bao l\u00e2u?<\/h3>\n<p style=\"text-align: justify\">Th\u1eddi gian t\u1ed1i \u01b0u c\u1ee7a FOLFOX ho\u1eb7c XELOX \u1edf ph\u00e1c \u0111\u1ed3 1 l\u00e0 v\u1ea5n \u0111\u1ec1 c\u00f2n tranh c\u00e3i.<\/p>\n<ul style=\"text-align: justify\">\n<li>N\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng t\u1ed1t v\u00e0 kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng th\u00ec c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb cho \u0111\u1ebfn khi kh\u1ed1i u ti\u1ebfn tri\u1ec3n.<\/li>\n<li>M\u1ed9t c\u00e1ch ti\u1ebfp c\u1eadn kh\u00e1c l\u00e0 d\u00f9ng FOLFOX ho\u1eb7c XELOX 3-4 th\u00e1ng, sau \u0111\u00f3 chuy\u1ec3n sang &#8220;h\u00f3a tr\u1ecb duy tr\u00ec&#8221; v\u1edbi FU v\u00e0 leucovorin ho\u1eb7c capecitabine, k\u00e8m ho\u1eb7c kh\u00f4ng k\u00e8m bevacizumab. Oxaliplatin s\u1ebd \u0111\u01b0\u1ee3c d\u00f9ng l\u1ea1i khi b\u1ec7nh ti\u1ebfn tri\u1ec3n. C\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y c\u00f3 th\u1ec3 gi\u00fap tr\u00ec ho\u00e3n s\u1ef1 xu\u1ea5t hi\u1ec7n t\u00e1c d\u1ee5ng ph\u1ee5 m\u00e0 oxaliplatin g\u00e2y l\u00ean h\u1ec7 th\u1ea7n kinh.<\/li>\n<li>N\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh nh\u01b0 t\u00ea tay ch\u00e2n n\u1eb7ng khi d\u00f9ng FOLFOX ho\u1eb7c XELOX, oxaliplatin c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i ng\u01b0ng ngh\u1ec9, \u00edt nh\u1ea5t l\u00e0 t\u1ea1m th\u1eddi, \u0111\u1ec3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ea3i thi\u1ec7n ho\u1eb7c kh\u00f4ng t\u1ec7 h\u01a1n. Trong th\u1eddi gian n\u00e0y, \u0111i\u1ec1u tr\u1ecb duy tr\u00ec b\u1eb1ng FU v\u00e0 leucovorin ho\u1eb7c capecitabine \u0111\u01a1n \u0111\u1ed9c c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb, ho\u1eb7c b\u00e1c s\u0129 c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc m\u1ed9t ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb kh\u00e1c nh\u01b0 FOLFIRI.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u01b0u v\u1edbi ph\u00e1c \u0111\u1ed3 FOLFIRI c\u0169ng kh\u00f4ng r\u00f5 r\u00e0ng. Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n d\u00f9ng FOLFIRI th\u01b0\u1eddng thay \u0111\u1ed5i ph\u00e1c \u0111\u1ed3 do ti\u1ebfn tri\u1ec3n b\u1ec7nh ch\u1ee9 kh\u00f4ng v\u00ec ph\u1ea3n \u1ee9ng ph\u1ee5.<\/p>\n<h3 style=\"text-align: justify\">T\u00f4i c\u00f3 th\u1ec3 ngh\u1ec9 \u0111i\u1ec1u tr\u1ecb kh\u00f4ng?<\/h3>\n<p style=\"text-align: justify\">Nh\u01b0 \u0111\u00e3 \u0111\u1ec1 c\u1eadp \u1edf tr\u00ean, vi\u1ec7c ng\u01b0ng d\u00f9ng oxaliplatin t\u1ea1m th\u1eddi sau 3-4 th\u00e1ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng FOLFOX ho\u1eb7c XELOX l\u00e0 c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc n\u1ebfu UT\u0110TT \u0111\u00e3 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb, kh\u00f4ng c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn ung th\u01b0 v\u00e0 v\u1ecb tr\u00ed kh\u1ed1i u kh\u00f4ng \u1ea3nh h\u01b0\u1edfng t\u1edbi ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c c\u01a1 quan kh\u00e1c (nh\u01b0 suy gan, t\u1eafc ru\u1ed9t). Tuy nhi\u00ean, vi\u1ec7c ngh\u1ec9 \u0111i\u1ec1u tr\u1ecb ho\u00e0n to\u00e0n th\u01b0\u1eddng kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch v\u00ec kh\u1ea3 n\u0103ng s\u1ed1ng s\u00f3t c\u00f3 th\u1ec3 b\u1ecb \u1ea3nh h\u01b0\u1edfng (ng\u1eafn \u0111i). Trong h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p, b\u00e1c s\u0129 th\u01b0\u1eddng khuy\u00ean ti\u1ebfp t\u1ee5c FU v\u00e0 leucovorin (ho\u1eb7c capecitabine) k\u00e8m theo ho\u1eb7c kh\u00f4ng k\u00e8m theo bevacizumab.<\/p>\n<p style=\"text-align: justify\">N\u1ebfu h\u00f3a tr\u1ecb b\u1ecb ng\u1eebng ho\u00e0n to\u00e0n do t\u00e1c d\u1ee5ng ph\u1ee5 ho\u1eb7c nguy\u1ec7n v\u1ecdng c\u1ee7a b\u1ec7nh nh\u00e2n, n\u00ean theo d\u00f5i ch\u1eb7t ch\u1ebd, b\u1eb1ng ch\u1ee5p CT m\u1ed7i hai th\u00e1ng m\u1ed9t l\u1ea7n. N\u1ebfu ung th\u01b0 b\u1eaft \u0111\u1ea7u ti\u1ebfn tri\u1ec3n, h\u00f3a tr\u1ecb th\u01b0\u1eddng \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ed9ng l\u1ea1i c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t.<\/p>\n<p style=\"text-align: justify\">V\u1ec1 FOLFIRI, hi\u1ec7n v\u1eabn ch\u01b0a c\u00f3 nhi\u1ec1u th\u00f4ng tin v\u1ec1 t\u00e1c h\u1ea1i ti\u1ec1m \u1ea9n c\u1ee7a vi\u1ec7c ng\u1eebng ho\u00e0n to\u00e0n ph\u00e1c \u0111\u1ed3 n\u00e0y. C\u00f3 m\u1ed9t nghi\u00ean c\u1ee9u cho r\u1eb1ng \u0111i\u1ec1u tr\u1ecb gi\u00e1n \u0111o\u1ea1n kh\u00f4ng g\u00e2y \u1ea3nh h\u01b0\u1edfng x\u1ea5u \u0111\u1ebfn th\u1eddi gian s\u1ed1ng.<\/p>\n<h3 style=\"text-align: justify\">K\u1ebft h\u1ee3p c\u00e1c thu\u1ed1c nh\u1eafm \u0111\u00edch<\/h3>\n<p style=\"text-align: justify\">S\u1ef1 k\u1ebft h\u1ee3p bevacizumab v\u00e0o ph\u00e1c \u0111\u1ed3 FOLFOX, XELOX ho\u1eb7c FOLFIRI l\u00e0m t\u0103ng kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb v\u00e0 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng so v\u1edbi khi kh\u00f4ng k\u00e8m thu\u1ed1c n\u00e0y.<\/p>\n<p style=\"text-align: justify\">Trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, bevacizumab \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb nh\u01b0 l\u00e0 m\u1ed9t th\u00e0nh ph\u1ea7n trong ph\u00e1c \u0111\u1ed3 1, c\u00f9ng v\u1edbi FOLFIRI, FOLFOX, ho\u1eb7c XELOX. Tuy nhi\u00ean, l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c k\u1ebft h\u1ee3p bevacizumab ph\u1ea3i \u0111\u01b0\u1ee3c c\u00e2n b\u1eb1ng v\u1edbi c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng c\u00f3 th\u1ec3 x\u1ea3y ra v\u1edbi thu\u1ed1c n\u00e0y nh\u01b0 ch\u1ea3y m\u00e1u, d\u1ec5 h\u00ecnh th\u00e0nh c\u1ee5c m\u00e1u \u0111\u00f4ng, cao huy\u1ebft \u00e1p&#8230;<\/p>\n<p style=\"text-align: justify\">Vi\u1ec7c d\u00f9ng th\u00eam m\u1ed9t trong nh\u1eefng thu\u1ed1c nh\u1eafm \u0111\u00edch kh\u00e1c nh\u01b0 cetuximab ho\u1eb7c panitumumab v\u00e0o ph\u00e1c \u0111\u1ed3 1 c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 mang l\u1ea1i l\u1ee3i \u00edch n\u1ebfu kh\u1ed1i u c\u1ee7a b\u1ec7nh nh\u00e2n <u>kh\u00f4ng c\u00f3 \u0111\u1ed9t bi\u1ebfn gen<\/u> RAS ho\u1eb7c BRAF V600E. C\u00e1c d\u1eef li\u1ec7u m\u1edbi h\u01a1n t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng cho th\u1ea5y v\u1ecb tr\u00ed ban \u0111\u1ea7u c\u1ee7a UT\u0110TT c\u0169ng li\u00ean quan t\u1edbi hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a cetuximab v\u00e0 bevacizumab. N\u1ebfu kh\u1ed1i ung th\u01b0 n\u1eb1m \u1edf ph\u00eda \u0111\u1ea1i tr\u00e0ng tr\u00e1i (\u0111\u1ea1i tr\u00e0ng xu\u1ed1ng, \u0111\u1ea1i tr\u00e0ng sigma v\u00e0 tr\u1ef1c tr\u00e0ng) th\u00ec cetuximab c\u00f3 v\u1ebb c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n.<\/p>\n<h3 style=\"text-align: justify\">B\u1ec7nh nh\u00e2n kh\u00f4ng dung n\u1ea1p \u0111\u01b0\u1ee3c FOLFOX, XELOX ho\u1eb7c FOLFIRI<\/h3>\n<p style=\"text-align: justify\">N\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 dung n\u1ea1p (ch\u1ecbu \u0111\u01b0\u1ee3c) ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb m\u1ea1nh nh\u01b0 FOLFOX, XELOX, ho\u1eb7c FOLFIRI v\u00ec tu\u1ed5i t\u00e1c, th\u1ec3 tr\u1ea1ng ho\u1eb7c c\u00e1c v\u1ea5n \u0111\u1ec1 s\u1ee9c kh\u1ecfe kh\u00e1c, b\u00e1c s\u0129 c\u00f3 th\u1ec3 \u0111\u1ec1 ngh\u1ecb m\u1ed9t v\u00e0i l\u1ef1a ch\u1ecdn:<\/p>\n<ul style=\"text-align: justify\">\n<li>Truy\u1ec1n FU qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch c\u00f9ng v\u1edbi leucovorin, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 bevacizumab \u0111i k\u00e8m. \u0110\u00e2y l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p thay th\u1ebf h\u1ee3p l\u00fd v\u00e0 \u00edt t\u00e1c d\u1ee5ng ph\u1ee5 h\u01a1n, nh\u1ea5t l\u00e0 khi FU \u0111\u01b0\u1ee3c truy\u1ec1n trong th\u1eddi gian d\u00e0i (46 gi\u1edd).<\/li>\n<li>M\u1ed9t l\u1ef1a ch\u1ecdn thay th\u1ebf kh\u00e1c l\u00e0 capecitabine k\u00e8m theo ho\u1eb7c kh\u00f4ng k\u00e8m theo bevacizumab. \u0110\u00e2y l\u00e0 thu\u1ed1c vi\u00ean \u0111\u1ec3 u\u1ed1ng hai l\u1ea7n m\u1ed9t ng\u00e0y trong su\u1ed1t 14 ng\u00e0y, v\u00e0 sau \u0111\u00f3 l\u00e0 7 ng\u00e0y ngh\u1ec9. Capecitabine c\u00f3 hi\u1ec7u qu\u1ea3 nh\u01b0 ti\u00eam t\u0129nh m\u1ea1ch FU v\u00e0 leucovorin. Nh\u1eefng ng\u01b0\u1eddi \u0111ang d\u00f9ng ph\u00e1c \u0111\u1ed3 ch\u1ee9a capecitabine c\u00f3 l\u1ebd kh\u00f4ng n\u00ean d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m proton (thu\u1ed1c l\u00e0m gi\u1ea3m l\u01b0\u1ee3ng acid trong d\u1ea1 d\u00e0y \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ch\u1ee9ng tr\u00e0o ng\u01b0\u1ee3c d\u1ea1 d\u00e0y-th\u1ef1c qu\u1ea3n, lo\u00e9t d\u1ea1 d\u00e0y ho\u1eb7c c\u00e1c b\u1ec7nh ti\u00eau h\u00f3a kh\u00e1c) v\u00ec thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn hi\u1ec7u qu\u1ea3 c\u1ee7a capecitabine.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">C\u00e1c ph\u00e1c \u0111\u1ed3 n\u00e0y c\u00f3 th\u1ec3 \u00edt hi\u1ec7u qu\u1ea3 h\u01a1n FOLFOX\/FOLFIRI, nh\u01b0ng ch\u00fang \u00edt \u0111\u1ed9c h\u01a1n.<\/p>\n<h2 style=\"text-align: justify\">Ph\u00e1c \u0111\u1ed3 2 d\u00f9ng trong Ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng di c\u0103n<\/h2>\n<p style=\"text-align: justify\">N\u1ebfu UT\u0110TT ti\u1ebfp t\u1ee5c ti\u1ebfn tri\u1ec3n trong khi h\u00f3a tr\u1ecb, ho\u1eb7c b\u1eaft \u0111\u1ea7u t\u0103ng k\u00edch th\u01b0\u1edbc sau m\u1ed9t th\u1eddi gian \u0111\u00e1p \u1ee9ng v\u1edbi ph\u00e1c \u0111\u1ed3 1, b\u00e1c s\u0129 c\u00f3 th\u1ec3 \u0111\u1ec1 ngh\u1ecb \u0111\u1ed5i sang ph\u00e1c \u0111\u1ed3 k\u1ebft h\u1ee3p c\u00e1c thu\u1ed1c kh\u00e1c, mi\u1ec5n l\u00e0 b\u1ec7nh nh\u00e2n v\u1eabn c\u00f2n kh\u1ecfe m\u1ea1nh \u0111\u1ee7 \u0111\u1ec3 dung n\u1ea1p \u0111i\u1ec1u tr\u1ecb. L\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3 2 th\u01b0\u1eddng ph\u1ee5 thu\u1ed9c v\u00e0o nh\u1eefng thu\u1ed1c \u0111\u00e3 d\u00f9ng tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 t\u00f9y theo \u0111\u1eb7c \u0111i\u1ec3m di truy\u1ec1n c\u1ee7a kh\u1ed1i u. V\u00ed d\u1ee5:<\/p>\n<ul style=\"text-align: justify\">\n<li>N\u1ebfu kh\u1ed1i u <u>kh\u00f4ng c\u00f3 \u0111\u1ed9t bi\u1ebfn<\/u> RAS ho\u1eb7c BRAF V600E, m\u1ed9t trong s\u1ed1 thu\u1ed1c nh\u1eafm \u0111\u00edch nh\u01b0 cetuximab ho\u1eb7c panitumumab c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u1ebft h\u1ee3p v\u00e0o ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb li\u1ec7u \u201cn\u1ec1n t\u1ea3ng\u201d, n\u1ebfu ch\u00fang ch\u01b0a \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf ph\u00e1c \u0111\u1ed3 1.<\/li>\n<li>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n UT\u0110TT thu\u1ed9c nh\u00f3m c\u00f3 &#8220;mismatch repair-deficient&#8221;, c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch (checkpoint inhibitors) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">Vi\u1ec7c \u0111\u01b0\u1ee3c d\u00f9ng <strong>T\u1ea4T C\u1ea2<\/strong> c\u00e1c lo\u1ea1i thu\u1ed1c h\u00f3a tr\u1ecb c\u00f3 s\u1eb5n, t\u1ea1i m\u1ed9t th\u1eddi \u0111i\u1ec3m n\u00e0o \u0111\u00f3 trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb c\u00f3 l\u1ebd l\u00e0 <u>quan tr\u1ecdng h\u01a1n<\/u> vi\u1ec7c d\u00f9ng thu\u1ed1c theo m\u1ed9t th\u1ee9 t\u1ef1 c\u1ee5 th\u1ec3. \u0110\u00f3 l\u00e0 do th\u1eddi gian s\u1ed1ng c\u1ee7a b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u00e9o d\u00e0i b\u1eb1ng c\u00e1c ph\u00e1c \u0111\u1ed3 k\u1ebf ti\u1ebfp.<\/p>\n<h2 style=\"text-align: justify\">T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a c\u00e1c ph\u00e1c \u0111\u1ed3 d\u00f9ng trong Ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng<\/h2>\n<p style=\"text-align: justify\">C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u00f3 th\u1ec3 x\u1ea3y ra t\u00f9y theo lo\u1ea1i thu\u1ed1c, c\u00e1ch k\u1ebft h\u1ee3p v\u00e0 l\u1ecbch tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. T\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a m\u1ed7i lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c li\u1ec7t k\u00ea d\u01b0\u1edbi \u0111\u00e2y, nh\u01b0ng l\u01b0u \u00fd l\u00e0 ch\u00fang c\u00f3 th\u1ec3 kh\u00f4ng x\u1ea3y ra. \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 ph\u1ea3i xem x\u00e9t t\u1ea5t c\u1ea3 c\u00e1c nguy c\u01a1 n\u00e0y v\u00e0 th\u1ea3o lu\u1eadn v\u1edbi b\u00e1c s\u0129 v\u00e0 nh\u00f3m ch\u0103m s\u00f3c v\u1ec1 t\u1eebng lo\u1ea1i thu\u1ed1c \u0111i\u1ec1u tr\u1ecb.<\/p>\n<ul style=\"text-align: justify\">\n<li><strong>FU v\u00e0 leucovorin<\/strong> &#8211; C\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 ti\u00eau ch\u1ea3y, vi\u00eam ni\u00eam m\u1ea1c mi\u1ec7ng (\u0111au nh\u1ee9c trong mi\u1ec7ng) v\u00e0 gi\u1ea3m huy\u1ebft thanh t\u1ea1m th\u1eddi. T\u00e1c d\u1ee5ng ph\u1ee5 (bao g\u1ed3m r\u1ee5ng t\u00f3c) c\u00f3 xu h\u01b0\u1edbng \u00edt x\u1ea3y ra h\u01a1n khi FU \u0111\u01b0\u1ee3c truy\u1ec1n ch\u1eadm su\u1ed1t 46 gi\u1edd thay v\u00ec truy\u1ec1n nhanh ho\u1eb7c ti\u00eam d\u1ea1ng &#8220;bolus&#8221;.<\/li>\n<li><strong>Capecitabine<\/strong> &#8211; T\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 h\u1ed9i ch\u1ee9ng b\u00e0n tay-b\u00e0n ch\u00e2n. Ngo\u00e0i ra, capecitabine c\u00f3 t\u00e1c d\u1ee5ng ph\u1ee5 t\u01b0\u01a1ng t\u1ef1 nh\u01b0 FU ti\u00eam t\u0129nh m\u1ea1ch, m\u1eb7c d\u00f9 ti\u00eau ch\u1ea3y v\u00e0 vi\u00eam ni\u00eam m\u1ea1c \u00edt g\u1eb7p h\u01a1n. T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a capecitabine c\u00f3 th\u1ec3 ph\u1ed5 bi\u1ebfn h\u01a1n khi d\u00f9ng sau c\u00e1c ph\u00e1c \u0111\u1ed3 c\u00f3 FU v\u00e0 leucovorin.<\/li>\n<li><strong>Irinotecan<\/strong> &#8211; Khi d\u00f9ng \u0111\u01a1n \u0111\u1ed9c, irinotecan th\u01b0\u1eddng g\u00e2y ti\u00eau ch\u1ea3y, \u1ee9c ch\u1ebf t\u1ee7y x\u01b0\u01a1ng, m\u1ec7t m\u1ecfi v\u00e0 r\u1ee5ng t\u00f3c nhi\u1ec1u h\u01a1n FU. Khi irinotecan k\u1ebft h\u1ee3p v\u1edbi FU v\u00e0 leucovorin (ph\u00e1c \u0111\u1ed3 FOLFIRI), ph\u1ea3n \u1ee9ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 ti\u00eau ch\u1ea3y. B\u1ec7nh nh\u00e2n n\u00ean g\u1ecdi ngay cho nh\u00e2n vi\u00ean y t\u1ebf n\u1ebfu b\u1ecb ti\u00eau ch\u1ea3y n\u1eb7ng.<\/li>\n<li><strong>Oxaliplatin<\/strong> &#8211; Oxaliplatin c\u00f3 th\u1ec3 g\u00e2y t\u00ea v\u00e0 ng\u1ee9a ran \u1edf b\u00e0n tay v\u00e0 b\u00e0n ch\u00e2n; hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y th\u01b0\u1eddng x\u1ea3y ra khi d\u00f9ng m\u1ed9t th\u1eddi gian d\u00e0i. Thu\u1ed1c c\u0169ng l\u00e0m nh\u1ea1y c\u1ea3m b\u1ea5t th\u01b0\u1eddng v\u1edbi nhi\u1ec7t \u0111\u1ed9 l\u1ea1nh, c\u00f3 th\u1ec3 g\u00e2y c\u1ea3m gi\u00e1c co th\u1eaft \u1edf c\u1ed5 h\u1ecdng khi h\u00edt ph\u1ea3i kh\u00f4ng kh\u00ed l\u1ea1nh ho\u1eb7c \u0103n \u0111\u1ed3 l\u1ea1nh. B\u1ec7nh nh\u00e2n n\u00ean tr\u00e1nh u\u1ed1ng n\u01b0\u1edbc l\u1ea1nh, h\u00edt kh\u00f4ng kh\u00ed l\u1ea1nh, v\u00e0 \u0111\u1ec3 tay v\u00e0 ch\u00e2n l\u1ea1nh trong v\u00e0i ng\u00e0y sau khi truy\u1ec1n oxaliplatin.<\/li>\n<li><strong>Bevacizumab, aflibercept, v\u00e0 ramucirumab<\/strong> &#8211; T\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c n\u00e0y c\u00f9ng g\u00e2y n\u00ean m\u1ed9t s\u1ed1 t\u00e1c d\u1ee5ng ph\u1ee5. V\u00ec ch\u00fang c\u00f3 kh\u1ea3 n\u0103ng l\u00e0m v\u1ebft th\u01b0\u01a1ng ch\u1eadm l\u00e0nh h\u01a1n, n\u00ean tr\u00e1nh ph\u1eabu thu\u1eadt v\u00e0i tu\u1ea7n tr\u01b0\u1edbc v\u00e0 sau khi \u0111i\u1ec1u tr\u1ecb v\u1edbi m\u1ed9t trong c\u00e1c thu\u1ed1c n\u00e0y.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">Bevacizumab, aflibercept v\u00e0 ramucirumab c\u0169ng c\u00f3 th\u1ec3 g\u00e2y xu\u1ea5t huy\u1ebft ti\u00eau h\u00f3a, ho\u1eb7c hi\u1ebfm h\u01a1n l\u00e0 th\u1ee7ng ru\u1ed9t trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb. Ch\u00fang c\u0169ng c\u00f3 th\u1ec3 l\u00e0m t\u0103ng huy\u1ebft \u00e1p ho\u1eb7c g\u00e2y ra protein ni\u1ec7u (c\u00f3 protein trong n\u01b0\u1edbc ti\u1ec3u). B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i ch\u1eb7t ch\u1ebd \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 \u0111i\u1ec1u tr\u1ecb s\u1edbm nh\u1eefng v\u1ea5n \u0111\u1ec1 n\u00e0y.<\/p>\n<p style=\"text-align: justify\">C\u00e1c thu\u1ed1c n\u00e0y c\u0169ng t\u0103ng nguy c\u01a1 h\u00ecnh th\u00e0nh c\u1ee5c huy\u1ebft kh\u1ed1i (m\u00e1u \u0111\u00f4ng), nh\u1ea5t l\u00e0 khi k\u1ebft h\u1ee3p v\u1edbi FU. Kho\u1ea3ng 2-4% b\u1ec7nh nh\u00e2n g\u1eb7p c\u00e1c bi\u1ebfn ch\u1ee9ng nghi\u00eam tr\u1ecdng nh\u01b0 \u0111\u1ed9t qu\u1ef5 v\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim trong khi \u0111i\u1ec1u tr\u1ecb. Nguy c\u01a1 n\u00e0y cao h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 tim t\u1eeb tr\u01b0\u1edbc v\u00e0 \u1edf nh\u1eefng ng\u01b0\u1eddi tr\u00ean 65 tu\u1ed5i. V\u00ec v\u1eady, thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng cho nh\u1eefng ng\u01b0\u1eddi tr\u00ean 65 tu\u1ed5i \u0111\u00e3 t\u1eebng \u0111\u1ed9t qu\u1ef5, thi\u1ebfu m\u00e1u n\u00e3o c\u1ee5c b\u1ed9 tho\u00e1ng qua (TIA) , ho\u1eb7c nh\u1ed3i m\u00e1u c\u01a1 tim trong v\u00f2ng 6-12 th\u00e1ng tr\u01b0\u1edbc \u0111\u00f3.<\/p>\n<ul style=\"text-align: justify\">\n<li><strong>Regorafenib<\/strong> &#8211; Gi\u1ed1ng nh\u01b0 bevacizumab, aflibercept v\u00e0 ramucirumab, regorafenib c\u0169ng nh\u1eafm \u0111\u1ebfn con \u0111\u01b0\u1eddng t\u00edn hi\u1ec7u VEGF v\u00e0 c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5 t\u01b0\u01a1ng t\u1ef1, bao g\u1ed3m ch\u1ea3y m\u00e1u, th\u1ee7ng ru\u1ed9t, v\u00e0 cao huy\u1ebft \u00e1p. Kh\u00f4ng gi\u1ed1ng c\u00e1c thu\u1ed1c tr\u00ean, regorafenib \u0111\u01b0\u1ee3c d\u00f9ng m\u1ed9t m\u00ecnh, kh\u00f4ng k\u1ebft h\u1ee3p c\u00e1c thu\u1ed1c h\u00f3a tr\u1ecb kh\u00e1c. C\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 c\u00f3 th\u1ec3 x\u1ea3y ra l\u00e0 m\u1ec7t m\u1ecfi, ti\u00eau ch\u1ea3y, t\u1ed5n th\u01b0\u01a1ng gan v\u00e0 h\u1ed9i ch\u1ee9ng b\u00e0n tay-b\u00e0n ch\u00e2n.<\/li>\n<li><strong>Cetuximab<\/strong> &#8211; Cetuximab c\u00f3 th\u1ec3 g\u00e2y d\u1ecb \u1ee9ng th\u01b0\u1eddng xuy\u00ean h\u01a1n bevacizumab m\u1ed9t ch\u00fat. N\u1ebfu nghi\u00eam tr\u1ecdng, c\u1ea7n ng\u1eebng d\u00f9ng thu\u1ed1c n\u00e0y. C\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 kh\u00e1c bao g\u1ed3m n\u1ed5i ban tr\u00ean da gi\u1ed1ng m\u1ee5n tr\u1ee9ng c\u00e1, ti\u00eau ch\u1ea3y, b\u1ecb huy\u1ebft kh\u1ed1i \u1edf ch\u00e2n, v\u00e0 h\u1ea1 magi\u00ea (Mg). M\u1ee9c magi\u00ea trong m\u00e1u th\u1ea5p c\u00f3 th\u1ec3 g\u00e2y y\u1ebfu c\u01a1, r\u1ed1i lo\u1ea1n nh\u1ecbp tim, h\u1ea1 kali v\u00e0 h\u1ea1 canxi.<\/li>\n<li><strong>Panitumumab<\/strong> &#8211; Panitumumab c\u0169ng c\u00f3 th\u1ec3 g\u00e2y d\u1ecb \u1ee9ng, nh\u01b0ng nguy c\u01a1 n\u00e0y th\u1ea5p h\u01a1n nhi\u1ec1u so v\u1edbi cetuximab ho\u1eb7c bevacizumab. C\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 kh\u00e1c c\u1ee7a panitumumab c\u0169ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u1ee7a cetuximab.<\/li>\n<li><strong>Trifluridine-tipiracil<\/strong> &#8211; C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 \u1ee9c ch\u1ebf t\u1ee7y x\u01b0\u01a1ng l\u00e0m gi\u1ea3m b\u1ea1ch c\u1ea7u, h\u1ed3ng c\u1ea7u v\u00e0\/ho\u1eb7c ti\u1ec3u c\u1ea7u, m\u1ec7t m\u1ecfi, bu\u1ed3n n\u00f4n, v\u00e0 ti\u00eau ch\u1ea3y. C\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 v\u1ec1 ti\u00eau h\u00f3a l\u00e0 kh\u00e1 ph\u1ed5 bi\u1ebfn nh\u01b0ng th\u01b0\u1eddng kh\u00f4ng nghi\u00eam tr\u1ecdng.<\/li>\n<li><strong>Nivolumab v\u00e0 pembrolizumab<\/strong> &#8211; Thu\u1ed1c \u1ee9c ch\u1ebf ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra kh\u00e1 nhi\u1ec1u c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5, nh\u1ea5t l\u00e0 c\u00e1c b\u1ec7nh\/ph\u1ea3n \u1ee9ng t\u1ef1 mi\u1ec5n trong \u0111\u00f3 h\u1ec7 mi\u1ec5n d\u1ecbch t\u1ea5n c\u00f4ng ch\u00ednh c\u01a1 th\u1ec3 b\u1ec7nh nh\u00e2n. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn m\u1ed9t lo\u1ea1t c\u00e1c ph\u1ea3n \u1ee9ng ph\u1ee5 m\u00e0 \u0111\u00f4i khi (&lt;5% s\u1ed1 ca \u0111i\u1ec1u tr\u1ecb) c\u00f3 th\u1ec3 nghi\u00eam tr\u1ecdng ho\u1eb7c \u0111e d\u1ecda \u0111\u1ebfn t\u00ednh m\u1ea1ng. Nh\u1eefng ph\u1ea3n \u1ee9ng ph\u1ee5 nguy hi\u1ec3m bao g\u1ed3m vi\u00eam ph\u1ed5i, vi\u00eam da, vi\u00eam gan, vi\u00eam th\u1eadn, vi\u00eam ru\u1ed9t v\u00e0 suy gi\u1ea3m ch\u1ee9c n\u0103ng c\u00e1c tuy\u1ebfn n\u1ed9i ti\u1ebft (tuy\u1ebfn y\u00ean, tuy\u1ebfn gi\u00e1p, ho\u1eb7c tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn).<\/li>\n<\/ul>\n<h2 style=\"text-align: justify\">T\u1ea7m quan tr\u1ecdng c\u1ee7a Vitamin D<\/h2>\n<p style=\"text-align: justify\">M\u1ee9c vitamin D\u00a0 th\u1ea5p c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn nh\u1eefng k\u1ebft c\u1ee5c t\u1ed3i t\u1ec7 h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n UT\u0110TT di c\u0103n.\u00a0K\u1ebft qu\u1ea3 c\u1ee7a m\u1ed9t th\u1eed nghi\u1ec7m so s\u00e1nh c\u00e1c ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb h\u00f3a h\u1ecdc kh\u00e1c nhau \u0111\u1ed1i v\u1edbi UT\u0110TT m\u00e3n t\u00ednh cho th\u1ea5y nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 l\u01b0\u1ee3ng vitamin D cao nh\u1ea5t s\u1ed1ng s\u00f3t l\u00e2u h\u01a1n nh\u1eefng ng\u01b0\u1eddi c\u00f3 m\u1ee9c th\u1ea5p nh\u1ea5t [\u00a0<a href=\"https:\/\/www.uptodate.com\/contents\/colorectal-cancer-treatment-metastatic-cancer-beyond-the-basics\/abstract\/7\">7<\/a>\u00a0].\u00a0C\u00e1c l\u1ee3i \u00edch c\u1ee7a vitamin D v\u1ec1 s\u1ee9c kho\u1ebb x\u01b0\u01a1ng v\u00e0 kh\u1ea3 n\u0103ng c\u00f3 k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c \u0111\u1ed9 cao h\u01a1n, c\u00e1c nh\u00e0 cung c\u1ea5p d\u1ecbch v\u1ee5 y t\u1ebf c\u00f3 th\u1ec3 ki\u1ec3m tra n\u1ed3ng \u0111\u1ed9 vitamin D trong huy\u1ebft thanh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n UT\u0110TT m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 cung c\u1ea5p b\u1ed5 sung cho nh\u1eefng ng\u01b0\u1eddi c\u00f3 m\u1ee9c \u0111\u1ed9 th\u1ea5p.<\/p>\n<h2 style=\"text-align: justify\">T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<ol>\n<li style=\"text-align: justify\"><a href=\"https:\/\/www.cancer.net\/cancer-types\/colorectal-cancer\" target=\"_blank\" rel=\"noopener\">https:\/\/www.cancer.net\/cancer-types\/colorectal-cancer<\/a><\/li>\n<li style=\"text-align: justify\"><a href=\"https:\/\/www.nccn.org\/patients\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.nccn.org\/patients\/<\/a><\/li>\n<li style=\"text-align: justify\"><a href=\"https:\/\/www.cancer.gov\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.cancer.gov\/<\/a><\/li>\n<li style=\"text-align: justify\"><a href=\"https:\/\/www.cancer.org\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.cancer.org\/<\/a><\/li>\n<li style=\"text-align: justify\"><a href=\"https:\/\/medlineplus.gov\/healthtopics.html\" target=\"_blank\" rel=\"noopener\">https:\/\/medlineplus.gov\/healthtopics.html<\/a><\/li>\n<li style=\"text-align: justify\"><a href=\"http:\/\/www.gastro.org\/\" target=\"_blank\" rel=\"noopener\">http:\/\/www.gastro.org\/<\/a><\/li>\n<li style=\"text-align: justify\"><a href=\"https:\/\/www.uptodate.com\/contents\/colorectal-cancer-treatment-metastatic-cancer-beyond-the-basics?source=search_result&amp;search=Colon%20cancer%20patient&amp;selectedTitle=3~150\" target=\"_blank\" rel=\"noopener\">https:\/\/www.uptodate.com\/contents\/colorectal-cancer-treatment-metastatic-cancer-beyond-the-basics?source=search_result&amp;search=Colon%20cancer%20patient&amp;selectedTitle=3~150<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>H\u1ea7u h\u1ebft vi\u1ec7c \u0111i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n Ung th\u01b0 \u0111\u1ea1i tr\u1ef1c tr\u00e0ng di c\u0103n, h\u00f3a tr\u1ecb to\u00e0n th\u00e2n l\u00e0 l\u1ef1a ch\u1ecdn th\u00edch h\u1ee3p nh\u1ea5t, \u0111\u00f4i khi c\u00f3 th\u1ec3 c\u1ea3 h\u00f3a tr\u1ecb v\u00e0 ph\u1eabu thu\u1eadt.<\/p>\n","protected":false},"author":108,"featured_media":7807,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2460,2595],"tags":[2713,2714,2598,2715,2712],"series":[1432],"coauthors":[],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.8 - 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