Điều trị hỗ trợ và giảm nhẹ cho ung thư tụy

Der Onkologe - Tập 16 - Trang 595-603 - 2010
H. Oettle1, U. Pelzer1, J. Stieler1, H. Riess1
1Zentrum für Tumormedizin – Medizinische Klinik m. S. Hämatologie und Onkologie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Deutschland

Tóm tắt

Phương pháp điều trị duy nhất có khả năng chữa khỏi cho ung thư tụy là cắt bỏ hoàn toàn (R0), tuy nhiên, khi chẩn đoán, chỉ tối đa 20% bệnh nhân có thể phẫu thuật. Tỷ lệ tử vong do phẫu thuật tại các trung tâm phẫu thuật chuyên khoa là rất thấp; tuy nhiên, phần lớn bệnh nhân vẫn gặp phải tái phát ngay cả sau khi cắt bỏ hoàn toàn và qua đời vì bệnh. Thời gian sống trung bình sau phẫu thuật dao động từ 11 đến 23 tháng, trong khi tỷ lệ sống sau năm năm của bệnh nhân đã phẫu thuật dao động từ 10 đến 25%. Dựa trên dữ liệu hiện tại, việc thực hiện hóa trị hỗ trợ ngày càng được chấp nhận. Các kết quả khả quan từ hai nghiên cứu sử dụng Gemcitabin đã cho thấy rằng có một cơ sở dữ liệu ổn định cho điều trị hỗ trợ. Tại Hoa Kỳ, liệu pháp xạ trị hóa trị với 5-Fluorouracil đã được khuyến nghị là liệu pháp tiêu chuẩn hỗ trợ có thể áp dụng, dựa trên kết quả của một nghiên cứu ngẫu nhiên từ Nhóm Nghiên cứu U quý tại đường tiêu hóa (GITSG). Tại châu Âu, liệu pháp xạ trị hóa trị thường không được sử dụng. Sự khác biệt này xuất phát từ những mâu thuẫn trong các nghiên cứu đã công bố, một phần do kích thước mẫu tương đối nhỏ và thiếu sót phương pháp. Liệu pháp với Gemcitabin đã trở thành điều trị tiêu chuẩn trong tình huống bệnh lý giảm nhẹ kể từ hơn 10 năm sau khi loại thuốc này được giới thiệu. Việc bổ sung Tyrosinkinaseinhibitor Erlotinib cho những bệnh nhân có phản ứng trên da mang lại lợi ích sống đáng kể. Những bệnh nhân có tình trạng chung tốt có thể được tiến hành phác đồ điều trị tích cực kết hợp, vì trong các nhóm phụ của các nghiên cứu cụ thể có lợi ích sống được thể hiện.

Từ khóa

#ung thư tụy #điều trị hỗ trợ #Gemcitabin #hóa trị liệu #xạ trị #điều trị giảm nhẹ

Tài liệu tham khảo

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