Types/brain/patient/child-glioma-treatment-pdq

Ukwelashwa kwe-Childhood Brain Stem Glioma Treatment (®) -Patient Version

Imininingwane ejwayelekile Mayelana Ne-Brain Stem Glioma

AMAPHUZU ASEMQOKA

• Ubuchopho bobuntwana be-stem glioma yisifo lapho amangqamuzana anobungozi (noncancer) noma amabi (umdlavuza) akha izicubu zomuthi wobuchopho.

• Kunezinhlobo ezimbili zama-gliomas stem stem ezinganeni.

• Imbangela yamathumba amaningi obuchopho ebuntwaneni ayaziwa.

• Izimpawu nezimpawu zobuchopho ze-glioma azifani kuyo yonke ingane.

• Ukuhlolwa okuhlola ubuchopho kusetshenziselwa ukuthola (ukuthola) ubuchopho bobuntwana be-stem glioma.

• I-biopsy ingenziwa ukuthola izinhlobo ezithile ze-brain stem glioma.

• Izici ezithile zithinta ukubikezela (ithuba lokululama).

Ubuchopho bobuntwana be-stem glioma yisifo lapho amangqamuzana anobungozi (noncancer) noma amabi (umdlavuza) akha izicubu zomuthi wobuchopho.

Ama-gliomas yizicubu ezakhiwa ngamaseli we-glial. Amaseli we-glial ebuchosheni abamba amangqamuzana ezinzwa endaweni yawo, aletha ukudla ne-oxygen kumaseli ezinzwa, futhi asize ukuvikela amangqamuzana ezinzwa ezifweni, njengokutheleleka. Ku-brain stem glioma, amaseli we-glial esiqwini sobuchopho ayathinteka.

Isiqu sobuchopho sakhiwa i-midbrain, i-pons, ne-medulla. Ingxenye ephansi kunazo zonke zobuchopho futhi ixhuma entanjeni yomgogodla, ngenhla nje ngemuva kwentamo. Isiqu sobuchopho silawula imisebenzi ebalulekile njengokuphefumula, ukushaya kwenhliziyo, nomfutho wegazi, nezinzwa nemisipha esetshenziselwa ukubona, ukuzwa, ukuhamba, ukukhuluma nokudla.

Iningi lama-brain stem stem ama-gliomas asakazeka ngaphakathi kwi-pontine gliomas (DIPG), akha emapon. Ama-gliomas agxile kwezinye izingxenye zobuchopho.

I-anatomy yobuchopho. Indawo ye-supratentorial (ingxenye ephezulu yobuchopho) iqukethe i-cerebrum, i-lateral ventricle ne-ventricle yesithathu (ene-cerebrospinal fluid ekhonjiswe ku-blue), i-choroid plexus, i-pineal gland, i-hypothalamus, i-pituitary gland, ne-optic nerve. Indawo engemuva kwe-fossa / infratentorial (ingxenye engezansi engemuva yobuchopho) iqukethe i-cerebellum, i-tectum, i-ventricle yesine, kanye nesiqu sobuchopho (i-midbrain, i-pons, ne-medulla). I-tentorium ihlukanisa i-supratentorium ne-infratentorium (iphaneli yesokudla). Ugebhezi namamenyu kuvikela ubuchopho nomgogodla (iphaneli engakwesobunxele).

Izicubu zobuchopho ziluhlobo lwesibili lomdlavuza olujwayelekile ezinganeni.

Lesi sifinyezo simayelana nokwelashwa kwezicubu eziyinhloko zobuchopho (izicubu eziqala ebuchosheni). Ukwelashwa kwezimila zobuchopho ze-metastatic, okuyizicubu ezakhiwa amangqamuzana omdlavuza aqala kwezinye izingxenye zomzimba futhi asabalale aye ebuchosheni, akuxoxwa ngakho kulesi sifinyeto.

Izicubu zobuchopho zingenzeka ezinganeni nakubantu abadala; kodwa-ke, ukwelashwa kwezingane kungahluka kunokwelashwa kwabantu abadala. Ngemininingwane yokwelashwa kwezimila zobuchopho kubantu abadala, bheka isifinyezo se- Adult Central Nervous System Tumors Treatment.

Kunezinhlobo ezimbili zama-gliomas stem stem ezinganeni.

Noma i-DIPG nobuchopho obugxile ekugxileni i-glioma kwifomu efanayo yeseli, benza ngokuhlukile:

• I-DIPG . I-DIPG iyisimila esikhula ngokushesha esakha emaphoyiseni. I-DIPG kunzima ukuyelapha futhi inezibikezelo ezimbi (ithuba lokululama) ngenxa yalokhu okulandelayo:

• Akusona isimila esichazwe kahle futhi sisakazeka phakathi kwamaseli aphilile esiqwini sobuchopho.

• Imisebenzi ebalulekile, njengokuphefumula nokushaya kwenhliziyo, kungathinteka.

• Ubuchopho obugqamile buphuma i-glioma. I-focal glioma iyisigaxa esikhula kancane esakha ngaphandle kwamaphononi nasendaweni eyodwa kuphela esiqwini sobuchopho. Kulula ukwelashwa futhi kunesibikezelo esingcono kune-DIPG.

Imbangela yamathumba amaningi obuchopho ebuntwaneni ayaziwa.

Noma yini enyusa ubungozi bokuthola isifo ibizwa ngokuthi ingozi. Ukuba nengcuphe akusho ukuthi uzothola umdlavuza; ukungabi nezici zobungozi akusho ukuthi ngeke uthole umdlavuza. Khuluma nodokotela wengane yakho uma ucabanga ukuthi ingane yakho ingaba sengcupheni. Izici ezinobungozi ezingaba khona ze-brain stem glioma zifaka:

• Ukuba nezinkinga ezithile zofuzo, ezinjenge-neurofibromatosis type 1 (NF1).

Izimpawu nezimpawu zobuchopho ze-glioma azifani kuyo yonke ingane.

Izimpawu nezimpawu zincike kokulandelayo:

• Lapho okuvela khona isimila ebuchosheni.

• Usayizi wesimila nokuthi ngabe usakazeke yini ebuchosheni.

• Sikhula ngokushesha kangakanani isimila.

• Iminyaka yengane nesigaba sokukhula.

Izimpawu nezimpawu zingabangelwa ubuchopho bengane obuyi-gliomas noma ngezinye izimo. Buza kudokotela wengane yakho uma ingane yakho inokunye kwalokhu okulandelayo:

• Inkinga ngokuhamba kwamehlo (iso liphendukele ngaphakathi).

• Izinkinga zombono.

• Ukuphathwa ikhanda ekuseni noma ikhanda elihamba ngemuva kokuhlanza.

• Isicanucanu nokuhlanza.

• Ukulala okungavamile.

• Ukulahleka kwekhono lokuhambisa uhlangothi lobuso noma lomzimba.

• Ukulahlekelwa ibhalansi nenkinga yokuhamba.

• Amandla amaningi noma amancane kunokujwayelekile.

• Izinguquko ekuziphatheni.

• Inkinga yokufunda esikoleni.

Ukuhlolwa okuhlola ubuchopho kusetshenziselwa ukuthola (ukuthola) ubuchopho bobuntwana be-stem glioma.

Lezi zivivinyo nezinqubo ezilandelayo zingasetshenziswa:

• Ukuhlolwa komzimba kanye nomlando wezempilo: Ukuhlolwa komzimba ukuhlola izimpawu ezijwayelekile zempilo, kufaka phakathi nokuhlola izimpawu zezifo, njengezigaxa noma yini enye ebonakala ingajwayelekile. Kuzothathwa nomlando wemikhuba yezempilo yesiguli kanye nokugula nokwelashwa kwangaphambilini.

• Ukuhlolwa kwe-Neurological: Uchungechunge lwemibuzo novivinyo lokuhlola ubuchopho, umgogodla nokusebenza kwe-nerve. Isivivinyo sihlola isimo somuntu somqondo, ukusebenzisana, kanye nekhono lokuhamba ngokujwayelekile, nokuthi izicubu, izinzwa, nokucabanga kusebenza kahle kangakanani. Lokhu kungabizwa nangokuthi ukuhlolwa kwe-neuro noma ukuhlolwa kwe-neurologic.

• I-MRI (imaging resonance imaging) ene-gadolinium: Inqubo esebenzisa uzibuthe, amagagasi omsakazo, nekhompyutha ukwenza uchungechunge lwezithombe ezinemininingwane yezindawo ezingaphakathi kobuchopho. Into ebizwa ngokuthi i-gadolinium ijojowe emthanjeni. I-gadolinium iqoqa izungeze amangqamuzana omdlavuza ukuze akhanye ngokugqamile esithombeni. Le nqubo ibizwa nangokuthi i-nuclear magnetic resonance imaging (i-NMRI).

I-biopsy ingenziwa ukuthola izinhlobo ezithile ze-brain stem glioma.

Uma ukuskena kwe-MRI kubukeka sengathi isimila kuyi-DIPG, i-biopsy imvamisa ayinakwenziwa futhi isimila asisuswa. Lapho imiphumela yokuskena kwe-MRI ingaqinisekile, kungenziwa i-biopsy.

Uma ukuskena kwe-MRI kubukeka njenge-focal brain stem glioma, kungenziwa i-biopsy. Ingxenye yogebhezi iyasuswa bese kusetshenziswa inaliti ukukhipha isampula lezicubu zobuchopho. Kwesinye isikhathi, inaliti iqondiswa ikhompyutha. Isazi sezifo sibheka izicubu ngaphansi kwesibonakhulu ukubheka amangqamuzana omdlavuza. Uma kutholakala amangqamuzana omdlavuza, udokotela uzosusa isimila esiningi ngangokunokwenzeka ngesikhathi sokuhlinzwa okufanayo.

I-Craniotomy: Kuvulwa imbobo kugebhezi bese kukhishwa ucezu logebhezi ukukhombisa ingxenye yobuchopho.

Ukuhlolwa okulandelayo kungenziwa kusampula yezicubu esuswe ngesikhathi sokuhlinzwa noma sokuhlinzwa:

• I-Immunohistochemistry: Isivivinyo selabhorethri esisebenzisa amasosha omzimba ukubheka ama-antigen (amakaki) athile kusampula yezicubu zesiguli. Amasosha omzimba avamise ukuhlanganiswa ne-enzyme noma udayi we-fluorescent. Ngemuva kokuthi ama-antibody abophele kwi-antigen ethile kusampula yezicubu, i-enzyme noma idayi iyasebenza, bese kuthi i-antigen ibonakale ngaphansi kwesibonakhulu. Lolu hlobo lokuhlola lusetshenziselwa ukuxilonga umdlavuza nokusiza ukutshela uhlobo oluthile lomdlavuza kolunye uhlobo lomdlavuza.

Izici ezithile zithinta ukubikezela (ithuba lokululama).

Isibikezelo sengane sincike kulokhu okulandelayo:

• Uhlobo lwe-brain stem glioma (i-DIPG noma i-focal glioma).

• Lapho kutholakala khona isimila ebuchosheni futhi uma sisabalale ngaphakathi kwesiqu sobuchopho.

• Iminyaka yengane etholwayo.

• Ingane inezimpawu ezingakanani ngaphambi kokuxilongwa.

• Ukuthi ingane inesimo esibizwa ngokuthi yi-neurofibromatosis type 1 noma cha.

• Noma ngabe kukhona ushintsho oluthile kuhlobo lwe-H3 K27m.

• Ukuthi isimila sisanda kutholakala yini noma sesiphindile (buyela emuva).

Iningi lezingane ezine-DIPG zihlala ngaphansi kwezinyanga eziyi-18 ngemuva kokuxilongwa. Izingane ezine-focal glioma zivame ukuhlala isikhathi eside kuneminyaka emi-5.

Izigaba ze-Childhood Brain Stem Glioma

AMAPHUZU ASEMQOKA

• Uhlelo lokwelashwa komdlavuza luxhomeke ekutheni ngabe isimila sisendaweni eyodwa yobuchopho noma sesisabalele bonke ubuchopho.

Uhlelo lokwelashwa komdlavuza luxhomeke ekutheni ngabe isimila sisendaweni eyodwa yobuchopho noma sesisabalele bonke ubuchopho.

Isiteji inqubo esetshenziswayo ukuthola ukuthi mningi kangakanani umdlavuza nokuthi umdlavuza ususabalele yini. Kubalulekile ukwazi isigaba ukuze uhlele ukwelashwa.

Akunasistimu ejwayelekile yokubeka ubuchopho ebuntwaneni i-glioma. Ukwelashwa kusekelwe kokulandelayo:

• Ukuthi isimila sisanda kutholakala yini noma siyaphindeka (sibuya emuva kokwelashwa).

• Uhlobo lwesimila (kungaba yi-pontine glioma noma i-focal glioma).

I-focal brain stem glioma ingahle ibuye emuva kweminyaka eminingi ilashwa okokuqala. Isimila singabuya ebuchosheni noma kwezinye izingxenye zesistimu yezinzwa emaphakathi. Ngaphambi kokunikezwa ukwelashwa komdlavuza, ukuhlolwa kwe-imaging, i-biopsy, noma ukuhlinzwa kungenziwa ukuze kuqinisekiswe ukuthi kunomdlavuza futhi kutholakale ukuthi ungakanani umdlavuza onawo.

Uhlolojikelele lwenketho yokwelashwa

AMAPHUZU ASEMQOKA

• Kunezinhlobo ezahlukahlukene zokwelashwa kwezingane ezine-brain stem glioma.

• Izingane ezine-brain stem glioma kufanele zihlelelwe ukwelashwa kwazo yiqembu labahlinzeki bezempilo abangongoti ekwelapheni

izimila zobuchopho ebuntwaneni.

• Izinhlobo ezinhlanu zokwelashwa okujwayelekile zisetshenzisiwe:

• Ukuhlinzwa

• Ukwelashwa ngemisebe

• Ukwelashwa ngamakhemikhali

• Ukuphambukisa uketshezi lweCerebrospinal

• Ukuqaphela

• Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

• Ukwelashwa okuhlosiwe

• Ukwelashwa kwe-stem yobuchopho bobuntwana kungadala imiphumela emibi.

• Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

• Iziguli zingangena ezivivinyweni zokwelashwa ngaphambi, ngesikhathi, noma ngemuva kokuqala ukwelashwa kwazo komdlavuza.

• Ukuhlolwa kokulandelela kungadingeka.

Kunezinhlobo ezahlukahlukene zokwelashwa kwezingane ezine-brain stem glioma.

Izinhlobo ezahlukene zokwelashwa ziyatholakala ezinganeni ezine-brain stem glioma. Ezinye izindlela zokwelapha zijwayelekile (indlela esetshenziswa njengamanje), kanti ezinye ziyahlolwa ezivivinyweni zokwelashwa. Isivivinyo somtholampilo wokwelashwa isifundo socwaningo esihloselwe ukusiza ukuthuthukisa ukwelashwa kwamanje noma ukuthola ulwazi ngezindlela zokwelashwa ezintsha zeziguli ezinomdlavuza. Lapho izivivinyo zokwelashwa zibonisa ukuthi ukwelashwa okusha kungcono kunokwelashwa okujwayelekile, ukwelashwa okusha kungaba ukwelashwa okujwayelekile.

Ngoba umdlavuza ezinganeni uyivelakancane, ukubamba iqhaza esivivinyweni somtholampilo kufanele kubhekwe. Ezinye izivivinyo zokwelashwa zivulekele kuphela iziguli ezingakaqali ukwelashwa.

Izingane ezine-brain stem glioma kufanele zihlelelwe ukwelashwa kwazo yiqembu labahlinzeki bezempilo abangongoti ekwelapheni izicubu zobuchopho ezinganeni.

Ukwelashwa kuzobhekwa ngudokotela wezingane oncologist, udokotela ogxile ekwelapheni izingane ezinomdlavuza. I-oncologist yezingane isebenza nabanye abahlinzeki bezokunakekelwa kwempilo yezingane abangongoti ekwelapheni izingane ezinamathumba obuchopho futhi abagxile ezindaweni ezithile zemithi. Lokhu kungafaka ongoti abalandelayo:

• Udokotela wezingane.

• I-Neurosurgeon.

• Isazi se-Neuropathologist.

• I-oncologist yemisebe yezingane.

• Neuro-oncologist.

• Isazi sezinzwa.

• Isazi se-Neuroradiologist.

• Isazi se-endocrinologist.

• Isazi sokusebenza kwengqondo.

• Uchwepheshe wokuvuselelwa.

• Usonhlala kahle.

• Ingcweti kwezempilo yengane.

Izinhlobo ezinhlanu zokwelashwa okujwayelekile zisetshenzisiwe:

Ukuhlinzwa

I-Biopsy noma ukuhlinzwa ukususa i-DIPG akuvamile ukwenziwa ngenxa yalokhu okulandelayo:

• I-DIPG ayisona isisindo esisodwa. Isakazeka phakathi kwamaseli obuchopho anempilo esiqwini sobuchopho.

• Imisebenzi ebalulekile, njengokuphefumula nokushaya kwenhliziyo kungathinteka.

I-biopsy yokuxilonga noma yokuhlinza ukususa isimila ingasetshenziselwa ubuchopho obugxile ebuntwaneni obuyi-glioma.

Ukwelashwa ngemisebe

Ukwelashwa ngemisebe ukwelashwa komdlavuza okusebenzisa amandla amakhulu ama-x-ray noma ezinye izinhlobo zemisebe ukubulala amangqamuzana omdlavuza noma ukuwagcina ekukhuleni. Kunezinhlobo ezimbili zokwelashwa ngemisebe:

• Ukwelashwa kwemisebe kwangaphandle kusebenzisa umshini ongaphandle komzimba ukuthumela imisebe ebheke emdlavuzeni.

• Ukwelashwa kwemisebe kwangaphakathi kusebenzisa into enemisebe eboshwe ngezinaliti, izimbewu, izintambo, noma ama-catheters abekwe ngqo noma eduze komdlavuza.

Indlela yokwelashwa ngemisebe enikezwa ngayo incike ohlotsheni lomdlavuza olashwa. Ukwelashwa kwemisebe yangaphandle kusetshenziselwa ukwelapha i-DIPG. Ukwelashwa kwemisebe yangaphandle kanye / noma kwangaphakathi kungasetshenziselwa ukwelapha i-focal brain stem gliomas.

Ezinyangeni ezimbalwa ngemuva kokwelashwa ngemisebe ebuchosheni, ukuhlolwa kwe-imaging kungakhombisa ushintsho kwezicubu zobuchopho. Lezi zinguquko zingabangelwa ukwelashwa ngemisebe noma kungasho ukuthi isimila siyakhula. Kubalulekile ukuthi uqiniseke ukuthi isimila siyakhula ngaphambi kokuba kunikezwe eminye imishanguzo.

Ukwelashwa ngamakhemikhali

I-Chemotherapy yindlela yokwelapha umdlavuza esebenzisa izidakamizwa ukuvimba ukukhula kwamangqamuzana omdlavuza, kungaba ngokubulala amaseli noma ngokuwavimba ekuhlukaniseni. Lapho i-chemotherapy ithathwa ngomlomo noma ifakwa emthanjeni noma emisipheni, izidakamizwa zingena egazini futhi zingafinyelela kumaseli womdlavuza emzimbeni wonke (systemic chemotherapy). Lapho i-chemotherapy ifakwa ngqo ku-cerebrospinal fluid, isitho, noma umgodi womzimba njengesisu, izidakamizwa zithinta kakhulu amangqamuzana omdlavuza kulezo zindawo (i-chemotherapy yesifunda). Indlela i-chemotherapy enikezwa ngayo incike ohlotsheni lomdlavuza owelashwa.

Ngoba ukwelashwa ngemisebe ebuchosheni kungathinta ukukhula nokukhula kobuchopho ezinganeni ezincane, i-chemotherapy inganikezwa ukubambezela noma ukunciphisa isidingo sokwelapha ngemisebe.

Ukuphambukisa uketshezi lweCerebrospinal

Ukuphambukiswa kweCerebrospinal fluid kuyindlela esetshenziselwa ukukhipha uketshezi olwakhiwe ebuchosheni. I-shunt (ithubhu ende, ezacile) ibekwa ku-ventricle (isikhala esigcwele uketshezi) ebuchosheni bese ifakwa ngaphansi kwesikhumba kwenye ingxenye yomzimba, imvamisa isisu. I-shunt ithwala uketshezi oluthe xaxa ukusuka ebuchosheni ngakho-ke ingangena kwenye indawo emzimbeni.

Ukuphambukiswa kweCerebrospinal fluid (CSF). I-CSF eyengeziwe isuswa kwi-ventricle ebuchosheni nge-shunt (ithubhu) futhi ithululelwa esiswini. I-valve ilawula ukuhamba kwe-CSF.

Ukuqaphela

Ukuqaphelisisa kusibhekisisa isimo sesiguli ngaphandle kokunikeza ukwelashwa kuze kuvele izimpawu noma izimpawu noma ushintsho.

Izinhlobo ezintsha zokwelashwa ziyahlolwa ezivivinyweni zokwelashwa.

Lesi sigaba esifingqiwe sichaza izindlela zokwelashwa ezicwaningwa ekuhlolweni kwemitholampilo. Kungenzeka kungasho yonke imishanguzo emisha efundwayo. Imininingwane mayelana nokuhlolwa kwemitholampilo iyatholakala kuwebhusayithi ye-NCI.

Ukwelashwa okuhlosiwe

Ukwelashwa okuhlosiwe uhlobo lokwelashwa olusebenzisa izidakamizwa noma ezinye izinto ukukhomba nokuhlasela amangqamuzana omdlavuza athile ngaphandle kokulimaza amaseli ajwayelekile.

Kunezinhlobo ezahlukahlukene zokwelashwa okuqondisiwe okufundwayo ekwelapheni ama-gliomas obuchopho obuthambile:

• Ukwelashwa kwe-Kinase inhibitor kuvimba amaprotheni athile, njenge-BRAF noma i-MEK, engasiza ukugcina amangqamuzana omdlavuza ukuthi angakhuli noma ahlukane. I-Dabrafenib (i-BRAF kinase inhibitor) ne-trametinib (i-MEK kinase inhibitor) ifundelwa ukwelapha i-focal glioma kanye nobuchopho obuphindiwe be-stem glioma.

• Ukwelashwa kwe-Histone deacetylase inhibitor (HDI) kungamisa ukukhula kwamangqamuzana wesimila ngokuvimba amanye ama-enzyme adingekayo ekukhuleni kwamaseli. Kubuye futhi uhlobo lwe-angiogenesis agent. IPanobinostat ifundelwa ekwelapheni i-DIPG engaphendulanga ekwelashweni noma ekuphindeni ibuye.

• I-monoclonal antibody therapy isebenzisa amasosha omzimba enziwe elebhu evela ohlotsheni olulodwa lwamaseli omzimba. La ma-antibody angakhomba izinto kumaseli womdlavuza noma ezintweni ezijwayelekile ezingasiza amangqamuzana omdlavuza ukuthi akhule. Amasosha omzimba anamathela ezintweni futhi abulale amangqamuzana omdlavuza, avimbe ukukhula kwawo, noma awagcine ekusakazekeni.

I-anti-monoclonal antibody, i-APX005M, ibophela kwi-CD40, i-receptor surface cell etholakala kumaseli athile omzimba namaseli athile womdlavuza. Ingalwa nomdlavuza ngokukhulisa amasosha omzimba nangokunciphisa ukukhula komdlavuza womdlavuza. Kufundwa ekwelapheni izicubu zobuchopho bezingane ezikhulayo, ezisakazekayo, noma eziya ngokuya ziba zimbi (eziqhubekayo), noma kwi-DIPG esanda kutholakala.

Ukwelashwa kwe-stem yobuchopho bobuntwana kungadala imiphumela emibi.

Ngemininingwane ngemiphumela emibi eqala ukwelashwa komdlavuza, bheka ikhasi lethu le-Side Effects.

Imiphumela emibi yokwelashwa komdlavuza eqala ngemuva kokwelashwa futhi iqhubeke izinyanga noma iminyaka ibizwa ngemiphumela ephuzile. Imiphumela yamuva ingafaka okulandelayo:

• Izinkinga zomzimba.

• Izinguquko zemizwa, imizwa, ukucabanga, ukufunda, noma inkumbulo.

• Umdlavuza wesibili (izinhlobo ezintsha zomdlavuza).

Eminye imiphumela yesikhashana ingalashwa noma ilawulwe. Kubalulekile ukukhuluma nodokotela bengane yakho ngemiphumela yokwelashwa komdlavuza engaba nayo enganeni yakho. (Bheka isifinyezo se- ngemiphumela yamuva yokwelashwa komdlavuza wezingane ukuthola eminye imininingwane).

Iziguli zingafuna ukucabanga ngokubamba iqhaza esivivinyweni somtholampilo.

Imininingwane mayelana nokuhlolwa kwemitholampilo iyatholakala kuwebhusayithi ye-NCI.

Kwezinye iziguli, ukubamba iqhaza esivivinyweni somtholampilo kungaba yindlela engcono kakhulu yokwelashwa. Ukuhlolwa kwemitholampilo kuyingxenye yenqubo yocwaningo lomdlavuza. Ukuhlolwa komtholampilo kuyenziwa ukuthola ukuthi ngabe ukwelashwa komdlavuza okusha kuphephile futhi kuyasebenza yini noma kungcono kunokwelashwa okujwayelekile.

Eziningi zezindlela zokwelashwa ezijwayelekile zomdlavuza zisuselwa ekuhlolweni kokuqala komtholampilo. Iziguli ezibamba iqhaza esivivinyweni somtholampilo zingathola ukwelashwa okujwayelekile noma zibe phakathi kwabokuqala ukuthola ukwelashwa okusha.

Iziguli ezibamba iqhaza ezivivinyweni zokwelashwa zisiza nokwenza ngcono indlela umdlavuza ozophathwa ngayo ngokuzayo. Noma izilingo zomtholampilo zingaholeli ekwelashweni okusha okusebenzayo, zivame ukuphendula imibuzo ebalulekile futhi zisize ukuqhubela phambili ucwaningo.

Iziguli zingangena ezivivinyweni zokwelashwa ngaphambi, ngesikhathi, noma ngemuva kokuqala ukwelashwa kwazo komdlavuza.

Ezinye izivivinyo zokwelashwa zifaka kuphela iziguli ezingakatholi ukwelashwa. Ezinye izilingo zivivinya ukwelashwa kweziguli ezinomdlavuza ongakabi ngcono. Kukhona nokuhlolwa komtholampilo okuhlola izindlela ezintsha zokunqanda umdlavuza ukuthi ungaphindi (ubuye) noma kunciphise imiphumela emibi yokwelashwa komdlavuza.

Ukuhlolwa kwemitholampilo kuyenzeka ezingxenyeni eziningi zezwe. Imininingwane mayelana nokuhlolwa kwemitholampilo esekelwa yi-NCI ingatholakala ekhasini lewebhu le-NCI lokuhlolwa kokuhlolwa kwemitholampilo. Izivivinyo zomtholampilo ezisekelwa ezinye izinhlangano zingatholakala kuwebhusayithi yeClinicalTrials.gov.

Ukuhlolwa kokulandelela kungadingeka.

Olunye uvivinyo olwenziwe ukuxilonga umdlavuza noma ukuthola isigaba somdlavuza lungaphindwa. Olunye uvivinyo luzophindwa ukuze kubonakale ukuthi umuthi usebenza kanjani. Izinqumo mayelana nokuthi uqhubeke, ushintshe, noma umise ukwelashwa zingasuselwa emiphumeleni yalezi zivivinyo.

Ezinye zezivivinyo zizoqhubeka ukwenziwa ngezikhathi ezithile ngemuva kokuphela kokwelashwa. Imiphumela yalezi zivivinyo ingakhombisa ukuthi ngabe isimo sengane yakho sishintshile noma uma umdlavuza ubuyile (buyela emuva). Lezi zivivinyo kwesinye isikhathi zibizwa ngokuthi izivivinyo zokulandelela noma ukuhlolwa.

Uma imiphumela yokuhlolwa kwe-imaging eyenziwe ngemuva kokwelashwa kwe-DIPG ikhombisa isisindo ebuchosheni, i-biopsy ingenziwa ukuthola ukuthi ngabe yakhiwe ngamangqamuzana ama-tumor afile noma uma amaseli omdlavuza amasha ekhula. Ezinganeni okulindeleke ukuthi ziphile isikhathi eside, ama-MRIs ajwayelekile angenziwa ukubona ukuthi umdlavuza ubuyile yini.

Ukwelashwa kwe-DIPG

Ngemininingwane mayelana nokwelashwa okubalwe ngezansi, bheka isigaba se-Treatment Option Overview section.

Ubuntwana obusanda kutholakala obusakazeka ebuchosheni be-stem glioma (i-DIPG) yisisu okunganikwanga ukwelashwa ngaso. Ingane kungenzeka ukuthi ithole izidakamizwa noma ukwelashwa ukukhulula izimpawu noma izimpawu ezibangelwa isimila.

Ukwelashwa okujwayelekile kwe-DIPG kungafaka okulandelayo:

• Ukwelashwa kwemisebe yangaphandle.

• I-Chemotherapy (ezinganeni).

• Isivivinyo somtholampilo sokwelapha okusha.

Ukwelashwa kwe-Focal Brain Stem Glioma

I-glioma egxile ebuntwaneni esanda kutholakala iyisilonda okunganikwanga ukwelashwa ngaso. Ingane kungenzeka ukuthi ithole izidakamizwa noma ukwelashwa ukukhulula izimpawu noma izimpawu ezibangelwa isimila.

Ukwelashwa kwe-focal glioma kungafaka okulandelayo:

• Ukuhlinzwa okususa isimila kungalandelwa ukwelashwa ngamakhemikhali kanye / noma ukwelashwa ngemisebe yangaphandle.

• Ukuqaphela izicubu ezincane ezikhula kancane. Ukuphambukiswa kwe-Cerebrospinal fluid kungenziwa uma kukhona uketshezi oluthe xaxa ebuchosheni.

• Ukwelashwa kwemisebe yangaphakathi ngembewu enemisebe, noma nge-chemotherapy noma ngaphandle kwayo, lapho isimila singeke sisuswe ngokuhlinzwa.

• Isivivinyo somtholampilo sokwelapha okuhlosiwe nge-BRAF kinase inhibitor (dabrafenib) kuhlanganiswe ne-MEK inhibitor (trametinib), yamathumba athile angenakususwa ngokuhlinzwa.

Ukwelashwa kwe-stem stem yeglioma ezinganeni ezine-neurofibromatosis type 1 kungaba ukubonwa. Izimila zikhula kancane kulezi zingane futhi kungenzeka zingadingi ukwelashwa okuqondile iminyaka.

Ukwelashwa kwe-Brain Stem Glioma eqhubekayo noma ephindaphindekayo

Lapho umdlavuza ungabi ngcono ngokwelashwa noma ubuya, ukunakekelwa okunciphisayo kuyingxenye ebalulekile yohlelo lokwelashwa kwengane. Kubandakanya ukusekelwa kwengane nomndeni ngokomzimba, ngokwengqondo, ngokwenhlalo nangokomoya. Umgomo wokunakekelwa okunciphisayo ukusiza ukulawula izimpawu nokunikeza ingane ikhwalithi engcono kakhulu yokuphila. Abazali bangahle bangaqiniseki ngokuthi baqhubeke nokwelashwa yini noma yiluphi uhlobo lwezokwelapha olungcono kakhulu ezinganeni zabo. Ithimba lezokunakekelwa kwempilo linganika abazali imininingwane yokubasiza benze lezi zinqumo.

Ukwelashwa ngemisebe eminingi kunganikezwa izingane ezine-pontine glioma (DIPG) yangaphakathi eqhubekayo noma ephindaphindayo ephendulile lapho iphathwa okokuqala ngemithi yokwelashwa ngemisebe. Ukwelashwa kwe-DIPG eqhubekayo noma ephindaphindwayo kungafaka futhi okulandelayo:

• Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

• Isivivinyo somtholampilo sokwelapha okuqondisiwe nge-histone deacetylase inhibitor (panobinostat) noma i-anti-monoclonal antibody (APX005M).

Ukwelashwa kwe-glioma yobuchopho obugxile ebuntwaneni obujwayelekile kungafaka okulandelayo:

• Ukuhlinzwa kwesibili ukukhipha isimila.

• Ukwelashwa kwemisebe yangaphandle.

• Ukwelashwa ngamakhemikhali.

• Isivivinyo somtholampilo esihlola isampula lesimila sesiguli ukuthola izinguquko ezithile zofuzo. Uhlobo lokwelashwa okuqondisiwe oluzonikezwa isiguli kuncike ohlotsheni lokushintsha kofuzo.

Ukufunda Okwengeziwe Ngamathumba Engqondo Ebuntwaneni

Ukuthola eminye imininingwane ngamathumba obuchopho bengane, bheka okulandelayo:

• I-Pediatric Brain Tumor Consortium (PBTC) Phuma Disclaimer

• Ukuxhumana ekunakekelweni komdlavuza

• Ukuhlela i-Transition to End-of-Life Care ku-Cancer Ethuthukile

• Ukunakekelwa Kwezingane Okusekelayo (Ukuphela Kokunakekelwa Kwempilo)

Ngemininingwane eminingi yomdlavuza wezingane nezinye izinsiza zomdlavuza ezijwayelekile, bheka okulandelayo:

• Mayelana Nomdlavuza

• Umdlavuza Wezingane

• I-CureSearch ye-Cancer YezinganePhuma Ukuzikhulula

• Imiphumela Emuva Yokwelapha Yomdlavuza Wezingane

• Intsha kanye nabantu abadala abancane abaneCancer

• Izingane Ezinomdlavuza: Umhlahlandlela Wabazali

• Umdlavuza Ezinganeni Nasebusheni

• Isiteji

• Ukubhekana Nomdlavuza

• Imibuzo Ongayibuza Udokotela Wakho mayelana Nomdlavuza

• Kwabasindile Nabanakekeli