UNikezelo lweChiza eliseKhaya loMhlaza: IsiKhokelo esiBanzi 

Ukuhanjiswa kweziyobisi endaweni yomhlaza yindlela yonyango egxininisa amayeza ngqo kwindawo yethumba. Le ndlela ijolise ekomelezeni ukusebenza konyango ngelixa kuncitshiswa iziphumo ebezingalindelekanga zenkqubo eziqhelekileyo ezinxulunyaniswa nechemotherapy yesintu.

Intshayelelo yoHanjiso lweziyobisi lwasekhaya

Unyango lwesintu lomhlaza olufana nechemotherapy luhlala lubandakanya ulawulo lweziyobisi, oko kuthetha ukuba iyeza lihamba wonke umzimba. Ngelixa isebenzayo ekujoliseni kwiiseli zomhlaza, le ndlela inokulimaza iiseli ezisempilweni, ezikhokelela kwiziphumo ebezingalindelekanga ezibalulekileyo. Ukuhanjiswa kweziyobisi endaweni yomhlaza inikeza indlela ekujoliswe kuyo ngakumbi, ukuhambisa iyeza ngokuthe ngqo kwindawo yethumba.

Le ndlela inokubandakanya iindlela ezahlukeneyo, kuquka:

• Isitofu ngokuthe ngqo samachiza kwithumba.
• Ukubekwa kofakelo lweziyobisi-eluting okanye wafers.
• Ukusetyenziswa kwe-nanoparticles ekujoliswe kuyo ukuhambisa iziyobisi ngokukodwa kwiiseli zomhlaza.
• I-chemotherapy yengingqi, apho iziyobisi zilawulwa kwindawo ethile yomzimba oqulethe i-tumor.

Izibonelelo zoHanjiso lweziyobisi lwasekhaya

Ukuhanjiswa kweziyobisi endaweni yomhlaza inikeza iingenelo ezininzi eziphambili kunyango lwenkqubo:

• Iziphumo ebezingalindelekanga eziNcitshisiweyo: Ngokujolisa iyeza kwindawo yethumba, ukuvezwa kwezicubu ezisempilweni kuyacuthwa, okukhokelela kwiziphumo ebezingalindelekanga ezimbalwa nezincinci.
• Ukonyuka kweziyobisi kwiTumor: Ukuhanjiswa kwendawo kunokufezekisa ukugxilwa kweziyobisi okuphezulu ngaphakathi kwethumba, okunokuphucula ukusebenza konyango.
• Umgangatho woBomi wesigulana ophuculweyo: Ukunciphisa iziphumo zecala kunye neziphumo zonyango eziphuculweyo zinokuphucula kakhulu umgangatho wobomi besigulane ngexesha lonyango lomhlaza.
• Okunokwenzeka kuNyango oluDityanisiweyo: Ukuhanjiswa kwendawo kunokudibaniswa kunye nezinye iindlela zonyango, ezifana notyando, unyango lwe-radiation, kunye ne-systemic chemotherapy, ukufezekisa iziphumo ze-synergistic.

Ubuchwephesha boNikezo lweziyobisi lwasekhaya

Iindlela ezininzi zisetyenziselwa ukuhanjiswa kweziyobisi endaweni yomhlaza, nganye ineengenelo zayo kunye nemida:

Isitofu Ngqo

Oku kubandakanya ukutofa iyeza ngokuthe ngqo kwithumba. Yindlela elula kwaye engabizi kakhulu ilungele amathumba afikelelekayo. I-Ultrasound okanye i-CT guided ingasetyenziselwa ukuqinisekisa ukubekwa ngokuchanekileyo. Imizekelo ibandakanya inaliti yeentsholongwane ze-oncolytic okanye i-chemotherapeutic agents.

Iziyobisi-Eluting Implants kunye Wafers

Ezi zixhobo zifakwe ngotyando ngqo okanye kufuphi nethumba. Balikhulula iyeza ngokucothayo ekuhambeni kwexesha, libonelela ngesiphumo esizinzileyo sonyango. Gliadel^? ii-wafers, ezine-carmustine (BCNU), ngumzekelo owaziwayo osetyenziswa emva koqhaqho loqhaqho lwamathumba ebuchotsheni.

Nanoparticles

I-Nanoparticles ngamasuntswana amancinci enzelwe ukuhambisa amachiza ngokukodwa kwiiseli zomhlaza. Zinokwenziwa ngobunjineli ukujolisa amanqaku athile kwiiseli zomhlaza, ukuphucula ukuqokelelwa kweziyobisi kwindawo yethumba kunye nokunciphisa iziphumo ebezijoliswe kuko. I-Liposomes, i-polymeric nanoparticles, kunye ne-nanoparticles yensimbi zisetyenziswa ngokuqhelekileyo.

Unyango ngamachiza oMmandla

Oku kubandakanya ukuhambisa amayeza echemotherapy kwindawo ethile yomzimba oqulethe ithumba. Imizekelo ibandakanya:

• Ukufakwa kwi-Hepatic Artery (HAI): Isetyenziselwa ukunyanga umhlaza wesibindi ngokuhambisa ichemotherapy ngqo esibindini nge-hepatic artery.
• I-Intraperitoneal Chemotherapy (IP): Isetyenziselwa ukunyanga umhlaza we-ovarian ngokuhambisa ichemotherapy ngqo kwindawo yesisu.
• Isolated Limb Perfusion (ILP): Isetyenziselwa ukunyanga i-melanoma kunye ne-sarcoma yamalungu ngokuhlukanisa ukujikeleza kwelungu kunye nokuhambisa iidosi eziphezulu ze-chemotherapy ngqo kwindawo echaphazelekayo.

Imizekelo yoNikezelo lweziyobisi lweNdawo kuNyango loMhlaza

Ukuhanjiswa kweziyobisi endaweni yomhlaza isetyenziswa kunyango lweentlobo ezahlukeneyo zomhlaza. Nantsi imizekelo embalwa:

Amathumba ebuchotsheni

Gliadel^? ii-wafers zifakwe kwingqondo emva kokususwa ngotyando lweegliomas zodidi oluphezulu. Ezi ziqwenga zikhupha i-carmustine (BCNU), iyeza lechemotherapy, ngqo kumngxunya wotyando, libulala naziphi na iiseli zomhlaza eziseleyo. Uphononongo olupapashwe kwi *Journal of Clinical Oncology* lubonise ukuba iGliadel^? Ii-wafers ziphucule kakhulu ukusinda kwizigulana ezine-gliomas ezisanda kufunyaniswa zikumgangatho ophezulu.¹

Umhlaza Wesibindi

I-Hepatic artery infusion (HAI) yindlela yengingqi yechemotherapy esetyenziselwa ukunyanga umhlaza wesibindi. Kubandakanya ukuhambisa amachiza echemotherapy ngokuthe ngqo esibindini nge-hepatic artery, eyona mithanjana yegazi inikezela ngesibindi. Oku kuvumela ukuba ugxininiso oluphezulu lwechiza lufikelele kwithumba ngelixa kuncitshiswa iziphumo ebezingalindelekanga zenkqubo. Uphononongo lubonise ukuba i-HAI inokuphucula ukuphila kwizigulane ezinomhlaza wesibindi ongaguqukiyo. Iingcali kwi IZiko loPhando ngoMhlaza laseShandong Baofa sebenzisa kakhulu obu buchule.

Umhlaza wesibeleko

I-Intraperitoneal chemotherapy (IP) yindlela yekhemotherapy yengingqi esetyenziselwa ukunyanga umhlaza wesibeleko. Kubandakanya ukuhambisa amachiza e-chemotherapy ngokuthe ngqo kumgodi wesisu, apho umhlaza we-ovarian uhlala usasazeka. Oku kuvumela ukugxila okuphezulu kweyeza ukufikelela kwiiseli zomhlaza kwisisu. Uphononongo lubonise ukuba i-IP ichemotherapy inokuphucula ukusinda kwizigulane ezinomhlaza we-ovarian ophezulu.

Imingeni kunye nezikhokelo zexesha elizayo

Ngelixa ukuhanjiswa kweziyobisi endaweni yomhlaza ibonelela ngeengenelo ezininzi, kukwakho nemiceli mngeni ekufuneka yoyiswe:

• I-Tumor Heterogeneity: Iiseli zomhlaza ngaphakathi kwethumba zinokuhluka ngokwemfuza, okwenza kube nzima ukujolisa zonke iiseli ngokufanelekileyo.
• Ukumelana neziyobisi: Iiseli zomhlaza zinokukhula ukuchasana namachiza echemotherapy, ukunciphisa ukusebenza konikezelo lwasekhaya.
• Izithintelo zohambiso: Amanye amathumba kunzima ukufikelela okanye abe nezithintelo zomzimba ezithintela ukuba amachiza afikelele kuzo zonke iiseli zomhlaza.
• Imiqobo yokuVelisa kunye noLawulo: Ukuphuhlisa nokuvelisa iinkqubo zokuhanjiswa kweziyobisi zasekhaya kunokuba nzima kwaye kuneendleko.

Uphando lwexesha elizayo lugxile ekujonganeni nale mingeni ngokuthi:

• Ukuphuhlisa izicwangciso eziphucukileyo zokujolisa ukoyisa i-tumor heterogeneity.
• Ukudibanisa ukuhanjiswa kweziyobisi kwendawo kunye nolunye unyango, olufana ne-immunotherapy kunye nonyango olujoliswe kuyo, ukoyisa ukunganyangeki ngamachiza.
• Ukuphuhlisa iinkqubo ezintsha zokuhanjiswa kweziyobisi ezinokungena kumathumba ngokufanelekileyo.
• Ukulungelelanisa ukwenziwa kunye neenkqubo zolawulo lweenkqubo zokuhanjiswa kweziyobisi zasekhaya.

Ukuqukumbela

Ukuhanjiswa kweziyobisi endaweni yomhlaza yindlela ethembisayo enokuphucula ukusebenza kwonyango kunye nokunciphisa imiphumo emibi. Njengoko uphando luqhubeka, le ndlela inokuthi idlale indima ebalulekileyo kunyango lomhlaza. Ngokujolisa kumachiza ngqo kwindawo yethumba, ukuhanjiswa kwendawo kunokunika ithemba elitsha kwizigulana ezilwa nesi sifo sitshabalalisayo.

Uluhlu Lwemigaqo

Iimbekiselo

1. Westphal, M., Hilt, D. C., Bortey, E., Del Mastro, R. F.,习惯, Kieser, M., & Combs, S. E. (2003). Ulingo lwesigaba sesi-3 sechemotherapy yasekhaya ene-biodegradable carmustine (BCNU) wafers (Gliadel wafers) kwizigulana ezine-glioma eyingozi. * Ijenali yeClinikhi ye-Oncology *, * 21 * (24), 4414-4419.