Ukulethwa Kwezidakamizwa Kwasendaweni Zomdlavuza: Umhlahlandlela Ophelele 

Ukulethwa kwezidakamizwa endaweni yomdlavuza kuyindlela yokwelapha egxilisa imithi ngqo endaweni yesimila. Le ndlela ihlose ukuthuthukisa ukusebenza ngempumelelo kokwelashwa kuyilapho inciphisa imiphumela engemihle yesistimu evame ukuhlotshaniswa nokwelashwa ngamakhemikhali okungokwesiko.

Isingeniso Sokulethwa Kwezidakamizwa Kwendawo

Ukwelashwa komdlavuza kwendabuko njenge-chemotherapy kuvame ukubandakanya ukuphathwa kwezidakamizwa okuhlelekile, okusho ukuthi umuthi uhamba wonke umzimba. Nakuba iphumelela ekuqondiseni amaseli omdlavuza, le ndlela ingase futhi ilimaze amaseli anempilo, okuholela emiphumeleni engathandeki ephawulekayo. Ukulethwa kwezidakamizwa endaweni yomdlavuza inikeza indlela eqondiswe kakhulu, ukuletha imithi ngqo endaweni yesimila.

Le ndlela ingabandakanya amasu ahlukahlukene, okuhlanganisa:

• Umjovo oqondile wezidakamizwa esimila.
• Ukubekwa kwezimila eziluting noma amawafa.
• Ukusetshenziswa kwama-nanoparticles okuhlosiwe ukuletha izidakamizwa ikakhulukazi kumaseli omdlavuza.
• I-Regional chemotherapy, lapho izidakamizwa zinikezwa endaweni ethile yomzimba equkethe isimila.

Izinzuzo Zokulethwa Kwezidakamizwa Kwendawo

Ukulethwa kwezidakamizwa endaweni yomdlavuza inikeza izinzuzo ezimbalwa ezibalulekile ngaphezu kokwelashwa kwesistimu:

• Imiphumela Emibi Encishisiwe: Ngokugxilisa umuthi endaweni yesimila, ukuchayeka ezicutshini ezinempilo kuyancishiswa, okuholela emiphumeleni engemihle embalwa futhi engemibi kangako.
• Ukwanda kokugxila kwezidakamizwa ku-Tumor: Ukulethwa kwasendaweni kungafinyelela ukugxila okuphezulu kwezidakamizwa ngaphakathi kwesimila, okungase kuthuthukise ukusebenza kahle kokwelashwa.
• Ikhwalithi Yempilo Yesiguli Ethuthukisiwe: Imiphumela emibi encishisiwe kanye nemiphumela yokwelashwa ethuthukisiwe ingathuthukisa kakhulu izinga lempilo yesiguli ngesikhathi sokwelashwa komdlavuza.
• Amathuba Emithi Yokwelapha Ehlanganisiwe: Ukulethwa kwendawo kungahlanganiswa nezinye izindlela zokwelapha, ezinjengokuhlinzwa, ukwelapha ngemisebe, kanye ne-systemic chemotherapy, ukuze kuzuzwe imiphumela ye-synergistic.

Amasu Okulethwa Kwezidakamizwa Kwasendaweni

Amasu amaningana asetshenziselwa ukulethwa kwezidakamizwa endaweni yomdlavuza, ngayinye inezinzuzo zayo kanye nemikhawulo:

Umjovo Oqondile

Lokhu kuhilela ukujova ngokuqondile umuthi esimila. Kuyindlela elula futhi engabizi kakhulu elungele izimila ezifinyelelekayo. I-Ultrasound noma isiqondiso se-CT singasetshenziswa ukuze kuqinisekiswe ukubekwa okunembile. Izibonelo zifaka umjovo wamagciwane we-oncolytic noma ama-chemotherapeutic agents.

Izimila Eluting Eluting and Wafers

Lezi zisetshenziswa zifakwa ngokuhlinzwa ngqo noma eduze kwesimila. Bakhulula umuthi kancane kancane ngokuhamba kwesikhathi, banikeze umphumela oqhubekayo wokwelapha. I-Gliadel^? ama-wafers, aqukethe i-carmustine (BCNU), ayisibonelo esaziwayo esisetshenziswa ngemva kokuhlinzwa kabusha kwamathumba obuchopho.

Nanoparticles

Ama-nanoparticles ayizinhlayiya ezincane eziklanyelwe ukuletha izidakamizwa ikakhulukazi kumaseli omdlavuza. Angakhiwa ukuze aqondise omaka abathile kumaseli omdlavuza, athuthukise ukunqwabelana kwezidakamizwa endaweni yesimila futhi ehlise nemiphumela engahlosiwe. Ama-Liposomes, ama-nanoparticles e-polymeric, nama-nanoparticles ensimbi avame ukusetshenziswa.

I-Regional Chemotherapy

Lokhu kuhlanganisa ukuletha izidakamizwa ze-chemotherapy endaweni ethile yomzimba equkethe isimila. Izibonelo zifaka:

• I-Hepatic Artery Infusion (HAI): Isetshenziselwa ukwelapha umdlavuza wesibindi ngokuletha i-chemotherapy ngqo esibindini nge-hepatic artery.
• I-Intraperitoneal Chemotherapy (IP): Isetshenziselwa ukwelapha umdlavuza wesibeletho ngokuletha i-chemotherapy ngqo emgodini wesisu.
• I-Isolated Limb Perfusion (ILP): Isetshenziselwa ukwelapha i-melanoma kanye ne-sarcoma yezitho ngokuhlukanisa ukuhamba kwelungu kanye nokuletha imithamo ephezulu ye-chemotherapy ngqo endaweni ethintekile.

Izibonelo Zokulethwa Kwezidakamizwa Kwendawo Ekwelapheni Umdlavuza

Ukulethwa kwezidakamizwa endaweni yomdlavuza isetshenziswa ekwelapheni izinhlobo ezahlukene zomdlavuza. Nazi izibonelo ezimbalwa:

Izimila Brain

I-Gliadel^? ama-wafer afakwa ebuchosheni ngemva kokususwa kokuhlinzwa kwama-gliomas ebanga eliphezulu. Lawa mawafa akhulula i-carmustine (BCNU), umuthi we-chemotherapy, ngqo endaweni yokuhlinzwa, ebulala noma yimaphi amangqamuzana omdlavuza asele. Ucwaningo olushicilelwe *kuJournal of Clinical Oncology* lubonise ukuthi i-Gliadel^? ama-wafers athuthukise kakhulu ukusinda ezigulini ezinama-gliomas asanda kutholwa ebanga eliphezulu.¹

Umdlavuza Wesibindi

I-Hepatic artery infusion (HAI) iyindlela yesifunda yokwelapha ngamakhemikhali esetshenziselwa ukwelapha umdlavuza wesibindi. Kuhilela ukuletha izidakamizwa ze-chemotherapy ngqo esibindini ngomthambo we-hepatic, umkhumbi wegazi oyinhloko ohlinzeka isibindi. Lokhu kuvumela ukuthi ukugxila okuphezulu komuthi kufinyelele isimila kuyilapho kunciphisa imiphumela emibi yesistimu. Ucwaningo luye lwabonisa ukuthi i-HAI ingathuthukisa ukusinda ezigulini ezinomdlavuza wesibindi onganqandeki. Ochwepheshe ku I-Shandong Baofa Cancer Research Institute sebenzisa kakhulu le nqubo.

I-Ovarian Cancer

I-Intraperitoneal chemotherapy (IP) iyindlela yesifunda yokwelapha ngamakhemikhali esetshenziselwa ukwelapha umdlavuza wesibeletho. Kubandakanya ukuletha izidakamizwa ze-chemotherapy ngqo emgodini wesisu, lapho umdlavuza we-ovarian uvame ukusabalala. Lokhu kuvumela ukuthi ukugxila okuphezulu komuthi kufinyelele kumaseli omdlavuza esiswini. Ucwaningo luye lwabonisa ukuthi i-IP chemotherapy ingathuthukisa ukusinda ezigulini ezinomdlavuza we-ovarian othuthukile.

Izinselele kanye Neziqondiso Zesikhathi esizayo

Ngenkathi ukulethwa kwezidakamizwa endaweni yomdlavuza inikeza izinzuzo eziningi, kukhona nezinselele okufanele uzinqobe:

• I-Tumor Heterogeneity: Amaseli omdlavuza ngaphakathi kwesimila angahlukahluka ngokofuzo, okwenza kube nzima ukukhomba wonke amaseli ngempumelelo.
• Ukumelana Nezidakamizwa: Amaseli omdlavuza angadala ukumelana nemithi ye-chemotherapy, anciphise ukusebenza kokulethwa kwendawo.
• Izithiyo Zokulethwa: Amanye amathumba kunzima ukufinyelela kuwo noma abe nezithiyo zomzimba ezivimbela izidakamizwa ukuthi zifinyelele kuwo wonke amangqamuzana omdlavuza.
• Izithiyo Zokukhiqiza Nezokulawula: Ukuthuthukisa nokukhiqiza amasistimu okulethwa kwezidakamizwa endaweni kungaba nzima futhi kubize.

Ucwaningo lwangomuso lugxile ekubhekaneni nalezi zinselelo ngokuthi:

• Ukuthuthukisa amasu okukhomba ayinkimbinkimbi ukuze anqobe i-tumor heterogeneity.
• Ukuhlanganisa ukulethwa kwezidakamizwa endaweni kanye nezinye izindlela zokwelapha, njenge-immunotherapy kanye nokwelashwa okuhlosiwe, ukuze kunqobe ukumelana nezidakamizwa.
• Ukuthuthukisa izinhlelo ezintsha zokulethwa kwezidakamizwa ezingangena kumathumba ngempumelelo kakhulu.
• Ukwenza lula ukukhiqiza kanye nezinqubo zokulawula zezinhlelo zokulethwa kwezidakamizwa zasendaweni.

Isiphetho

Ukulethwa kwezidakamizwa endaweni yomdlavuza kuyindlela ethembisayo engathuthukisa ukusebenza kokwelashwa futhi inciphise imiphumela engemihle. Njengoba ucwaningo luqhubeka, le ndlela cishe izodlala indima ebalulekile ekwelapheni umdlavuza. Ngokukhomba izidakamizwa ngqo endaweni yesimila, ukulethwa kwendawo kunganikeza ithemba elisha ezigulini ezilwa nalesi sifo esibhubhisayo.

Uhlu Lwamagama Amagama

Izithenjwa

1. Westphal, M., Hilt, D. C., Bortey, E., Del Mastro, R. F.,习惯, Kieser, M., & Combs, S. E. (2003). Ukuhlolwa kwesigaba sesi-3 sokwelashwa ngamakhemikhali kwasendaweni ngamawafers e-biodegradable carmustine (BCNU) (ama-wafers e-Gliadel) ezigulini ezine-glioma eyingozi eyinhloko. *Iphephabhuku le-Clinical Oncology*, *21*(24), 4414-4419.