{"id":19191,"date":"2023-04-12T19:55:51","date_gmt":"2023-04-12T12:55:51","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=19191"},"modified":"2023-04-13T09:48:19","modified_gmt":"2023-04-13T02:48:19","slug":"huong-dan-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/12\/huong-dan-dieu-tri-ung-thu-bieu-mo-te-bao-gan-theo-bo-y-te\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan"},"content":{"rendered":"

Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (UTBMTBG) l\u00e0 lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong\u00a0 c\u00e1c lo\u1ea1i ung th\u01b0 t\u1ea1i gan, n\u1eb1m trong s\u00e1u lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t tr\u00ean th\u1ebf gi\u1edbi v\u00e0 n\u1eb1m trong ba lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t t\u1ea1i Vi\u1ec7t Nam. UTBMTBG \u0111\u1ee9ng \u0111\u1ea7u trong\u00a0 c\u00e1c nguy\u00ean nh\u00e2n t\u1eed vong li\u00ean quan \u0111\u1ebfn ung th\u01b0 t\u1ea1i Vi\u1ec7t Nam. \u0110i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan c\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p cho t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3.<\/strong><\/p>\n

1. \u0110I\u1ec0U TR\u1eca UTBMTBG\u00a0<\/b><\/h2>\n

1.1. Nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb UTBMTBG\u00a0<\/b><\/h3>\n

– <\/span>\u0110i\u1ec1u tr\u1ecb (c\u00e1c) kh\u1ed1i ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan \u1edf giai \u0111o\u1ea1n c\u00f2n kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb. <\/span><\/p>\n

– <\/span>\u0110i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd n\u1ec1n t\u1ea3ng hay y\u1ebfu t\u1ed1 nguy c\u01a1 (vi\u00eam gan si\u00eau vi B ho\u1eb7c C, x\u01a1 gan…). <\/span><\/p>\n

– <\/span>\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa k\u1ebft h\u1ee3p ch\u0103m s\u00f3c gi\u1ea3m nh\u1eb9 \u1edf giai \u0111o\u1ea1n mu\u1ed9n.\u00a0<\/span><\/p>\n

1.2. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi t\u1ed5n th\u01b0\u01a1ng ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan<\/b><\/h3>\n

1.2.1. Ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf ph\u1ea7n gan c\u00f3 mang kh\u1ed1i u (ph\u1eabu thu\u1eadt c\u1eaft gan)<\/span><\/h4>\n

Ph\u1eabu thu\u1eadt c\u1eaft gan \u0111\u01b0\u1ee3c coi l\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7t \u0111\u1ec3 \u0111\u1ed1i v\u1edbi ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan v\u00e0 an to\u00e0n ngay c\u1ea3\u00a0 \u0111\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 x\u01a1 gan.\u00a0<\/span><\/p>\n

T\u1ea1i Vi\u1ec7t Nam, ph\u1eabu thu\u1eadt c\u1eaft gan n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p: <\/span><\/p>\n

– <\/span>Ph\u1ea7n gan c\u00f3 kh\u1ed1i u d\u1ef1 ki\u1ebfn c\u1eaft b\u1ecf \u0111\u01b0\u1ee3c (theo gi\u1ea3i ph\u1eabu hay kh\u00f4ng theo gi\u1ea3i ph\u1eabu).\u00a0<\/span><\/p>\n

– <\/span>Th\u1ec3 t\u00edch gan d\u1ef1 ki\u1ebfn c\u00f2n l\u1ea1i ph\u00f9 h\u1ee3p v\u1edbi b\u1ec7nh nh\u00e2n. N\u00ean \u0111o th\u1ec3 t\u00edch gan \u0111\u1ec3 g\u00f3p\u00a0 ph\u1ea7n ra ch\u1ec9 \u0111\u1ecbnh c\u1eaft gan \u0111\u1ed1i v\u1edbi c\u00e1c tr\u01b0\u1eddng h\u1ee3p d\u1ef1 ki\u1ebfn c\u1eaft \u2265 50% th\u1ec3 t\u00edch gan.\u00a0<\/span><\/p>\n

– <\/span>Ch\u1ee9c n\u0103ng gan l\u00e0 Child-Pugh A \u0111\u1ebfn B7. C\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng gan\u00a0 d\u1ef1a tr\u00ean x\u00e9t nghi\u1ec7m thanh l\u1ecdc Indocyanin green (ICG test) \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh m\u1ee9c \u0111\u1ed9\u00a0 c\u1eaft gan.\u00a0<\/span><\/p>\n

– <\/span>\u0110i\u1ec3m ho\u1ea1t \u0111\u1ed9ng c\u01a1 th\u1ec3 (Performance Status – PS) 0-2, kh\u00f4ng c\u00f3 di c\u0103n xa.\u00a0<\/span><\/p>\n

N\u00ean xem x\u00e9t ph\u1eabu thu\u1eadt c\u1eaft gan cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch c\u1eeda c\u00f9ng\u00a0 b\u00ean v\u1edbi ph\u1ea7n gan \u0111\u1ecbnh c\u1eaft, c\u0169ng nh\u01b0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u1ed5n th\u01b0\u01a1ng di c\u0103n ngo\u00e0i gan\u00a0 (h\u1ea1ch cu\u1ed1ng gan, tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn, di c\u0103n t\u1ea1i m\u1ea1c n\u1ed1i l\u1edbn, \u2026) c\u00f3 th\u1ec3 l\u1ea5y b\u1ecf \u0111\u01b0\u1ee3c khi\u00a0 ph\u1eabu thu\u1eadt c\u1eaft gan.\u00a0<\/span><\/p>\n

1.2.2. Ph\u1eabu thu\u1eadt gh\u00e9p gan\u00a0<\/span><\/h4>\n

Ph\u1eabu thu\u1eadt gh\u00e9p gan l\u00e0 bi\u1ec7n ph\u00e1p duy nh\u1ea5t c\u00f3 th\u1ec3 gi\u00fap b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb c\u1ea3\u00a0 UTBMTBG l\u1eabn b\u1ec7nh l\u00fd gan n\u1ec1n. Ch\u1ec9 \u0111\u1ecbnh gh\u00e9p gan cho b\u1ec7nh nh\u00e2n UTBMTBG t\u00f9y\u00a0 thu\u1ed9c v\u00e0o nhi\u1ec1u y\u1ebfu t\u1ed1, trong \u0111\u00f3 c\u00f3 c\u00e2n nh\u1eafc t\u1edbi hi\u1ec7u qu\u1ea3 c\u1ee7a ph\u1eabu thu\u1eadt c\u1eaft gan v\u00e0 c\u00e1c\u00a0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7 – t\u1ea1i v\u00f9ng, c\u0169ng nh\u01b0 m\u1ee9c \u0111\u1ed9 \u01b0u ti\u00ean so v\u1edbi nhu c\u1ea7u gh\u00e9p\u00a0 gan c\u1ee7a c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng ph\u1ea3i l\u00e0 UTBMTBG.\u00a0<\/span><\/p>\n

C\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb tr\u00ean th\u1ebf gi\u1edbi \u0111\u1ec1u khuy\u1ebfn c\u00e1o xem Ti\u00eau chu\u1ea9n Milan (ch\u1ec9 c\u00f3 01\u00a0 u v\u1edbi k\u00edch th\u01b0\u1edbc kh\u1ed1i u kh\u00f4ng qu\u00e1 5cm, hay kh\u00f4ng qu\u00e1 03 u v\u1edbi k\u00edch th\u01b0\u1edbc m\u1ed7i u\u00a0 kh\u00f4ng qu\u00e1 3cm) l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng \u0111\u1ec3 gh\u00e9p gan cho UTBMTBG, v\u00e0 gh\u00e9p gan l\u00e0 l\u1ef1a\u00a0 ch\u1ecdn h\u00e0ng \u0111\u1ea7u cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG n\u1eb1m trong Ti\u00eau chu\u1ea9n Milan nh\u01b0ng\u00a0 kh\u00f4ng ph\u00f9 h\u1ee3p \u0111\u1ec3 ph\u1eabu thu\u1eadt c\u1eaft gan, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi c\u00f3 x\u01a1 gan m\u1ea5t b\u00f9. C\u00e1c c\u01a1 s\u1edf y t\u1ebf\u00a0 c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc v\u1eadn d\u1ee5ng c\u00e1c ti\u00eau chu\u1ea9n m\u1edf r\u1ed9ng h\u01a1n khi ch\u1ec9 \u0111\u1ecbnh gh\u00e9p gan nh\u01b0ng c\u1ea7n\u00a0 c\u00f3 h\u1ed9i ch\u1ea9n c\u1ee5 th\u1ec3.\u00a0<\/span><\/p>\n

C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eafc c\u1ea7u \u0111\u1ec3 l\u00e0m gi\u1ea3m giai \u0111o\u1ea1n UTBMTBG\u00a0 tr\u01b0\u1edbc khi xem x\u00e9t gh\u00e9p gan.\u00a0<\/span><\/p>\n

1.2.3. Ph\u00e1 h\u1ee7y kh\u1ed1i u t\u1ea1i ch\u1ed7 (\u0111\u1ed1t u)\u00a0<\/span><\/h4>\n

Ph\u00e1 h\u1ee7y kh\u1ed1i u t\u1ea1i ch\u1ed7 (\u0111\u1ed1t u) c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n b\u1eb1ng s\u00f3ng cao t\u1ea7n (Radiofrequency Ablation-RFA), b\u1eb1ng vi s\u00f3ng (Microwave Ablation-MWA), b\u1eb1ng c\u00e1ch ti\u00eam c\u1ed3n v\u00e0o <\/span>kh\u1ed1i u (Percutaneous Ethanol Injection-PEI) hay b\u1eb1ng \u0111\u1ed1t l\u1ea1nh (cryoablation) tr\u00ean b\u1ec7nh\u00a0 nh\u00e2n c\u00f3 PS 0-2, ch\u1ee9c n\u0103ng gan l\u00e0 Child Pugh A,B, kh\u00f4ng c\u00f3 di c\u0103n xa.\u00a0<\/span><\/p>\n

Ph\u00e1 h\u1ee7y kh\u1ed1i u t\u1ea1i ch\u1ed7 (\u0111\u1ed1t u) n\u00ean th\u1ef1c hi\u1ec7n cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG c\u00f3 s\u1ed1\u00a0 l\u01b0\u1ee3ng u \u2264 3 v\u1edbi k\u00edch th\u01b0\u1edbc u \u2264 3cm, ho\u1eb7c c\u00f3 1 u v\u1edbi k\u00edch th\u01b0\u1edbc u \u2264 5cm, nh\u1ea5t l\u00e0 khi\u00a0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y kh\u00f4ng ph\u00f9 h\u1ee3p \u0111\u1ec3 ph\u1eabu thu\u1eadt c\u1eaft gan (do v\u1ecb tr\u00ed u, do t\u00ecnh tr\u1ea1ng b\u1ec7nh\u00a0 nh\u00e2n). Ph\u00e1 h\u1ee7y kh\u1ed1i u t\u1ea1i ch\u1ed7 (\u0111\u1ed1t u) c\u0169ng \u0111\u01b0\u1ee3c coi l\u00e0 bi\u1ec7n ph\u00e1p thay th\u1ebf cho ph\u1eabu\u00a0 thu\u1eadt c\u1eaft gan trong tr\u01b0\u1eddng h\u1ee3p u c\u00f3 k\u00edch th\u01b0\u1edbc nh\u1ecf \u2264 3cm.\u00a0<\/span><\/p>\n

Ph\u00e1 h\u1ee7y kh\u1ed1i u t\u1ea1i ch\u1ed7 (\u0111\u1ed1t u) n\u00ean th\u1ef1c hi\u1ec7n cho c\u00e1c kh\u1ed1i u d\u1ec5 ti\u1ebfp c\u1eadn d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn\u00a0 c\u1ee7a h\u00ecnh \u1ea3nh h\u1ecdc (si\u00eau \u00e2m, CT scan, MRI). Nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 \u0111\u1ecbnh ph\u00e1 h\u1ee7y kh\u1ed1i u\u00a0 k\u00edch th\u01b0\u1edbc > 5cm c\u1ea7n \u0111\u01b0\u1ee3c h\u1ed9i ch\u1ea9n.\u00a0<\/span><\/p>\n

Ti\u00eam c\u1ed3n v\u00e0o kh\u1ed1i u ch\u1ec9 n\u00ean th\u1ef1c hi\u1ec7n khi c\u00e1c bi\u1ec7n ph\u00e1p ph\u00e1 h\u1ee7y kh\u1ed1i u (\u0111\u1ed1t u) kh\u00e1c\u00a0 kh\u00f4ng th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c v\u00ec l\u00fd do k\u1ef9 thu\u1eadt, v\u00e0 n\u1ebfu s\u1eed d\u1ee5ng th\u00ec ch\u1ee7 y\u1ebfu l\u00e0 cho u \u2264 2cm.\u00a0<\/span><\/p>\n

\u0110\u1ed1i v\u1edbi (c\u00e1c) kh\u1ed1i u ch\u01b0a lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c l\u00e0 UTBMTBG, c\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p sinh thi\u1ebft v\u00e0\u00a0 ph\u00e1 h\u1ee7y u t\u1ea1i ch\u1ed7 trong c\u00f9ng m\u1ed9t l\u1ea7n n\u1eb1m vi\u1ec7n.\u00a0<\/span><\/p>\n

1.2.4. C\u1eaft ngu\u1ed3n m\u00e1u nu\u00f4i kh\u1ed1i u ph\u1ed1i h\u1ee3p v\u1edbi di\u1ec7t t\u1ebf b\u00e0o ung th\u01b0 b\u1eb1ng h\u00f3a ch\u1ea5t <\/span><\/h4>\n

C\u00f3 c\u00e1c h\u00ecnh th\u1ee9c nh\u01b0:\u00a0<\/span><\/p>\n

– <\/span>N\u00fat m\u1ea1ch h\u00f3a ch\u1ea5t th\u01b0\u1eddng quy (conventional TransArterial Chemo-Embolization – cTACE)\u00a0<\/span><\/p>\n

– <\/span>N\u00fat m\u1ea1ch s\u1eed d\u1ee5ng h\u1ea1t nh\u00fang h\u00f3a ch\u1ea5t (Drug-eluting bead TACE – DEB-TACE)\u00a0<\/span><\/p>\n

TACE \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG m\u00e0 kh\u1ed1i u kh\u00f4ng c\u1eaft \u0111\u01b0\u1ee3c, ho\u1eb7c\u00a0 c\u00f3 nhi\u1ec1u u \u1edf c\u1ea3 hai th\u00f9y, ch\u01b0a c\u00f3 x\u00e2m nh\u1eadp m\u1ea1ch m\u00e1u v\u00e0 ch\u01b0a c\u00f3 di c\u0103n ngo\u00e0i gan,\u00a0 tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 PS 0-2, ch\u1ee9c n\u0103ng gan l\u00e0 Child Pugh A,B. TACE n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c\u00a0 hi\u1ec7n ch\u1ecdn l\u1ecdc hay si\u00eau ch\u1ecdn l\u1ecdc \u0111\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3, gi\u1ea3m bi\u1ebfn ch\u1ee9ng v\u00e0 gi\u1ea3m \u1ea3nh h\u01b0\u1edfng\u00a0 \u0111\u1ebfn ph\u1ea7n gan l\u00e0nh quanh u.\u00a0<\/span><\/p>\n

TACE ch\u1ecdn l\u1ecdc c\u0169ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p u nh\u1ecf nh\u01b0ng kh\u00f4ng th\u1ec3 th\u1ef1c\u00a0 hi\u1ec7n \u0111\u1ed1t u \u0111\u01b0\u1ee3c do v\u1ecb tr\u00ed kh\u00f3 hay do c\u00f3 c\u00e1c b\u1ec7nh l\u00fd \u0111i k\u00e8m l\u00e0m t\u0103ng nguy c\u01a1 bi\u1ebfn\u00a0 ch\u1ee9ng.\u00a0<\/span><\/p>\n

Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 u \u0111\u00e3 v\u1ee1 ho\u1eb7c c\u00f3 nguy c\u01a1 v\u1ee1 m\u00e0 t\u00ecnh tr\u1ea1ng ch\u1ee9c n\u0103ng gan\u00a0 ho\u1eb7c t\u00ecnh tr\u1ea1ng c\u01a1 th\u1ec3 kh\u00f4ng cho ph\u00e9p l\u00e0m TACE th\u00ec c\u00f3 th\u1ec3 l\u00e0m n\u00fat m\u1ea1ch \u0111\u01a1n thu\u1ea7n\u00a0 (TransArterial Embolization – TAE) \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u1ea1m th\u1eddi.\u00a0<\/span><\/p>\n

\u0110\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a TACE c\u1ea7n d\u1ef1a v\u00e0o h\u00ecnh \u1ea3nh h\u1ecdc v\u00e0 s\u1ef1 thay \u0111\u1ed5i c\u1ee7a c\u00e1c ch\u1ec9 d\u1ea5u\u00a0 sinh h\u1ecdc c\u0169ng nh\u01b0 c\u1ee7a ch\u1ee9c n\u0103ng gan sau TACE. T\u1ea1i Vi\u1ec7t Nam, c\u00f3 th\u1ec3 th\u1ef1c hi\u1ec7n\u00a0 TACE nhi\u1ec1u l\u1ea7n n\u1ebfu (c\u00e1c) kh\u1ed1i u c\u00f2n ti\u1ebfn tri\u1ec3n ho\u1eb7c xu\u1ea5t hi\u1ec7n u m\u1edbi v\u00e0 t\u00ecnh tr\u1ea1ng ch\u1ee9c\u00a0 n\u0103ng gan v\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1 th\u1ec3 cho ph\u00e9p. C\u1ea7n h\u1ed9i ch\u1ea9n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 TACE th\u1ea5t b\u1ea1i hay\u00a0 kh\u00f4ng tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh ng\u01b0ng l\u00e0m TACE ti\u1ebfp t\u1ee5c \u0111\u1ec3 chuy\u1ec3n sang h\u00f3a tr\u1ecb to\u00e0n th\u00e2n.\u00a0<\/span><\/p>\n

1.2.5. X\u1ea1 tr\u1ecb trong ch\u1ecdn l\u1ecdc (Selective Internal Radiation Therapy – SIRT) <\/span><\/h4>\n

S\u1eed d\u1ee5ng h\u1ea1t vi c\u1ea7u ph\u00f3ng x\u1ea1 Ytrium-90 (<\/span>90<\/span>Y) b\u01a1m v\u00e0o \u0111\u1ed9ng m\u1ea1ch nu\u00f4i kh\u1ed1i u gan.\u00a0 C\u00e1c h\u1ea1t vi c\u1ea7u n\u00e0y s\u1ebd \u0111i v\u00e0o c\u00e1c nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch nh\u1ecf kh\u1eafp trong kh\u1ed1i u g\u00e2y t\u1eafc m\u1ea1ch.\u00a0<\/span><\/p>\n

Kh\u1ed1i u s\u1ebd b\u1ecb ti\u00eau di\u1ec7t theo hai c\u01a1 ch\u1ebf: gi\u1ea3m nu\u00f4i d\u01b0\u1ee1ng u v\u00e0 b\u1ee9c x\u1ea1 b\u00eata n\u0103ng l\u01b0\u1ee3ng\u00a0 0,93MeV \u0111\u01b0\u1ee3c ph\u00e1t ra t\u1eeb \u0111\u1ed3ng v\u1ecb ph\u00f3ng x\u1ea1 <\/span>90<\/span>Y g\u1eafn tr\u00ean c\u00e1c h\u1ea1t vi c\u1ea7u s\u1ebd ti\u00eau di\u1ec7t c\u00e1c\u00a0 t\u1ebf b\u00e0o ung th\u01b0 v\u00e0 l\u00e0m gi\u1ea3m th\u1ec3 t\u00edch ho\u1eb7c ti\u00eau ho\u00e0n to\u00e0n kh\u1ed1i u gan m\u00e0 r\u1ea5t \u00edt \u1ea3nh h\u01b0\u1edfng\u00a0 \u0111\u1ebfn t\u1ed5 ch\u1ee9c l\u00e0nh xung quanh.\u00a0\u00a0<\/span><\/p>\n

– <\/span>Ch\u1ec9 \u0111\u1ecbnh:\u00a0<\/span><\/p>\n

+ <\/span>UTBMTBG kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng ph\u1eabu thu\u1eadt, ho\u1eb7c c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt\u00a0 hay b\u1ec7nh nh\u00e2n t\u1eeb ch\u1ed1i ph\u1eabu thu\u1eadt.\u00a0\u00a0<\/span><\/p>\n

+ <\/span>T\u1ed5ng tr\u1ea1ng c\u00f2n t\u1ed1t ECOG \u2264 1, ch\u1ee9c n\u0103ng gan c\u00f2n b\u00f9 (Child-Pugh A, B) <\/span>+ <\/span>Shunt l\u01b0u th\u00f4ng ho\u1ea1t t\u00ednh ph\u00f3ng x\u1ea1 l\u00ean ph\u1ed5i < 20% tr\u00ean x\u1ea1 h\u00ecnh Tc-99m MAA <\/span>+ <\/span>Ch\u01b0a t\u1eebng x\u1ea1 tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3 v\u00e0o gan\u00a0<\/span><\/p>\n

– <\/span>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:\u00a0<\/span><\/p>\n

+ <\/span>C\u00f3 lu\u1ed3ng th\u00f4ng \u0111\u1ed9ng m\u1ea1ch gan-ph\u1ed5i (shunt gan-ph\u1ed5i) l\u1edbn (> 20%) <\/span>+ <\/span>X\u01a1 gan m\u1ea5t b\u00f9, b\u1ec7nh n\u00e3o gan\u00a0<\/span><\/p>\n

+ <\/span>Th\u1ec3 tr\u1ea1ng qu\u00e1 y\u1ebfu, d\u1ef1 ki\u1ebfn th\u1eddi gian s\u1ed1ng th\u00eam d\u01b0\u1edbi 3 th\u00e1ng.\u00a0\u00a0<\/span><\/p>\n

1.2.6. Truy\u1ec1n ho\u00e1 ch\u1ea5t qua \u0111\u1ed9ng m\u1ea1ch gan (Hepatic Arterial Infusion Chemotherapy – HAIC)\u00a0<\/span><\/h4>\n

Ph\u01b0\u01a1ng ph\u00e1p s\u1eed d\u1ee5ng bu\u1ed3ng truy\u1ec1n v\u00e0 d\u00e2y d\u1eabn \u0111\u1eb7t ch\u1ecdn l\u1ecdc v\u00e0o \u0111\u1ed9ng m\u1ea1ch gan sau\u00a0 khi \u0111\u00e3 n\u00fat t\u1eafc c\u00e1c nh\u00e1nh m\u1ea1ch c\u1ee7a \u0111\u1ed9ng m\u1ea1ch gan c\u1ea5p m\u00e1u cho c\u00e1c t\u1ea1ng kh\u00e1c. Ph\u01b0\u01a1ng\u00a0 ph\u00e1p n\u00e0y gi\u00fap \u0111\u01b0a h\u00f3a ch\u1ea5t khu tr\u00fa t\u1ea1i gan n\u00ean gi\u1ea3m c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 h\u01a1n so v\u1edbi h\u00f3a\u00a0 tr\u1ecb to\u00e0n th\u00e2n. H\u00f3a ch\u1ea5t th\u01b0\u1eddng d\u00f9ng l\u00e0 t\u1ed5 h\u1ee3p li\u1ec1u th\u1ea5p c\u1ee7a Cisplatin v\u1edbi 5-Fluorouracil\u00a0 (ph\u00e1c \u0111\u1ed3 FP li\u1ec1u th\u1ea5p). Ch\u1ec9 \u0111\u1ecbnh ch\u1ee7 y\u1ebfu cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG giai \u0111o\u1ea1n ti\u1ebfn\u00a0 xa c\u00f3 x\u00e2m l\u1ea5n t\u0129nh m\u1ea1ch c\u1eeda. C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p n\u00e0y bao g\u1ed3m: vi\u00eam t\u1eafc\u00a0 m\u1ea1ch, lo\u00e9t d\u1ea1 d\u00e0y ru\u1ed9t do r\u00f2 thu\u1ed1c v\u00e0 nhi\u1ec5m khu\u1ea9n ho\u1eb7c t\u1eafc d\u00e2y truy\u1ec1n.\u00a0<\/span><\/p>\n

1.2.7. X\u1ea1 tr\u1ecb\u00a0<\/span><\/h4>\n

– <\/span>X\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i\u00a0<\/span><\/p>\n

+ <\/span>Ch\u1ec9 \u0111\u1ecbnh: x\u1ea1 tr\u1ecb chi\u1ebfu ngo\u00e0i b\u1eb1ng m\u00e1y gia t\u1ed1c c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ed1i v\u1edbi nh\u1eefng tr\u01b0\u1eddng\u00a0 h\u1ee3p kh\u00f4ng ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c. L\u1ef1a ch\u1ecdn tr\u01b0\u1eddng chi\u1ebfu x\u1ea1 ph\u1ee5 thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed, k\u00edch\u00a0 th\u01b0\u1edbc kh\u1ed1i u. Li\u1ec1u x\u1ea1 tr\u1ecb t\u00f9y thu\u1ed9c v\u00e0o th\u1ec3 t\u00edch tr\u01b0\u1eddng chi\u1ebfu, dao \u0111\u1ed9ng t\u1eeb 50- 70Gy, ph\u00e2n li\u1ec1u 2Gy\/ng\u00e0y.\u00a0<\/span><\/p>\n

+ <\/span>Ch\u1ec9 \u0111\u1ecbnh x\u1ea1 tr\u1ecb to\u00e0n gan trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb gi\u1ea3m nh\u1eb9 tri\u1ec7u ch\u1ee9ng,\u00a0 li\u1ec1u x\u1ea1 21Gy, ph\u00e2n li\u1ec1u 3Gy\/ng\u00e0y.\u00a0<\/span><\/p>\n

+ <\/span>Ngo\u00e0i ra, c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh x\u1ea1 tr\u1ecb cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p UTBMTBG di c\u0103n x\u01b0\u01a1ng,\u00a0 di c\u0103n n\u00e3o, di c\u0103n ph\u1ed5i, di c\u0103n h\u1ea1ch. Th\u1ec3 t\u00edch v\u00e0 li\u1ec1u x\u1ea1 ph\u1ee5 thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed v\u00e0\u00a0 k\u00edch th\u01b0\u1edbc t\u1ed5n th\u01b0\u01a1ng.\u00a0<\/span><\/p>\n

+ <\/span>M\u00f4 ph\u1ecfng b\u1eb1ng CT, MRI ho\u1eb7c PET\/CT, PET\/MRI.<\/span><\/p>\n

+ <\/span>K\u1ef9 thu\u1eadt: c\u00f3 th\u1ec3 d\u00f9ng c\u00e1c k\u1ef9 thu\u1eadt th\u01b0\u1eddng quy 3D, ho\u1eb7c c\u00e1c k\u1ef9 thu\u1eadt x\u1ea1 tr\u1ecb ti\u00ean\u00a0 ti\u1ebfn gi\u00fap t\u0103ng hi\u1ec7u qu\u1ea3, \u0111\u1ed9 ch\u00ednh x\u00e1c v\u00e0 gi\u1ea3m thi\u1ec3u t\u00e1c d\u1ee5ng ph\u1ee5 nh\u01b0 x\u1ea1 tr\u1ecb \u0111i\u1ec1u\u00a0 bi\u1ebfn li\u1ec1u (Intensity Modulated Radiation Therapy \u2013 IMRT), x\u1ea1 tr\u1ecb \u0111i\u1ec1u bi\u1ebfn th\u1ec3\u00a0 t\u00edch (Volumetric Modulated Arc Therapy \u2013 VMAT).\u00a0<\/span><\/p>\n

– <\/span>X\u1ea1 ph\u1eabu\u00a0<\/span><\/p>\n

+ <\/span>X\u1ea1 ph\u1eabu c\u00f3 th\u1ec3 b\u1eb1ng dao gamma c\u1ed5 \u0111i\u1ec3n, dao gamma quay (Rotating Gamma\u00a0 Knife), CyberKnife, \u2026\u00a0<\/span><\/p>\n

+ <\/span>Nguy\u00ean l\u00fd: b\u1ee9c x\u1ea1 h\u1ed9i t\u1ee5 v\u1edbi li\u1ec1u r\u1ea5t cao t\u1ea1i ti\u00eau \u0111i\u1ec3m kh\u1ed1i u g\u00e2y ho\u1ea1i t\u1eed ho\u1eb7c\u00a0 b\u1ea5t ho\u1ea1t t\u1ebf b\u00e0o u, \u0111\u1ed3ng th\u1eddi li\u1ec1u x\u1ea1 t\u1ea1i c\u00e1c m\u00f4 l\u00e0nh \u1edf m\u1ee9c t\u1ed1i thi\u1ec3u, r\u1ea5t \u00edt g\u00e2y t\u00e1c\u00a0 d\u1ee5ng ph\u1ee5 cho c\u01a1 quan l\u00e0nh xung quanh.\u00a0<\/span><\/p>\n

+ <\/span>Ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p di c\u0103n m\u1ed9t v\u00e0i \u1ed5 t\u1ea1i n\u00e3o.\u00a0<\/span><\/p>\n

– <\/span>X\u1ea1 ph\u1eabu \u0111\u1ecbnh v\u1ecb th\u00e2n (Stereotatic Body Radiation Therapy – SBRT)\u00a0<\/span><\/p>\n

+ <\/span>X\u1ea1 ph\u1eabu \u0111\u1ecbnh v\u1ecb th\u00e2n l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111ang c\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng \u0111\u00e1nh gi\u00e1 t\u00e1c\u00a0 d\u1ee5ng t\u00edch c\u1ef1c, c\u00f3 th\u1ec3 d\u00f9ng cho c\u00e1c kh\u1ed1i u nguy\u00ean ph\u00e1t t\u1ea1i gan, kh\u00f4ng c\u00f2n kh\u1ea3\u00a0 n\u0103ng c\u1eaft b\u1ecf hay c\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u00e1 hu\u1ef7 u t\u1ea1i ch\u1ed7, v\u00e0 c\u00e1c kh\u1ed1i u di c\u0103n \u1edf gan.\u00a0<\/span><\/p>\n

– <\/span>C\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1\u00a0<\/span><\/p>\n

+ <\/span>C\u1ea5y h\u1ea1t ph\u00f3ng x\u1ea1 v\u00e0o kh\u1ed1i u ho\u1eb7c di\u1ec7n u trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng ph\u1eabu thu\u1eadt\u00a0 tri\u1ec7t c\u0103n ho\u1eb7c kh\u00f4ng th\u1ec3 ph\u1eabu thu\u1eadt do c\u00f3 b\u1ec7nh l\u00fd k\u00e8m theo hay b\u1ec7nh nh\u00e2n t\u1eeb\u00a0 ch\u1ed1i ph\u1eabu thu\u1eadt.\u00a0<\/span><\/p>\n

+ <\/span>C\u00e1c bi\u1ec7n ph\u00e1p x\u1ea1 tr\u1ecb kh\u00e1c b\u1eb1ng tia h\u1ea1t (Particle Beam Radiation Therapy) nh\u01b0\u00a0 tia proton hay ion carbon cho c\u00e1c k\u1ebft qu\u1ea3 b\u01b0\u1edbc \u0111\u1ea7u kh\u00e1 kh\u00edch l\u1ec7 nh\u01b0ng v\u1eabn c\u00f2n\u00a0 c\u1ea7n c\u00e1c nghi\u00ean c\u1ee9u ti\u1ebfp theo \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi UTBMTBG.\u00a0<\/span><\/p>\n

1.2.8. \u0110i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n\u00a0<\/span><\/h4>\n

C\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG ti\u1ebfn tri\u1ec3n, kh\u00f4ng c\u00f2n ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt, n\u00fat m\u1ea1ch, \u0111\u1ed1t u th\u00ec c\u00f3 th\u1ec3 xem x\u00e9t d\u00f9ng \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n.\u00a0\u00a0<\/span><\/p>\n

a. \u0110i\u1ec1u tr\u1ecb \u0111\u00edch v\u00e0 \u0111i\u1ec1u tr\u1ecb mi\u1ec5n d\u1ecbch ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan<\/span><\/i><\/h5>\n

– <\/span>Sorafenib l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf \u0111a kinase \u0111\u01b0\u1eddng u\u1ed1ng, \u1ee9c ch\u1ebf kho\u1ea3ng 40 kinase, bao g\u1ed3m\u00a0 c\u1ea3 VEGFR-2 (vascular endothelial growth factor receptor 2) v\u00e0 BRAF (B-Raf proto-oncogene, serine\/threonine kinase). Sorafenib \u0111\u01b0\u1ee3c coi l\u00e0 \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc m\u1ed9t\u00a0 chu\u1ea9n cho c\u00e1c tr\u01b0\u1eddng h\u1ee3p UTBMTBG kh\u00f4ng c\u00f2n \u0111\u00e1p \u1ee9ng ho\u1eb7c kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi\u00a0 c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb can thi\u1ec7p t\u1ea1i ch\u1ed7 t\u1ea1i v\u00f9ng nh\u01b0 n\u00fat m\u1ea1ch h\u00f3a ch\u1ea5t, ho\u1eb7c \u0111\u00e3 c\u00f3\u00a0 x\u00e2m nh\u1eadp m\u1ea1ch m\u00e1u \u0111\u1ea1i th\u1ec3 hay di c\u0103n ngo\u00e0i gan, v\u1edbi \u0111i\u1ec1u ki\u1ec7n ch\u1ee9c n\u0103ng gan c\u00f2n\u00a0 t\u1ed1t (Child-Pugh A hay B7). C\u00e1c t\u00e1c d\u1ee5ng c\u1ee7a sorafenib c\u00f3 th\u1ec3 g\u1eb7p nh\u01b0: ph\u1ea3n \u1ee9ng da\u00a0 b\u00e0n tay-b\u00e0n ch\u00e2n, ti\u00eau ch\u1ea3y, t\u0103ng huy\u1ebft \u00e1p,\u2026.C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0y th\u01b0\u1eddng x\u1ea3y ra\u00a0 s\u1edbm v\u00e0 c\u00f3 th\u1ec3 d\u1ef1 ph\u00f2ng v\u00e0 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p d\u00f9ng thu\u1ed1c v\u00e0 kh\u00f4ng\u00a0 d\u00f9ng thu\u1ed1c. Li\u1ec1u d\u00f9ng sorafenib l\u00e0 400mg, u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y cho t\u1edbi khi b\u1ec7nh ti\u1ebfn\u00a0 tri\u1ec3n. C\u00f3 th\u1ec3 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u sorafenib cho ph\u00f9 h\u1ee3p theo m\u1ee9c \u0111\u1ed9 c\u1ee7a \u0111\u1ed9c t\u00ednh. N\u00ean\u00a0 duy tr\u00ec vi\u1ec7c s\u1eed d\u1ee5ng sorafenib cho b\u1ec7nh nh\u00e2n \u00edt nh\u1ea5t cho t\u1edbi khi b\u1ec7nh ti\u1ebfn tri\u1ec3n tr\u00ean\u00a0<\/span>h\u00ecnh \u1ea3nh h\u1ecdc, ho\u1eb7c tr\u00ean l\u00e2m s\u00e0ng, khi \u0111\u00f3 n\u00ean h\u1ed9i ch\u1ea9n \u0111\u1ec3 xem x\u00e9t chuy\u1ec3n sang \u0111i\u1ec1u\u00a0 tr\u1ecb b\u01b0\u1edbc hai.\u00a0<\/span><\/p>\n

– <\/span>Lenvatinib l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf \u0111a kinase \u0111\u01b0\u1eddng u\u1ed1ng, \u1ee9c ch\u1ebf VEGFR 1-3, FGFR 1-4 (fibroblast growth factor receptor 1-4) v\u00e0 m\u1ed9t s\u1ed1 kinase kh\u00e1c. Lenvatinib cho k\u1ebft\u00a0 qu\u1ea3 v\u1ec1 th\u1eddi gian s\u1ed1ng c\u00f2n kh\u00f4ng k\u00e9m h\u01a1n sorafenib v\u00e0 c\u00f3 th\u1eddi gian s\u1ed1ng kh\u00f4ng\u00a0 b\u1ec7nh ti\u1ebfn tri\u1ec3n, th\u1eddi gian cho \u0111\u1ebfn khi b\u1ec7nh ti\u1ebfn tri\u1ec3n v\u00e0 t\u1ef7 l\u1ec7 \u0111\u00e1p \u1ee9ng chung \u01b0u th\u1ebf h\u01a1n sorafenib trong c\u00e1c nghi\u00ean c\u1ee9u tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n UTBMTBG ti\u1ebfn tri\u1ec3n,\u00a0 kh\u00f4ng c\u00f2n \u0111\u00e1p \u1ee9ng \u0111\u1ed1i v\u1edbi c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u1ea1i ch\u1ed7, t\u1ea1i v\u00f9ng ho\u1eb7c \u0111\u00e3 c\u00f3 di c\u0103n\u00a0 ngo\u00e0i gan, nh\u01b0ng ch\u01b0a c\u00f3 huy\u1ebft kh\u1ed1i nh\u00e1nh ch\u00ednh t\u0129nh m\u1ea1ch c\u1eeda. Lenvatinib \u0111\u01b0\u1ee3c\u00a0 s\u1eed d\u1ee5ng \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc m\u1ed9t cho c\u00e1c b\u1ec7nh nh\u00e2n thu\u1ed9c nh\u00f3m tr\u00ean. Li\u1ec1u d\u00f9ng lenvatinib\u00a0 l\u00e0 12mg\/ng\u00e0y \u1edf b\u1ec7nh nh\u00e2n tr\u00ean 60kg ho\u1eb7c 8mg\/ng\u00e0y \u1edf b\u1ec7nh nh\u00e2n d\u01b0\u1edbi 60kg, u\u1ed1ng\u00a0 h\u00e0ng ng\u00e0y. C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a lenvatinib c\u0169ng t\u01b0\u01a1ng t\u1ef1 sorafenib.\u00a0<\/span><\/p>\n

– <\/span>Regorafenib, m\u1ed9t thu\u1ed1c \u1ee9c ch\u1ebf \u0111a kinase \u0111\u01b0\u1eddng u\u1ed1ng, t\u00e1c \u0111\u1ed9ng v\u00e0o c\u00e1c qu\u00e1 tr\u00ecnh\u00a0 sinh m\u1ea1ch m\u00e1u, t\u0103ng sinh t\u1ebf b\u00e0o u v\u00e0 vi m\u00f4i tr\u01b0\u1eddng u v\u1edbi c\u00e1c \u0111\u00edch \u1ee9c ch\u1ebf nh\u01b0\u00a0 VEGFR 1-3, KIT, RET, RAF-1, BRAF, PDGFR, FGFR, CSF1R gi\u00fap c\u1ea3i thi\u1ec7n t\u1ec9 l\u1ec7\u00a0 s\u1ed1ng c\u00f2n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n UTBMTBG \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng sorafenib, dung n\u1ea1p \u0111\u01b0\u1ee3c\u00a0 sorafenib, nh\u01b0ng b\u1ec7nh v\u1eabn ti\u1ebfn tri\u1ec3n. C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a regorafenib c\u0169ng t\u01b0\u01a1ng\u00a0 t\u1ef1 sorafenib. Do \u0111\u00f3, regorafenib \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn nh\u01b0 l\u00e0 \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc hai cho\u00a0 UTBMTBG khi \u0111\u00e3 th\u1ea5t b\u1ea1i v\u1edbi sorafenib. Regorafenib l\u00e0 thu\u1ed1c c\u00f3 nghi\u00ean c\u1ee9u \u0111\u00e1nh\u00a0 gi\u00e1 hi\u1ec7u qu\u1ea3 c\u1ee7a chu\u1ed7i ph\u1ed1i h\u1ee3p sau ti\u1ebfn tri\u1ec3n v\u1edbi sorafenib, cho th\u1ea5y th\u1eddi gian s\u1ed1ng\u00a0 c\u00f2n l\u00e0 26 th\u00e1ng t\u00ednh t\u1eeb th\u1eddi \u0111i\u1ec3m b\u1eaft \u0111\u1ea7u b\u01b0\u1edbc 1. Li\u1ec1u d\u00f9ng regorafenib:\u00a0 160mg\/ng\u00e0y, u\u1ed1ng ng\u00e0y 1-21, chu k\u1ef3 28 ng\u00e0y.\u00a0<\/span><\/p>\n

– <\/span>Pembrolizumab l\u00e0 c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ed1t ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch (immune checkpoints\u00a0 inhibitors) cho th\u1ea5y c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n t\u1ec9 l\u1ec7 s\u1ed1ng c\u00f2n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n UTBMTBG \u0111\u00e3\u00a0 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng sorafenib ho\u1eb7c lenvatinib, v\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc hai cho\u00a0 UTBMTBG khi \u0111\u00e3 th\u1ea5t b\u1ea1i v\u1edbi sorafenib ho\u1eb7c lenvatinib. C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 ch\u1ee7 y\u1ebfu\u00a0 l\u00e0 m\u1ec7t m\u1ecfi, ng\u1ee9a v\u00e0 ph\u00e1t ban. Li\u1ec1u dung pembrolizumab: 200mg, truy\u1ec1n t\u0129nh m\u1ea1ch\u00a0 chu k\u1ef3 3 tu\u1ea7n\u00a0<\/span><\/p>\n

– <\/span>M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u cho th\u1ea5y vi\u1ec7c k\u1ebft h\u1ee3p bevacizumab v\u1edbi atezolizumab cho hi\u1ec7u\u00a0 qu\u1ea3 trong vi\u1ec7c c\u1ea3i thi\u1ec7n th\u1eddi gian s\u1ed1ng th\u00eam kh\u00f4ng b\u1ec7nh \u1edf c\u00e1c b\u1ec7nh nh\u00e2n\u00a0 UTBMTBG giai \u0111o\u1ea1n mu\u1ed9n ho\u1eb7c t\u00e1i ph\u00e1t. Li\u1ec1u d\u00f9ng:\u00a0<\/span><\/p>\n

Atezolizumab : 1200mg truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1\u00a0<\/span><\/p>\n

Bevacizumab : 15mg\/kg truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, chu k\u1ef3 21 ng\u00e0y\u00a0<\/span><\/p>\n

– <\/span>Ramucirumab l\u00e0 kh\u00e1ng th\u1ec3 kh\u00e1ng VEGFR c\u00f3 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 gan c\u00f3 AFP\u00a0 \u2265 400 ng\/ml.\u00a0<\/span><\/p>\n

– <\/span>Cabozantinib l\u00e0 m\u1ed9t thu\u1ed1c \u1ee9c ch\u1ebf MET, VEGFR2, AXL v\u00e0 RET, c\u0169ng gi\u00fap c\u1ea3i\u00a0 thi\u1ec7n t\u1ec9 l\u1ec7 s\u1ed1ng c\u00f2n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n UTBMTBG \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng sorafenib.\u00a0\u00a0<\/span><\/p>\n

b. H\u00f3a tr\u1ecb to\u00e0n th\u00e2n: m\u1ed9t s\u1ed1 ph\u00e1c \u0111\u1ed3 h\u00f3a ch\u1ea5t c\u00f3 th\u1ec3 \u00e1p d\u1ee5ng trong UTBMTBG nh\u01b0ng\u00a0 hi\u1ec7u qu\u1ea3 r\u1ea5t h\u1ea1n ch\u1ebf.\u00a0<\/span><\/i><\/h5>\n

– <\/span>Ph\u00e1c \u0111\u1ed3 PIAF : chu k\u1ef3 3 tu\u1ea7n<\/span><\/p>\n

Doxorubicin : 40mg\/m<\/span>2<\/span>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1\u00a0<\/span><\/p>\n

Cisplatin : 20mg\/m<\/span>2<\/span>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, 2, 3, 4\u00a0<\/span><\/p>\n

5-FU : 400mg\/m<\/span>2<\/span>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, 2, 3, 4 Interferon \u03b1-2a : ti\u00eam d\u01b0\u1edbi da 5 MIU\/m<\/span>2<\/span>, ng\u00e0y 1, 2, 3, 4\u00a0<\/span><\/p>\n

– <\/span>Ph\u00e1c \u0111\u1ed3 GEMOX : chu k\u1ef3 2 tu\u1ea7n\u00a0<\/span><\/p>\n

Gemcitabine : 1.000mg\/m<\/span>2<\/span>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1\u00a0<\/span><\/p>\n

Oxaliplatin : 100mg\/m<\/span>2<\/span>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 2\u00a0<\/span><\/p>\n

– <\/span>Ph\u00e1c \u0111\u1ed3 FOLFOX 4 : chu k\u1ef3 2 tu\u1ea7n\u00a0<\/span><\/p>\n

Folinic acid : 200mg\/m<\/span>2<\/span>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1\u00a0<\/span><\/p>\n

Oxaliplatin : 85mg\/m<\/span>2<\/span>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1\u00a0<\/span><\/p>\n

5-FU : 400mg\/m<\/span>2<\/span>, ti\u00eam\/truy\u1ec1n t\u0129nh m\u1ea1ch bolus ng\u00e0y 1\u00a0 5-FU : 1.200mg\/m<\/span>2<\/span>, truy\u1ec1n t\u0129nh m\u1ea1ch ng\u00e0y 1, 2 <\/span><\/p>\n

1.3. Ph\u1ed1i h\u1ee3p c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb\u00a0<\/b><\/h3>\n

C\u00f3 th\u1ec3 ph\u1ed1i h\u1ee3p c\u00e1c ph\u01b0\u01a1ng ph\u00e1p n\u00f3i tr\u00ean cho t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3. <\/span><\/p>\n

1.4. \u0110i\u1ec1u tr\u1ecb gi\u1ea3m nh\u1eb9\u00a0<\/b><\/h3>\n

\u0110\u01b0\u1ee3c th\u1ef1c hi\u1ec7n khi\u00a0<\/span><\/p>\n

– <\/span>T\u1ed5ng th\u1ec3 t\u00edch c\u00e1c kh\u1ed1i u v\u01b0\u1ee3t qu\u00e1 50% th\u1ec3 t\u00edch gan.\u00a0<\/span><\/p>\n

– <\/span>\u0110\u00e3 c\u00f3 huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch c\u1eeda, t\u0129nh m\u1ea1ch gan, t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi, \u2026 <\/span><\/p>\n

– <\/span>\u0110\u00e3 c\u00f3 di c\u0103n ngo\u00e0i gan.\u00a0<\/span><\/p>\n

– <\/span>PS > 2, Child Pugh C.\u00a0<\/span><\/p>\n

\u1ede c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 x\u01a1 gan, c\u00f3 th\u1ec3 d\u00f9ng Acetaminophen (Paracetamol) \u0111\u1ec3 gi\u1ea3m \u0111au\u00a0 n\u1ebfu \u0111au nh\u1eb9, v\u00e0 d\u00f9ng c\u00e1c thu\u1ed1c gi\u1ea3m \u0111au g\u00e2y nghi\u1ec7n (opioids) n\u1ebfu \u0111au t\u1eeb v\u1eeba \u0111\u1ebfn\u00a0 nhi\u1ec1u (l\u01b0u \u00fd tr\u00e1nh t\u00e1c d\u1ee5ng ph\u1ee5 l\u00e0 t\u00e1o b\u00f3n). C\u00f3 th\u1ec3 x\u1ea1 tr\u1ecb \u0111\u1ec3 gi\u1ea3m \u0111au do di c\u0103n x\u01b0\u01a1ng\u00a0 hay \u0111\u1ec3 ng\u0103n ng\u1eeba g\u00e3y x\u01b0\u01a1ng b\u1ec7nh l\u00fd.\u00a0<\/span><\/p>\n

C\u1ea7n l\u01b0u \u00fd \u0111\u1ebfn v\u1ea5n \u0111\u1ec1 dinh d\u01b0\u1ee1ng v\u00e0 h\u1ed7 tr\u1ee3 t\u00e2m l\u00fd cho c\u00e1c b\u1ec7nh nh\u00e2n UTBMTBG giai\u00a0 \u0111o\u1ea1n mu\u1ed9n.\u00a0<\/span><\/p>\n

1.5. \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3\u00a0<\/b><\/h3>\n

– <\/span>\u0110i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd gan n\u1ec1n t\u1ea3ng v\u00e0 n\u00e2ng \u0111\u1ee1 ch\u1ee9c n\u0103ng gan.\u00a0<\/span><\/p>\n

– <\/span>D\u00f9ng thu\u1ed1c kh\u00e1ng virus khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh.\u00a0<\/span><\/p>\n

– <\/span>H\u1ed7 tr\u1ee3 dinh d\u01b0\u1ee1ng \u0111\u1ec3 n\u00e2ng t\u1ed5ng tr\u1ea1ng.\u00a0<\/span><\/p>\n

– <\/span>\u0110i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd \u0111i k\u00e8m.<\/span><\/p>\n

2. THEO D\u00d5I V\u00c0 T\u00c1I KH\u00c1M\u00a0<\/b><\/h2>\n

– <\/span>Theo d\u00f5i \u0111\u1ecbnh k\u1ef3 cho \u0111\u1ebfn khi b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c theo d\u00f5i n\u1eefa (t\u1eed\u00a0 vong, m\u1ea5t li\u00ean l\u1ea1c,\u2026).\u00a0<\/span><\/p>\n

– <\/span>T\u00f9y ph\u01b0\u01a1ng ph\u00e1p, hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, th\u1eddi gian b\u1ec7nh \u1ed5n \u0111\u1ecbnh hay ti\u1ebfn tri\u1ec3n m\u00e0 h\u1eb9n t\u00e1i\u00a0 kh\u00e1m m\u1ed7i th\u00e1ng, m\u1ed7i hai th\u00e1ng, hay m\u1ed7i ba th\u00e1ng, c\u1ee5 th\u1ec3:\u00a0<\/span><\/p>\n

+ <\/span>B\u1ec7nh nh\u00e2n v\u1eeba \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb s\u1ebd \u0111\u01b0\u1ee3c h\u1eb9n t\u00e1i kh\u00e1m sau 01 th\u00e1ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u1ebft\u00a0 qu\u1ea3 \u0111i\u1ec1u tr\u1ecb. N\u1ebfu b\u1ec7nh ti\u1ebfn tri\u1ec3n v\u00e0 c\u00f2n kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb th\u00ec ch\u1ec9 \u0111\u1ecbnh ph\u01b0\u01a1ng\u00a0 ph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u00e0 cho l\u1ecbch h\u1eb9n. N\u1ebfu k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb l\u00e0 \u1ed5n th\u00ec h\u1eb9n t\u00e1i kh\u00e1m sau 02\u00a0 th\u00e1ng.\u00a0<\/span><\/p>\n

+ <\/span>N\u1ebfu t\u1ea1i l\u1ea7n t\u00e1i kh\u00e1m sau 02 th\u00e1ng m\u00e0 b\u1ec7nh ti\u1ebfn tri\u1ec3n l\u1ea1i v\u00e0 c\u00f2n kh\u1ea3 n\u0103ng \u0111i\u1ec1u tr\u1ecb\u00a0 th\u00ec ch\u1ec9 \u0111\u1ecbnh ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb v\u00e0 cho l\u1ecbch h\u1eb9n. N\u1ebfu b\u1ec7nh v\u1eabn \u1ed5n th\u00ec h\u1eb9n t\u00e1i\u00a0 kh\u00e1m sau m\u1ed7i 03 th\u00e1ng.\u00a0<\/span><\/p>\n

– <\/span>M\u1ed7i l\u1ea7n t\u00e1i kh\u00e1m, b\u1ec7nh nh\u00e2n s\u1ebd \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 v\u1ec1 l\u00e2m s\u00e0ng v\u00e0 l\u00e0m \u0111\u1ea7y \u0111\u1ee7 c\u00e1c x\u00e9t\u00a0 nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng v\u00e0 h\u00ecnh \u1ea3nh h\u1ecdc nh\u01b0 \u0111\u00e3 n\u00eau trong ph\u1ea7n Ch\u1ea9n \u0111o\u00e1n. C\u1ea7n thi\u1ebft\u00a0 l\u00e0m c\u00e1c ch\u1ec9 d\u1ea5u sinh h\u1ecdc AFP, AFP-L3, PIVKA II (DCP) \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 k\u1ebft qu\u1ea3 \u0111i\u1ec1u\u00a0 tr\u1ecb, theo d\u00f5i di\u1ec5n ti\u1ebfn b\u1ec7nh v\u00e0 ph\u00e1t hi\u1ec7n t\u00e1i ph\u00e1t UTBMTBG.\u00a0<\/span><\/p>\n

– <\/span>N\u1ebfu \u0111\u00e3 x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec5m virus vi\u00eam gan B hay C th\u00ec n\u00ean l\u00e0m \u0111\u1ea7y \u0111\u1ee7\u00a0 c\u00e1c x\u00e9t nghi\u1ec7m \u0111\u1ec3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb (n\u1ebfu c\u1ea7n) v\u00e0 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u00e1c virus\u00a0 n\u00e0y, c\u1ee5 th\u1ec3 l\u00e0: HBsAg, HbsAb, HbcAb, HBeAg, HBeAb, \u0111\u1ecbnh l\u01b0\u1ee3ng HBV-DNA,\u00a0 AntiHCV, \u0111\u1ecbnh l\u01b0\u1ee3ng HCV-RNA\u2026\u00a0<\/span><\/p>\n

3. PH\u00d2NG B\u1ec6NH\u00a0<\/b><\/h2>\n

– <\/span>Ti\u00eam vaccine ph\u00f2ng b\u1ec7nh vi\u00eam gan si\u00eau vi B cho nh\u1eefng ng\u01b0\u1eddi ch\u01b0a nhi\u1ec5m, \u0111\u1eb7c\u00a0 bi\u1ec7t l\u00e0 cho tr\u1ebb s\u01a1 sinh.\u00a0<\/span><\/p>\n

– <\/span>Ch\u1ee7 \u0111\u1ed9ng t\u1ea7m so\u00e1t \u0111\u1ecbnh k\u1ef3 UTBMTBG tr\u00ean nh\u1eefng ng\u01b0\u1eddi c\u00f3 nhi\u1ec5m HBV, HCV, x\u01a1\u00a0 gan.\u00a0<\/span><\/p>\n

– <\/span>Tuy\u00ean truy\u1ec1n gi\u00e1o d\u1ee5c tr\u00e1nh l\u00e2y nhi\u1ec5m HBV, HCV qua \u0111\u01b0\u1eddng t\u00ecnh d\u1ee5c v\u00e0 t\u1eeb m\u1eb9\u00a0 sang con, ki\u1ec3m so\u00e1t ch\u1eb7t ch\u1ebd vi\u1ec7c truy\u1ec1n c\u00e1c ch\u1ebf ph\u1ea9m m\u00e1u.\u00a0<\/span><\/p>\n

– <\/span>Tuy\u00ean truy\u1ec1n h\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng c\u00e1c \u0111\u1ed3 u\u1ed1ng c\u00f3 c\u1ed3n.<\/span><\/p>\n

\"S\u01a1
S\u01a1 \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan<\/figcaption><\/figure>\n

B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/b><\/a> \u0111\u00e3 \u0111\u01b0a h\u1ec7 th\u1ed1ng m\u00e1y m\u00f3c, thi\u1ebft b\u1ecb hi\u1ec7n \u0111\u1ea1i \u0111\u1ea1t chu\u1ea9n v\u00e0o c\u00f4ng t\u00e1c th\u0103m kh\u00e1m, ch\u1ea9n \u0111o\u00e1n, g\u00e2y m\u00ea v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn gan. \u0110\u1ec3 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ea1i vi\u1ec7n, Qu\u00fd kh\u00e1ch vui l\u00f2ng b\u1ea5m s\u1ed1 HOTLINE<\/b><\/a>\u00a0ho\u1eb7c \u0111\u1eb7t l\u1ecbch tr\u1ef1c ti\u1ebfp\u00a0T\u1ea0I \u0110\u00c2Y<\/b><\/a>. T\u1ea3i v\u00e0 \u0111\u1eb7t l\u1ecbch kh\u00e1m t\u1ef1 \u0111\u1ed9ng tr\u00ean\u00a0\u1ee9ng d\u1ee5ng MyVinmec<\/a>\u00a0\u0111\u1ec3 qu\u1ea3n l\u00fd, theo d\u00f5i l\u1ecbch v\u00e0 \u0111\u1eb7t h\u1eb9n m\u1ecdi l\u00fac m\u1ecdi n\u01a1i ngay tr\u00ean \u1ee9ng d\u1ee5ng.<\/p>\n

Ngu\u1ed3n: GLOBOCAN. B\u1ed9 Y t\u1ebf, \u201cH\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan (UTBMTBG) l\u00e0 lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t trong\u00a0 c\u00e1c lo\u1ea1i ung th\u01b0 t\u1ea1i gan, n\u1eb1m trong s\u00e1u lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t tr\u00ean th\u1ebf gi\u1edbi v\u00e0 n\u1eb1m trong ba lo\u1ea1i ung th\u01b0 ph\u1ed5 bi\u1ebfn nh\u1ea5t t\u1ea1i Vi\u1ec7t Nam. UTBMTBG \u0111\u1ee9ng \u0111\u1ea7u trong\u00a0 c\u00e1c nguy\u00ean nh\u00e2n t\u1eed […]<\/p>\n","protected":false},"author":15,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[6,33],"tags":[3],"yoast_head":"\nH\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan - Vinmec<\/title>\n<meta name=\"description\" content=\"\u0110i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan c\u00f3 nhi\u1ec1u ph\u01b0\u01a1ng ph\u00e1p cho t\u1eebng tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3, t\u1eeb c\u1eaft gan, \u0111\u1ed1t s\u00f3ng cao t\u1ea7n, gh\u00e9p gan \u0111\u1ebfn ho\u00e1 x\u1ea1 tr\u1ecb.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o gan - 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